A 23-year-old female patient presented to the Ronald Reagan University of California Los Angeles Medical Center, Los Angeles, California, in 2016 with a two-month history of prog-ressive swelling and pain of the upper and lower jaws and palate, drooling, lisping and difficulty chewing and swallowing. She had undergone a bilateral nephrectomy due to a bilateral Wilms' tumour 22 years prior at 14 months of age. She then received haemodialysis until she was six years old, at which time she received a kidney transplant. However, the transplanted kidney failed due to medication noncompliance and she subsequently resumed haemodialysis at the age of 16 years. She had secondary hyperparathyroidism and was noncompliant with medications to control the disorder. She also had congestive heart failure and cryptogenic organising pneumonia requiring home oxygen therapy. She had no family history of hyperparathyroidism. If left untreated, patients with ULO may develop severe disfigurement, dysphagia, speech impairment, respiratory distress and blindness.2–4 The management of ULO cases should focus on controlling secondary or tertiary hyperparathyroidism, either with medication or surgically with a parathyroidectomy. Unfortunately, surgical resection was not feasible in the current case and the patient did not adhere to prescribed medical therapy. As such, there was no evidence of clinical improvement at a one-month follow-up appointment.