Osteonecrosis of Bilateral Mandibular Tori After Direct Laryngoscopy
A 36-year-old man underwent direct laryngoscopy with routine general anesthesia for a knee procedure. Several days later, he experienced pain involving an ulceration along the medial aspect of the right mandible in the floor of the mouth. This evolved to a painful bony mass, and subsequently, a bony sequestrum was spontaneously shed. The initially misdiagnosed pathologic process occurred several more times on both sides of the mouth. A computed tomography scan eventually revealed large bilateral mandibular tori, a feature that likely predisposed the patient to this course of events. Pain in the floor of the mouth after airway manipulation should be carefully evaluated and the possibility of osteonecrosis considered.
Edematous, erythematous, ulcerated mucosa along the medial aspect of the left mandible (arrow).
Bony sequestrum (2 pieces) exfoliated from the ulcerated mucosal lesion shown in Figure 1.
Computed tomography scan obtained 1 month after symptoms began, demonstrating large bilateral mandibular tori (arrows), a likely predisposing factor to the osteonecrosis that occurred after direct laryngoscopy.
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