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

Laith Mahmoud Abdulhadi, BDS, CES, DDS


May 17, 2021

Physical Examination and Workup

The patient is well-built and febrile. Cervical lymph nodes are palpable. Intraorally, a large opening is undermined by mucosal elevation, located at the left retromolar area near the ramus of the mandible.

Radiographic examination of the mandible reveals the presence of an extensive radiolucent area located at the posterior part of the mandible extending to the entire left ramus, except for the condyle and coronoid holding bone segment (Figures 1, 2). The border of the lesion in the remaining bone was distinct but irregular.

Figure 1.

Figure 2.

Acid-fast bacillus smear (AFB) findings taken from the lesion are negative. Laboratory findings reveal an elevated erythrocyte sedimentation rate (ESR) and a positive purified protein derivative (PPD) test result. Microbial culture findings of the discharge are positive for AFB after 5 weeks of incubation.


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