International Journal of Head and Neck Surgery

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Volume  14 (2023)
Volume  13 (2022)
Volume  12 (2021)
Volume  11 (2020)
Volume  10 (2019)
Volume  9 (2018)
Volume  8 (2017)
Volume  7 (2016)
Volume  6 (2015)
Volume  5 (2014)
Volume  4 (2013)
Volume  3 (2012)
Volume  2 (2011)
Volume  1 (2010)
Related articles

VOLUME 2 , ISSUE 1 ( January-April, 2011 ) > List of Articles

REVIEW ARTICLE

Osteoradionecrosis

SS Pagare, Sukhjinder Kaur Khosa

Citation Information : Pagare S, Khosa SK. Osteoradionecrosis. Int J Head Neck Surg 2011; 2 (1):27-32.

DOI: 10.5005/jp-journals-10001-1043

Published Online: 01-08-2012

Copyright Statement:  Copyright © 2011; The Author(s).


Abstract

Osteoradionecrosis (ORN) is a major complication of surgery or trauma in previously irradiated bone. This condition is often painful, debilitating and may result in significant bone loss. ORN of the mandible is the commonest site in patients who receive radiotherapy for head and neck cancer because of the relatively poor vascularization in this area. Risk factors include the total radiation dose, modality of treatment, fraction size and dose rate, oral hygiene, timing of tooth extractions as well as the continued use of tobacco and alcohol. Conversely, steroid use before or after radiation may have a protective effect related to the inhibition of the initial inflammatory phase of ORN. The management of this side effect is difficult and can result in bone or soft tissue loss, affecting the quality of life. The recommended treatment guidelines are irrigation, antibiotics, hyperbaric oxygen therapy and surgical techniques, including hemimandibulectomy and graft placements.

PDF Share
  1. Osteoradionecrosis: A new concept of pathophysiology. J Oral Maxillofac Surg 1983;41(5):283-88.
  2. Hyperbaric oxygen for the management of radionecrosis of bone and cartilage. Laryngoscope 1998;108(9):1291-96.
  3. Hyperbaric oxygen therapy in the treatment of radio-induced lesions in normal tissues: A literature review. Radiother Oncol 2004;72:1-13.
  4. Postradiation osteonecrosis of the mandible: A long-term follow-up study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:657-62.
  5. Osteoradionecrosis: Pathogenesis, treatment and prevention. Tandlaegeblet 1990;94:669-73.
  6. DNA-DNA Hybridization demonstrates multiple bacteria in osteradionecrosis. Int J Oral Maxillofacial Surg 200;34(2):193-96.
  7. Osteoradionecrosis contains a wide variety of cultivable and non-cultivable bacteria Jorn A. Journal of Oral Microbiology, incl Supplements 2010;2.
  8. The radiation-induced fibroatrophic process: Therapeutic perspective via the antioxidant pathway. Radiother Oncol 2004;73(2):119-31.
  9. Osteoradionecrosis of the jaws—A current overview-part 1: Physiopathology and risk and predisposing factors. Oral and Maxillofac Surg 2010;14(1):3-16.
  10. Conservative management of osteoradioinecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84:16-21.
  11. Osteoradionecrosis of the mandible. Journal of the National Medical Association 2000;92(12):579-84.
  12. Osteoradionecrosis of the mandible: Minimized risk profile following intensity modulated radiation therapy (IMRT). Strahlenther Onkol 2006;182(5):283-88.
  13. Reducing the risk of xerostomia and mandibular osteoradionecrosis: The potential benefits of intensity modulated radiation therapy (IMRT) in advanced oral cavity carcinoma. Med Dosim 2009;34(3):217-24.
  14. Verification of tomotherapy dose delivery. J Med Phys 2009;34(3):188-90.
  15. J Oral Maxillofac Surg 1983;41:283-88.
  16. Osteonecrosis of the jaws by intravenous biphosphonates and osteoradionecrosis: A comparative study. Med Oral Patol Oral Cir Bucal 2009;14(12):e616-19.
  17. Osteoradionecrosis of the mandible: Etiology, prevention, diagnosis and treatment. Indian J Plast Surg 2007;40:65-71.
  18. Microvascular free tissue transfer for treatment of osteoradionecrosis of the maxilla. Plast Reconstr Surg 2005;115:54-60.
  19. A study of factors contributing to the development of osteoradionecrosis of jaws. J Prosthet Dent 1988;59(2):194-201.
  20. Risk factor assessment for the development of osteoradionecrosis. J Oral Maxillofac Surg 2007;65(11):2311-16.
  21. Oral sequelae of head and neck radiotherapy. Crit Rev Oral Biol Med 2003;14:199-212.
  22. Physical and chemical effects on jaws and teeth. Principles and Practice of Oral Radiologic Interpretation 330-46.
  23. Periostitis, Osteomyelitis, Osteitis, Noma and Bone necrosis. Oral Surgery (5th ed): 779-818.
  24. Chemotherapy- and radiotherapy-induced mucositis in head and neck cancer patients: New trends in pathophysiology. Prevention and treatment. Eur Arch Otorhinolaryngol 2001;258:481-87.
  25. Dental extractions in the irradiated head and neck patient: A retrospective analysis of memorial Sloan-Kettering cancer center protocols, criteria and end results. J Oral Maxillofac Surg 2003;61:1123-31.
  26. Systematic management of osteoradionecrosis in the head and neck. Laryngoscope 1999;109:1324-28.
  27. Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumor patients: A report of a thirty year retrospective review. Int J Oral Maxillofac Surg 2003;32:289-95.
  28. The head and neck radiotherapy patient part 2 - Management of oral complications. Compendium 1994;15(4):442,444 446-52 passim: quiz 458.
  29. Oral complications of radiotherapy. Lancet Oncol 2006;7:175-83.
  30. Osteonecrosis of the jaw associated with bisphosphonate use: Presentation of seven cases and literature review. Laryngoscope 2007;117:30-34.
  31. Complete healing of severe osteoradionecrosis by treatment combining pentoxifylline, tocopherol and clodronate. Br J Radiol 2002;75:467-69.
  32. Alanagement of head and neck cancer (2nd ed) Philadelphia: Lippincott Publishers 1994;253.
  33. Preliminary results of a pilot study of pentoxifylline in the treatment of late radiation soft tissue necrosis. Int J Radiat Oncol Biol Phys 1990;19(2):401-07.
  34. Osteoradionecrosis of the mandible. Curr Opin Otolaryngo Head Neck Surg 2005;13(4):217-21.
  35. Ultrasound therapy for osteoradionecrosis. Br J Maxillofac Surg 1992;30:313-18.
  36. Preradiation dental extractions and the incidence of bone necrosis. Head Neck Surg 1983;5:514-21.
  37. Lingual mandibular sequestration and ulceration. Oral Surg Oral Med Oral Pathol 1993;75: 739-43.
  38. Conservative management of osteoradionecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;84(1):16-21.
  39. Osteoradionecrosis: An update. Oral Oncology 2010;46:471-74.
  40. Recent advances in hyperbaric oxygen therapy, Medicine Update 2004;14.
  41. Hyperbaric oxygen therapy and mandibular osteoradionecrosis: A retrospective study and analysis of treatment outcomes. J Can Dent Assoc 2001;67:384.
  42. Review of Marx protocol: Prevention and marnagemiient of ORN. S Aft I entalj. 1998;53:469-71.
  43. Available from http://oralcancerfoundation.org/dental/hyperbaric.htm.
  44. Hyperbaric oxygen therapy for osteonecrosis of the jaw: A randomized, placebo-controlled doubl-blind trial from the ORN96 study group. J Clin Oncol 2004;22(24):4893-900.
  45. Influence of prior hyperbaric oxygen therapy in complications following microvascular reconstruction for advanced osteoradionecrosis. Arch otolaryngol head neck surg 2003;129:72-76.
  46. The treatment of osteoradionecrosis of the mandible: The case for hyperbaric oxygen and bone graft reconstruction. J Oral Maxillofac Surg 2006;64:956-60.
  47. Surgical treatment of mandibular osteoradionecrosis. Scand J Plast Reconstr Surg Hand Surg 1996;30:291-98.
  48. Resection and immediate microvascular reconstruction in the management of osteoradionecrosis of the mandible. Head Neck 1997;19: 406-11.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.