The patient proceeded to biopsy under direct visualisation by the maxillofacial surgeons. 

Histopathology

Macroscopic description: "Bone": Six pieces of brown/pale tissue 2-6 mm.

Microscopic description: Section show fragments of lamellar bone with empty lacunae. The bone is surrounded by cellular debris and sheets of gram positive cocci. Numerous filamentous fungal hyphae consistent with Actinomyces are present. There is no evidence of malignancy.

Diagnosis: Left mandible bone: Features in keeping with osteoradionecrosis. 

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