Findings:
A sclerotic and lytic lesion with buccal and lingual cortical bone perforation is detected in the left body of the mandible, involving the second premolar and molar regions. Separated piece of bone within osteolysis is in keeping with bony sequestrum.
The inferior alveolar nerve canal courses along the inferior aspect of the lesion with focal area of dehiscence of the canal.
On axial CT in soft tissue window mild adjacent soft tissue thickening is noted. No abscess formation.
Area of radiolucency is seen surrounding the root of the left lower first premolar, in keeping with apical periodontitis.
Horizontally impacted right lower third molar.
Mild mucosal thickening is seen in the right sphenoid and both maxillary sinuses. The paranasal sinuses are otherwise clear.
Minimal fluid is seen in a few mastoid air cells in the right mastoid process. The mastoid air cells and middle ear cavities are otherwise clear.
Grade 1, degenerative anterolisthesis at C4/5. Osteopenic bone structure is noted.
Conclusion:
Features in keeping with the clinically suspected medication related osteonecrosis of the jaw (MRONJ) involving the left body of mandible.