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).

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Figure 1

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

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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