Death Caused by Acute Osteomyelitis Superimposed on a Pathological Mandibular Fracture Secondary to Metastatic Oral Cancer: An Unusual Presentation in Medicolegal Death Investigation.

Acute osteomyelitis of the mandible is uncommon in medicolegal investigations, particularly when it occurs in conjunction with a pathological fracture caused by malignant infiltration and subsequently leads to death. This report presents a rare case involving a 56-year-old man who died from acute osteomyelitis superimposed on a pathological mandibular fracture secondary to metastatic oral squamous cell carcinoma. The decedent was found deceased in his rented room without accessible medical history or relatives at the scene, necessitating a comprehensive medicolegal investigation. Postmortem computed tomography performed before autopsy revealed a mandibular fracture accompanied by osteolytic destruction and surrounding soft tissue swelling. Subsequent autopsy and histologic examination confirmed acute inflammatory infiltrates within the mandibular bone and adjacent soft tissue, together with infiltration of squamous cell carcinoma. The cause of death was determined to be sepsis resulting from acute osteomyelitis associated with the pathological fracture due to metastatic oral cancer. This case highlights the heightened vulnerability of irradiated or tumor-involved mandibular bone to acute infection. It further underscores the importance of integrating postmortem imaging, autopsy findings, histological assessment, and, when available, past medical history in the medicolegal evaluation of unusual deaths with limited investigative information.