Chronic Mandibular Osteomyelitis with Normal Value of C-reactive Protein

Abstract

A 58-year-old male was referred to our pain clinic with right lower facial pain of visual analogue scale 8/10 cm. One week ago, his right lower 3rd molar was extracted for vesicles at the buccal mucosal membrane and right lower facial hypoesthesia. Immunoserologic tests revealed negative varicella-zoster virus immunoglobulin-M, positive immunoglobulin-G and normal value of C-reactive protein. Buccal mucosa biopsy revealed squamous epithelial hyperplasia. Medications for pain control was pregabalin 150 mg PO bid, amitriptyline 10 mg PO hs, fentanyl patch 12.5 Ռg/h, carbamazepine 200 mg PO hs. C-arm guided block and pulsed radiofrequency lesionning was performed at mandibular branch of the right trigeminal nerve. And then VAS score was reduced to 4/10 cm. On facial bone CT, facial MRI and 3-phase bone scan, chronic osteomyelitis was suspected on the right mandible. Herpes zoster by atypical clinical manifestations was excluded. After additional biopsy and culture on lesion, antibiotics were used to treat the osteomyelitis and surgical follow-up was planned for surgical removal of necrotic tissue.