Osteoradionecrosis - a review of clinical features and management

Abstract

Radiotherapy is an important part of oral cancer management. A significant complication of radiotherapy to the head and neck is osteoradionecrosis (ORN). The present report reviews the risk factors, clinical features, and management of ORN affecting the maxilla and mandible. A “PubMed” database search was done to identify “case reports” of ORN that were published, using the keywords “osteoradionecrosis”, “jaw'”, “mandible” and “maxilla”. Data on ORN published within the past 10 years from 2008 to 2018 were collected and analyzed. A total of 23 full text articles reporting 27 cases of ORN were identified. Males constituted 84% of the cases. The mandible was affected in 96% of cases with bilateral involvement in 26.9% of cases and posterior mandibular involvement in 53.8% of cases. The amount of radiation received ranged from 50 Gy to 77 Gy. ORN occurred in 3.87 years on average after radiotherapy. The highest risk of developing ORN was associated with extraction of mandibular teeth within the radiation field in patients who received a radiation dose greater than 60 Gy. ORN was managed using varied methods such as surgical therapy, reconstruction with free fibular graft, low level laser therapy, and platelet rich gel. The recurrence of ORN was reported in 22% cases ranging from three weeks to one year later. In conclusion, the present review highlights the clinical features and risk factors associated as well as the various methods used in the treatment of ORN. The use of preventive strategies and advanced methods of management can decrease the incidence of ORN.