Introduction: In recent years, bisphosphonate-related osteonecrosis of de jaws has been reported in wide number. At the present time, prevention and conservative protocol are the choice. However, it is not possible in patients with presence of an extraoral fistula and osteolysis extending to the inferior borden or a pathological fracture may be evident.

Case report: A 70 years old woman was referred to our department for the treatment of a pathological fracture. Her medical history included osteoporosis. The patient has been receiving oral alendronic acid monthly for 3 years.

Results: The treatment consists of segmental resection of the osteonecrotic part of the mandibule. A reconstruction plate was used to budge the gap and stabilize the segments. A follow-up for 6 month demonstrates a favorable response to the procedure.

Conclusion: Prospective clinical trials and further research are necessary to improve the treatment of patients with BORNJ. Further knowledge of its pathogenesis is needed to define treatment guidelines for advanced stage of BRONJ.

Conflict of interest: None declared.