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Elderly man with mandibular pain
  1. Kevin C Lee,
  2. Bridget M Ferguson
  1. Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York City, New York, USA
  1. Correspondence to Dr Kevin C Lee, Division of Oral and Maxillofacial Surgery, NewYork-Presbyterian/Columbia University Medical Center, New York City, NY 10032, USA; kcl2136{at}cumc.columbia.edu

Abstract

Clinical introduction A 77-year-old man presented to the ED with a history of fevers, purulent drainage and right mandibular pain. He had been diagnosed with multiple myeloma 2 years previously and was receiving treatment with pamidronate. On presentation, the lower right lip and chin were anaesthetic, tooth number 31 had grade 2 mobility and a 15 mm long ulceration was present on the lingual aspect of the mandible (figure 1). Antibiotics were administered, and a maxillofacial CT without contrast was performed (figure 2).

Figure 1

Clinical examination revealing a 15 mm long ulceration (arrow mark) associated with the lingual aspect of tooth number 31.

Figure 2

CT maxillofacial (coronal) demonstrating osseous destruction (arrow mark) of the right mandibular body.

Question What is your diagnosis?

  1. Odontogenic abscess

  2. Benign fibro-osseous lesion

  3. Medication-related osteonecrosis of the jaw (MRONJ)

  4. Metastatic malignancy

Question

  • head
  • infection
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Footnotes

  • Contributors KCL planned and drafted the article, collected the images and participated in patient care. BMF determined the significance of the topic, assisted with the editing and participated in patient care.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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