Leontiasis ossea is a term that can be used to describe the progressive hypertrophy of facial and cranial bones associated with a group of diseases, including Paget disease and fibrous dysplasia,1 and in patients with chronic renal failure and secondary hyperparathyroidism. It is important that the clinician is aware of the diagnosis and management of this debilitating condition. Although rare, the consequences of poor management and treatment can be serious. Furthermore, patients who are diagnosed with this condition require intensive management by a multidisciplinary team.