The patient, a 43-year-old woman, had a 6-year history of diffuse cutaneous systemic sclerosis. At the time of presentation to the rheumatology clinic at our institution, lateral radiography of the facial bones revealed osteolysis of one mandibular angle (white arrow) and the undersurface of the anterior mandibular bodies bilaterally (black arrows), with calcinosis overlying the mandibular angle and in the submandibular soft tissues (arrowheads). Mandibular osteolysis occurs in 13–33% of patients with systemic sclerosis, most commonly affecting the mandibular angle, followed by the condyle and coronoid process. Involvement of the mandibular body is uncommon. Mandibular osteolysis has been associated with pathologic fracture. Onset occurs an average of 5–7 years after diagnosis of systemic sclerosis. Proposed etiologies include extrinsic pressure from tight facial skin or ischemia (1, 2). 1