Macrognathia Secondary to Renal Osteodystrophy in a Hemodialysis Patient: A Case Report and Literature Review

Background: Renal osteodystrophy (ROD) is a complex metabolic bone disorder encompassing the full spectrum of skeletal abnormalities arising from chronic kidney disease–mineral and bone disorder (CKD-MBD). Although ROD is a well-recognized systemic complication of end-stage renal disease (ESRD), its manifestation as progressive maxillofacial enlargement macrognathia is rare and may precede recognition of the underlying nephropathy in clinical dental settings. The paper aims to report a case of ROD-associated macrognathia in a patient on long-term hemodialysis and a contemporary literature review. Case Presentation: We describe a 45-year-old female patient on long-term maintenance hemodialysis for ESRD secondary to Grade I bilateral nephropathy who presented to our dental clinic with a 6-month history of progressive, painless diffuse swelling of the mandibular anterior region that subsequently involved the hard palate. Oral examination revealed bilateral jaw enlargement, severe generalised periodontitis, xerostomia, uremic fetor, and hyposalivation. Panoramic radiography demonstrated ground-glass trabecular changes, cortical thinning, and loss of the inferior cortex. Histopathology of an incisional biopsy revealed features of fibrous replacement of medullary bone, irregular osteoid mineralization, increased osteoblastic activity, and osteoclastic resorption lacunae suggestive of osteitis fibrosa cystica. Conclusions: This case illustrates the importance of the dental clinician’s role in recognizing the oral and maxillofacial manifestations of systemic metabolic disease. Macrognathia should be included in the differential diagnosis of jaw enlargement in any patient with a history of CKD or ESRD. Multidisciplinary collaboration between dentists, oral pathologists, and nephrologists is essential for timely diagnosis and optimal management.