Bad To The Bone

Question:  A 65 year old man presents to you for complaints of recurrent pain over his left manibule and occasional drainage from a "hole" in his ipsilateral submandibular skin.  He has a history of a T3N2aM0 HPV negative squamous cell carcinoma of the left tonsil which was treated with chemoradiation 10 years ago.  He has a history of heavy tobacco and alcohol use, but quit both with his diagnosis.  Within 2 years of his treatment he required complete dental extractions.  On exam you see no sign of recurrent tumor, but are concerned about osteoradionecrosis.  CT of the mandible demonstrates loss of both the lingual and buccal crtices, and a pathologic fracture through the body of the mandible.  How would you grade this?  [Answer will be posted with next week's new question]

Answer to last week's question, Don't Spaz Out (August 24, 2015): 

The AAO-HNS Clinical Practice Guidelines on hoarseness recommend botulinum toxin injection to the posterior cricoarytenoid muscle for ABDuctor spasmodic dysphonia.