A 52-Year-Old Man With a Hole in His Jaw and Alcoholism

Laith Mahmoud Abdulhadi, BDS, CES, DDS

Disclosures

May 17, 2021

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.

Background

A 52-year-old man without teeth presents after seeking to have dentures fabricated. He had long described severe soreness and intolerance to mild pressure on the mandibular residual ridge and mandibular deviation on the affected side. Upon inspection, his dentist found a large opening located at the left retromolar area, undermined by soft tissues. The patient describes profuse purulent discharge, mostly during morning.

The most relevant past medical history is a fracture of the mandible body at the junction with ramus, which was unsuccessfully treated 4 years prior. He describes the use of several antibiotics without positive result. The patient's medical history is notable for hypertension, diabetes mellitus, and alcoholism.

In addition, he has been treated for depression caused by continuous pain and inability to eat. The patient claims that he had never been hospitalized or experienced any other significant chronic disease beyond those mentioned. He describes weight loss of 33 lbs (15 kg) over the past year and has a history of nocturnal fever and sweats.

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