Mandibular osteoradionecrosis

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

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

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

Features include 2,4:

  • cortical destruction that is ill-defined resulting in a mixed sclerotic-lucent pattern
  • sequestration, especially of the buccal bone
  • an 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

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

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Article information

rID: 26024
Synonyms or Alternate Spellings:
  • Osteoradionecrosis of the mandible
  • Osteoradionecrosis of mandible
  • Radiation osteonecrosis of the mandible
  • Mandibular ORN

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Cases and figures

  • Case 1
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  • Case 2
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  • Case 3
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  • Case 4: with pathological fracture
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  • Case 5
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