The diagnosis and management of a pathological fracture: a case report


Emergency medicine


A 64 year old female patient presented to the Accident and Emergency (A&E) department at the Royal Lancaster Infirmary (RLI) with a significant left sided jaw pain. This patient reported paraesthesia and a shooting pain radiating down her left mandible. There was also marked trismus on examination. Her medical history included a history of a previously diagnosed Squamous Cell Carcinoma (SCC) of the left soft palate. This was staged at T2N0M0 and treated with radiotherapy and chemotherapy. Following a clinical examination, special investigations via imaging were obtained prior to a formal diagnosis of pathological fracture of the left mandible following previous radiotherapy for her SCC treatment.

This case report will discuss the incidence, background, management and treatment of osteoradionecrosis (grade 3) (ORN) of the mandibular jaw bone as well as the associated pathological fractures and the detrimental effects following the use of radiotherapy to the head and neck region.


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