Mandibular osteoradionecrosis

Changed by Henry Knipe, 10 Sep 2015

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Mandibular osteoradionecrosis (ORN) is more common after radiation therapy for head and neck malignancies due to the superficial position of mandible, which makes it exposed to high radiation. The maxilla can also be involved, but this is less frequent.

Epidemiology

Mandibular ORN may occur in ~20% (5-37%) of patients ^2,4.

Pathology

Mandibular ORN typically occurs in patient who have received a dose of >60 Gy ⁴. Osteoradionecrosis ~~changes~~ changes may occur within a year of therapy.

Complications

~~pathological fractures~~
~~infection~~
~~radiation induced neoplasia~~

Radiographic appearance

Features include^2,4

cortical destruction that is ill-defined resulting in a mixed sclerotic-lucent pattern
~~absence~~sequestration, especially of ~~sequestration~~the buccal bone
absence of soft tissue mass is an important feature to differentiate it from neoplastic recurrence but the presence of soft tissue does not exclude ORN

Treatment and prognosis

Conservative treatment is initially medication only (e.g. pentoxifylline, vitamen E) but more severe cases may require hyperbaric oxygen therapy and/or debridement. Some patients will require resection and reconstruction of the mandible ³.

Complications

pathological fractures
infection
radiation-induced neoplasia

Differential diagnosis

~~Consider other forms of osteonecrosis of the jaw which include~~

drug related osteonecrosis ~~- e~~, e.g. bisphosphonate-related osteonecrosis of the jaw (BRONJ)

chronic osteomyelitis

malignancy

-<p><strong>Mandibular osteoradionecrosis</strong> is more common after radiation therapy for head and neck malignancies due to the superficial position of mandible, which makes it exposed to high radiation. <a href="/articles/osteoradionecrosis">Osteoradionecrosis</a> changes may occur within a year of therapy.</p><h4>Complications</h4><ul>
+<p><strong>Mandibular osteoradionecrosis (ORN)</strong> is more common after radiation therapy for head and neck malignancies due to the superficial position of <a href="/articles/mandible">mandible</a>, which makes it exposed to high radiation. The maxilla can also be involved, but this is less frequent. </p><h4>Epidemiology</h4><p>Mandibular ORN may occur in ~20% (5-37%) of patients <sup>2,4</sup>. </p><h4>Pathology</h4><p>Mandibular ORN typically occurs in patient who have received a dose of >60 Gy <sup>4</sup>. <a href="/articles/osteoradionecrosis">Osteoradionecrosis</a> changes may occur within a year of therapy.</p><h4>Radiographic appearance</h4><p>Features include <sup>2,4</sup></p><ul>
+<li>cortical destruction that is ill-defined resulting in a mixed sclerotic-lucent pattern</li>
+<li>sequestration, especially of the buccal bone</li>
+<li>absence of soft tissue mass is an important feature to differentiate it from neoplastic recurrence but the presence of soft tissue does not exclude ORN</li>
+</ul><h4>Treatment and prognosis</h4><p>Conservative treatment is initially medication only (e.g. pentoxifylline, vitamen E) but more severe cases may require hyperbaric oxygen therapy and/or debridement. Some patients will require resection and reconstruction of the mandible <sup>3</sup>.</p><h5>Complications</h5><ul>
~~-<li>radiation induced neoplasia</li>~~
~~-</ul><h4>Radiographic appearance</h4><p>Features include</p><ul>~~
~~-<li>cortical destruction that is ill-defined </li>~~
~~-<li>absence of sequestration</li>~~
~~-<li>absence of soft tissue mass is an important feature to differentiate it from neoplastic recurrence</li>~~
-</ul><h4>Differential diagnosis</h4><p>Consider other forms of osteonecrosis of the jaw which include</p><ul><li>drug related osteonecrosis - e.g. <a href="/articles/bisphosphonate-related-osteonecrosis-of-the-jaw">bisphosphonate-related osteonecrosis of the jaw</a> (BRONJ)</li></ul><p> </p><p> </p>
+<li>radiation-induced neoplasia</li>
+</ul><h4>Differential diagnosis</h4><ul>
+<li>drug related osteonecrosis, e.g. <a href="/articles/bisphosphonate-related-osteonecrosis-of-the-jaw">bisphosphonate-related osteonecrosis of the jaw</a> (BRONJ)</li>
+<li>chronic osteomyelitis</li>
+<li>malignancy</li>
+</ul>

References changed:

2. Chong J, Hinckley L, Ginsberg L. Masticator Space Abnormalities Associated with Mandibular Osteoradionecrosis: MR and CT Findings in Five Patients. AJNR Am J Neuroradiol. 2000;21(1):175-8. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7976370">PMC7976370</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/10669246">Pubmed</a>
3. Mendenhall W. Mandibular Osteoradionecrosis. J Clin Oncol. 2004;22(24):4867-8. <a href="https://doi.org/10.1200/JCO.2004.09.959">doi:10.1200/JCO.2004.09.959</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/15520050">Pubmed</a>
4. Curé J, Vattoth S, Shah R. Radiopaque Jaw Lesions: An Approach to the Differential Diagnosis. Radiographics. 2012;32(7):1909-25. <a href="https://doi.org/10.1148/rg.327125003">doi:10.1148/rg.327125003</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/23150848">Pubmed</a>

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