Fig 5. A 77-year-old woman (patient 4) with multiple myeloma initially treated with pamidronate and subsequently zoledronate.

A, The initial orthopantogram demonstrates osseous sclerosis (arrow).

B, Orthopantomogram 9 months later demonstrates lytic destruction of the mandible, most prominent in the left body of the mandible (arrow). Surgical debridement was performed.

C, Photomicrograph at low power (x40) of the curettage specimen stained with hematoxylin-eosin demonstrates fragments of necrotic bone with empty lacunae (arrow). There is extensive infiltration with inflammatory cells with surface resorption of bone (arrowhead) and bacteria (*).