Case of September 2021

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Clinical History:

A 61-year-old man had a history of Kappa light chain myeloma with baseline PET-CT showing extensive osteolytic lesions involving the whole skeleton (predominantly ribs and pelvis). The disease went into remission with combined chemotherapy VTD (bortezomib, thalidomide, and dexamethasone) with stem cell transplantation. He was put on regular Pamidronate (Zometa) infusion. He presented with chin swelling for one month. On examination there was submental soft tissue swelling extending from floor of mouth, swollen buccal sulcus with pus discharging into sinus. Necrotic alveolar bone was seen exposed from teeth 32, 33, 34 and 35. Radiographs were taken and urgent CT was arranged.