Pathologic mandibular fracture as the presenting manifestation of multiple myeloma.

The authors report on the management of a patient who presented with a pathologic mandibular fracture as the initial presenting sign of multiple myeloma. The patient underwent surgical resection of the mandibular area involved by the pathologic fracture and osteolytic lesion. Then, he was prescribed combined thalidomide, melphalan, and prednisone for systemic treatment. The patient tolerated his treatment well and is currently being followed up on outpatient basis. The treatment of a mandibular pathologic fracture associated with a solitary multiple myeloma lesion should include a segmental resection of the mandibular bone that is involved by the lesion. An appropriate reconstruction can be immediately performed or delayed. Anyway, the importance of an early beginning of systemic treatment should always be remembered.