TY - JOUR T1 - Elderly man with mandibular pain JF - Emergency Medicine Journal JO - Emerg Med J SP - 17 LP - 32 DO - 10.1136/emermed-2018-207623 VL - 36 IS - 1 AU - Kevin C Lee AU - Bridget M Ferguson Y1 - 2019/01/01 UR - http://emj.bmj.com/content/36/1/17.abstract N2 - 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 ER -