Letters to the Editor

We saw a 56-year-old gentleman who presented with a 4-week history of slow growing swelling of floor of the mouth and refractory pain. He had visited an emergency dentist who noted that his lower left canine and first premolar were infected and loose, and advised a course of antibiotics. During this course, the lower left first premolar tooth exfoliated on its own. He also complained of odynophagia and throat pain. His past medical history was insignificant. He smoked about 10 cigarettes/day and consumed on average, approximately 56 units of alcohol per week.

On examination, he had firm submental swelling measuring approximately 4–5 cm in diameter with overlying erythema. Additionally, there was a firm, non-tender swelling of the floor of the mouth with an open socket of lower left first premolar tooth (LL4) showing pus discharge. The lower left canine tooth (LL3) was Grade 3 mobile and non-tender. The associated gingiva was firm and indurated. No obvious worrying signs of airway compromise were noted. A panoramic radiograph (Figure 3) showed an empty socket of LL4 and pronounced bone loss associated with LL3. The lower left first molar tooth was grossly decayed. There were faint lucent lines on the associated mandibular bone. There was increased amount of hyoid bone and cervical spine ‘ghosting’ of the left mandibular region preventing further analyses. A CT scan was requested that showed destructive process of the left mandible leading to pathological fracture. Histopathological evaluation of bone was consistent with chronic osteomyelitis of the jaw (Figures 4 and 5).