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The manipulations required for airway management in anesthesia may cause a variety of different types of trauma in the mouth and pharynx, including lacerations, contusions, and dental injury. 1 In some patients, the forces applied during direct laryngoscopy, or the continual pressure exerted on the mucosa in the floor of the mouth by an endotracheal tube (ETT), may lead to unappreciated mucosal trauma and erosions. Occasionally, these lesions can lead to bony injury and even to osteonecrosis. 2 Torus mandibularis is a benign, generally

. Continuous mandibular nerve block for intractable mandibular pain due to antiresorptive agent-related osteonecrosis of the jaw: a case report . Kobe J Med Sci . 2020 ; 66 : E90 – E93 . 6.  Singh B, Bhardwaj V. Continuous mandibular nerve block for pain relief. A report of two cases . Can J Anesth . 2002 ; 49 : 951 – 953 . 7

arthritis. Their anti-inflammatory efficacy surpasses that of the nonsteroidal agents, eg, ibuprofen, but their potential for side effects is also greater. Although short-term use (1 week) is relatively safe, chronic use introduces many concerns regarding side effects. Glucocorticoids inhibit osteoblast function, which is thought to account for osteoporosis that affects ∼50% of patients treated for longer than 12 months. 3 Osteonecrosis (also termed avascular necrosis) is also a well recognized complication. This condition consists of a rapid and focal

contacts and have mastication training to aid in sufficient muscular function. 20 Patients with DMD may be taking oral bisphosphonates to offset glucocorticoid-induced osteoporosis. 22 It is advisable to contact the patient’s physician if there is a need to perform a procedure that may result in osteonecrosis. Local anesthesia with epinephrine can be used safely in these patients in the usual and standard fashion. If the disease progression has cardiac involvement, consideration should be given to limiting the amount of epinephrine to only what is required to keep the