Osteoradionecrosis of the Jaws and Management Strategies

Abstract

Background: Osteoradionecrosis of the jaws (ORNJ) is a severe complication arising from radiotherapy for head and neck cancers. It results from irreversible damage to osteocytes, leading to nonhealing of exposed bone. The condition can cause substantial pain, swelling, trismus, and in severe cases, pathological fractures of the jaw, substantially impacting the patient's quality of life and increasing morbidity. Aims: This review aims to describe the pathophysiology of ORNJ, evaluate current management strategies, and explore emerging therapies to provide a comprehensive understanding of this condition. Methods: A comprehensive literature review was conducted to describe the pathophysiology, clinical presentation, and treatment of ORNJ. Results: The pathophysiology of ORNJ involves multiple theories, including radiation-induced fibrosis and the “hypoxia, hypocellular, and hypovascular” model. Management strategies include surgical debridement, hyperbaric oxygen therapy (HBOT), and emerging biological approaches such as tissue engineering and platelet-rich plasma (PRP), which are all discussed. Discussion: Radiotherapy significantly impairs wound healing, leading to chronic fibrosis and tissue necrosis. Although ORNJ is uncommon, its impact on patients is substantial. Current treatments offer limited success, necessitating a multidisciplinary approach and ongoing research into innovative therapies. Emerging treatments, including tissue engineering and PRP, offer potential but require further research. Conclusion: ORNJ remains a challenging condition with substantial patient morbidity. Understanding its pathophysiology is crucial for patient education, early detection and developing effective management strategies.