Osteoradionecrosis of mandible with infection

Case contributed by Prof Oliver Hennessy

Presentation

Prior DXT following total glossectomy, Increasing jaw pain. Known osteoradionecrosis. ?? Infection

Patient Data

Age: 65
Gender: Female

Irregular soft tissue bony erosion and lucencies remain in both sides of the mandible. Alveolar bone margin erosions. Bone expansion at the posterior alveolar margin is now associated with a small gaseous cavity, in keeping with active infection. There is cortical breach of anterior left parasymphyseal mandible surface, measuring about 5 mm. Small 2 mm inferior left bone sinus communicates with the submental region. More lateral anterior left mandibular erosion enlarging from 10 mm to 12.5mm. A 7 mm inferior right parasymphyseal mandible sinus communicates with right submental region. Both mandibular canals are involved in the low density sequestrum. Previous left glossectomy. No nodal disease.

CONCLUSION:Ongoing destruction of the mandible. New bone sinuses are seen extending inferiorly and anteriorly on the left. Enlarging right inferior mandibular sinus. Ongoing bone expansion at posterior right alveolar margin now associated with a small air cavity.

There are changes of extensive lysis and sclerosis involving particularly the body of the mandible.

CT is advised to assess for sinus formation and sequestrum formation

The appearances would be in keeping with diffuse osteonecrosis.

Case Discussion

Osteonecrosis of the mandible occurs following high dose radiotherapy for cancers in this region, e.g. SCC of the oral cavity.

Other complications that maybe seen are infection and or fracturing in the mandible. The presence of sinus formation and or sequestrum is in keeping with infection.

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Case information

rID: 33514
Case created: 15th Jan 2015
Last edited: 8th Sep 2015
System: Head & Neck
Inclusion in quiz mode: Included

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