Rationale:
Radiolucent lesions over the angle-body region of the mandible are frequently difficult to diagnose but crucial to provide patient-centred care.
Patient concerns:
An elderly female presented with a painless slow-growing swelling over her left lower face for one year, radiographically appearing as a well-defined unilocular radiolucency over the left body of the mandible.
Diagnosis:
Aspiration was negative, and biopsy was inconclusive. Further imaging, bone marrow biopsy, immune profile and serum electrophoresis confirmed the diagnosis of multiple myeloma.
Treatment:
She was referred to Medical Oncology for chemotherapy of lenalidomide, bortezomib and dexamethasone regimen cycle that was repeated every 21 days.
Outcomes:
There was no increase in swelling, and radiographically 'punched-out' lesions were reduced significantly.
Take-away lessons:
Maxillofacial clinicians should be attentive to the oral manifestations of underlying disease, have a high index of suspicion and start the treatment promptly to increase chances of a favourable outcome.