Introduction : Osteomyelitis of the maxilla is extremely rare. In developed countries, maxillary osteomyelitis has been linked as a secondary factor to osteopetrosis (Albers–Schonberg disease) with only 3 cases reported in the maxilla to date. In the developing countries, possible aetiological factors include odontogenic infection, cancrum oris, tooth extraction, acute ulcerative gingivitis, fracture and periodontal disease. With particular reference to maxillary cases in the region of Africa, associated debilitating conditions included relatively high incidence of viral fever (measles), malnutrition, malaria and anaemia.

Case report : We report a rare incident of a 56 year-old male Togolese patient presenting to the Mercy Ships Dental Clinic, Lomé, Togo, with subtotal maxillary osteomyelitis causing the detachment of the palatal shelf presenting with the maxilla in his hand. Although it was difficult to ascertain the full history of the patient, he informed us that he had noticed his maxilla beginning to feel ‘different’ after contracting cholera in 1998. He was sick for 3 months and subsequently his jaw ‘became loose’ until finally falling out 3 weeks prior to presentation to the clinic. He was asymptomatic without evidence of pain or discharge or any symptoms of acute onset. Interestingly he had been using the maxilla as a natural obturator to prevent communication with his nasal space and aid with eating and drinking.

Conclusion : Management is difficult of these devastating, extreme and rare cases of subtotal maxillary osteomyelitis with total palatal avulsion. Extensive re-constructive surgery is required but often beyond the reach of these desperate patients.