Case presentation
In November 2018, a 58 years-old-woman with BRAF-mutated metastatic
melanoma, treated at the Immunotherapy Unit of Our Institute, was
referred to our Oral Pathology Outpatient Clinic. During a regular
follow-up visit, the patient reported that she was experiencing severe
pain in the oral cavity since four months due to a non-healing alveolus,
after the extraction of the lower right third molar. During this time,
the patient had been treated by her dentist for an alveolar osteitis
(AO, dry sockets) with one-week cycle of Amoxicilline + Clavulanic Acid
(2.25 + 0.75 grams/day per os) and Chlorexidine 0.2% mouthwash daily
socket irrigation. She referred that she had repeated this therapy three
times during those months, continuing Chlorexidine 0.2% mouthwash daily
socket irrigation among the antibiotic cycles. She referred that,
occasionally, she also underwent application of zinc oxide eugenol in
her alveolus. Furthermore, the patient had used Chlorexidine 0.12%
mouth rinse since day before the extraction. Every treatment tried up
until now had been unsuccessful. She had no extra-oral sign of swelling
nor of ongoing abscess. Intraorally, clinical inspection confirmed the
presence of a non-healed alveolar socket; the bottom and the walls of
the alveolus were clearly visible, made of non-vascularized
non-suppurated bone, surrounded by swollen mucosa (figure 1).