PT - JOURNAL ARTICLE AU - Kevin C Lee AU - Bridget M Ferguson TI - Elderly man with mandibular pain AID - 10.1136/emermed-2018-207623 DP - 2019 Jan 01 TA - Emergency Medicine Journal PG - 17--32 VI - 36 IP - 1 4099 - http://emj.bmj.com/content/36/1/17.short 4100 - http://emj.bmj.com/content/36/1/17.full SO - Emerg Med J2019 Jan 01; 36 AB - 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?Odontogenic abscessBenign fibro-osseous lesionMedication-related osteonecrosis of the jaw (MRONJ)Metastatic malignancyQuestion