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Clinical Problem Solving: Radiology
April 2008

Radiology Quiz Case

Author Affiliations
 

HUDGINSPATRICIA A.MD

Arch Otolaryngol Head Neck Surg. 2008;134(11):1229. doi:10.1001/archotol.134.11.1229

A 66-year-old man with multiple myeloma presented with a 6-month history of swelling and pain in the edentulous right premolar mandibular region. He reported that he had undergone 1 tooth (premolar) extraction 1 year earlier and 2 unsuccessful alveolar debridements after the extraction in another center. One year before presentation, he had been treated monthly with intravenous zoledronate (Zometa) infusions, at a dose of 4 mg, over a period of 15 minutes (17 sessions). Intraoral examination revealed a painful moderate expansion of the alveolar bone at the surgical site. The surrounding soft tissue was erythematous and edematous (Figure 1). Panoramic radiography (Figure 2) and computed tomography with multiplanar reconstruction of the jaws (DentaScan) revealed a bone sequestrum in the right mandibular region (Figure 3and Figure 4). Conservative treatment with a combination of oral antibiotics (amoxicillin–clavulanate potassium) and chlorhexidine mouthwash was initiated. After 2 weeks, another intraoral examination showed that no progress had been made in wound healing at the site. Minimal sequestrectomy was subsequently performed with the patient under local anesthesia.

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