The lack of normal enhancement of the left maxilla and inferior turbinate seen on imaging was initially concerning for invasive infection with mucosal/ bone necrosis. The patient was taken to surgery. Endoscopic nasal exam revealed severe edema and granulation tissue in the left nasal cavity and maxillary sinus. The surgical team debrided necrotic bone of the left maxilla and left inferior nasal turbinate. Surgical specimen was negative for hyphae and culture was negative for fungus. 

Further clinical history revealed bisphosphonate use. This, along with the patient's relatively stable clinical course and pathology findings, is in keeping with bisphosphonate-related osteonecrosis of the jaw (BRONJ).