Diagnosis of mandibular osteomyelitis in probable coexisting tumor recurrence: role of Tc-99m ciprofloxacin imaging.

We demonstrate the use of Tc-99m ciprofloxacin imaging in a follow-up case of squamous cell carcinoma of the tongue post hemi-mandibulectomy with clinical suspicion of local recurrence of osteomyelitis. On Tc-99m ciprofloxacin scan, we observed a focus of sharply increasing radiotracer concentration in the left side of the mandible after 24 hours, indicating active bacterial infection. Histopathologic analysis revealed no evidence of local recurrence, whereas the culture examination showed bacterial growth sensitive to ciprofloxacin. A follow-up Tc-99m ciprofloxacin scan after debridement and 8 weeks of antibiotic treatment showed no focus of tracer concentration in the region of the mandible.