Delayed Presentation of Mandibular Osteonecrosis Following Herpes Zoster Infection - A Case Report

Apart from the usual presentation of herpes zoster (HZ) infection (HZI), reports of spontaneous teeth exfoliation and osteonecrosis are infrequent and sporadic. A 51-year-old male patient presented with spontaneous exfoliation of multiple teeth and subsequent pathological fracture on the right side of the lower jaw after three months of HZI. Biopsy was taken from the alveolar bone of the oedematous region, which revealed the presence of trabeculae of dead bone with empty lacunae. Necrosed part of the alveolar bone was excised under local anaesthesia and antibiotic coverage, which was followed by open reduction and internal fixation of the pathological fracture under general anaesthesia. The patient was followed up for one year without any evidence of recurrences. Presentation of osteonecrosis following HZI is unique but rare and should be diagnosed at the earliest.