A 70-year-old woman reported oral malodor and left mandibular pain accompanied by numbness on the left side of the lower lip. She had been receiving alendronate therapy for more than 2 years. Examination revealed halitosis, hypoesthesia of the left lower lip, and a submental discharging sinus (Panel A). Oral examination showed chronic osteonecrosis of the left mandible (Panel B). Treatment with a combination of antimicrobial agents and surgical débridement was eventually successful. Pathological examination of a surgical specimen confirmed necrotic bone. Osteomyelitis is uncommon in the jaw; however, bone disorders (e.g., osteopetrosis), infarction (of the type that can occur in sickle cell disease), or immune defects may predispose to jaw osteomyelitis. Osteonecrosis of the jaw has been described in association with bisphosphonate therapy or herpes zoster and is seen especially in patients undergoing cancer therapy.
This patient has problem in one of trigeminalnerve special mandibular nerve which inervate the part of mandible and problem to buccinator muscl's nerve
Did the patient have any other risk factors? how: diabetes, hypertension, hypercholesterolemia, obesity, chronic use of corticosteroids, methotrexate, smoking habit; what they may have synergistic effect . Paiva-Fonseca F, Santos-Silva AR, Della-Coletta R, Vargas PA, Lopes MA. Alendronate-associated osteonecrosis of the jaws: a review of the main topics. Med Oral Patol Oral Cir Bucal. 2014;19(2):e106‐e111. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4015053/