Figure 1.

A 65-year-old woman suffering from metastases after breast cancer and receiving intravenous administrations of bisphosphonates (zoledronate) with an extended manifestation of bisphosphonate-related osteonecrosis of the right side of the mandible. (A) Extraoral view with a swelling of the right submandibular area, which was painful on palpation. (B) Intraoral view with a large area of exposed necrotic bone and sign of massive superinfection (swelling, pus) and a visible fracture of the mandible with mobile segments. (C) Panoramic radiograph of the patient with a mixed radiolucent and radiopaque appearance and a visible fracture line the right mandibular body. (D) Large bone sequesters that could be removed in the course of the treatment including segmental resection of the mandible, rigid internal fixation using a Synthes 2.4 unilock plate (DePuy Synthes, Germany), and complete closure of the wound. (E) Postoperative panoramic radiograph showing the resected area of the right mandible and the rigid internal fixation (Synthes 2.4 unilock plate). (F) Intraoral view 3 weeks postoperatively with a late dehiscence and plate exposure in region 47/48. (G) Intraoral view 4 months postoperatively with complete mucosal healing after local disinfectant measurements using disinfectant mouth rinses and activated photodynamic therapy.