Dead Bone Walking

February 9, 2016

A 65-year-old male presented with pain in the left lower jaw of one-month duration. His past medical history was significant for multiple myeloma, and he had undergone autologous stem cell transplantation 6 months prior. His current treatment regimen included lenalidomide, steroids, and monthly zoledronic acid injections. The pain was progressive and associated with a low-grade fever. On examination he was noted to have a tender left lower jaw with mild swelling and erythema of the overlying skin. Halitosis and trismus were also noted. Exam of the mouth showed carious teeth and multiple edentulous sockets. A purulent sinus was noted on the lingual aspect of the left mandibular alveolus in an edentulous socket. Submandibular tender lymphadenopathy was noted as well. A roentgenogram of the mandible was obtained (Figure 1). 

References:
1. Rodan GA, Reszka AA. Bisphosphonate mechanism of action. CurrMol Med. 2002 Sep. 2(6):571-7. 
2. Ruggiero SL. Guidelines for the diagnosis of bisphosphonate-related osteonecrosis of the jaw. Clin Cases Miner Bone Metab. 2007 Jan-Apr; 4(1): 37–42.


Authors:
1. Khalid Hamid Changal. MBBS, MD Internal Medicine Sher-i-Kashmir Institute of Medical Sciences Srinagar, India. Senior Resident. khalidchangal@gmail.com 
2. Rehana Bashir. BDS, MDS Orthodontics, Institute of Dental Studies & Technologies, Meerut, India.  Resident.
3. Manzoor Parray. MBBS, MD Internal Medicine Sher-i-Kashmir Institute of Medical Sciences Srinagar, India. Senior Resident.