Abstract
Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment. It is a severe delayed radiation-induced injury, characterized by bone tissue necrosis and failure to heal for at least 3 months. In most cases osteoradionecrosis gradually progresses, becoming more extensive and painful that leads to infection and pathological fracture. The present paper provides a literature review and update on the risk factors underlying osteoradionecrosis, its clinical and diagnostic particulars, prevention and most widely accepted treatment options including the latest treatment modalities. Lastly, a new early management protocol is proposed based on the current clinical criteria relating to osteonecrosis secondary to treatment with bisphosphonates, together with the adoption of new therapies supported by increased levels of evidence.
Similar content being viewed by others
References
Lyons A, Ghazali N (2008) Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg 46:653–660
Harris M (1992) The conservative management of osteoradionecrosis of the mandible with ultrasound therapy. Br J Oral Maxillofac Surg 30:313–318
Schwartz HC, Kagan AR (2002) Osteoradionecrosis of the mandible: scientific basis for clinical staging. Am J Clin Oncol 25:168–171
Store G, Boysen M (2000) Mandibular osteoradionecrosis: clinical behavior and diagnostic aspects. Clin Otolaryngol Allied Sci 25:378–384
Kluth EV, Jain PR, Stuchell RN, Frich JC Jr (1988) A study of factors contributing to the development of osteoradionecrosis of the jaws. J Prosthet Dent 59:194–201
Jacobson Adam S et al (2010) Paradigm shifts in the management of osteoradionecrosis of the mandible. Oral Oncol 46:795–801
Teng MS, Futran ND (2005) Osteoradionecrosis of the mandible. Curr Opin Otolaryngol Head Neck Surg 13:217–221
Thorn JJ et al (2000) Osteoradionecrosis of the jaws: clinical characteristics and relation to the field of irradiation. J Oral Maxillofac Surg 58:1088–1093
Watson WL, Scarborough JE (1938) Osteoradionecrosis in intraoral cancer. Am J Roengenol 40:524–534
Gowgiel JM (1960) Experimental radio-osteonecrosis of the jaws. J Dent Res 39:176–197
Titterington WP (1971) Osteomyelitis and osteoradionecrosis of the jaws. J Oral Med 26:7–16
Beumer JIII, Curtis T, Harrison RE (1979) Radiation therapy of the oral cavity: sequelae and management, part 1. Head Neck Surg 1:301–312
Epstein J, Wong F, Stevenson-Moore P (1987) Osteoradionecrosis: clinical experience and a proposal for classification. J Oral Maxillofac Surg 45:104–111
Marx RE (1983) A new concept in the treatment of osteoradionecrosis. J Oral Maxillofac Surg 41:351–357
Jereczek-Fossa BA, Orecchia R (2002) Radiotherapy-induced mandibular bone complications. Cancer Treat Rev 28:65–74
Silvestre-Rangil J, Silvestre FJ (2011) Clinico-therapeutic management of osteoradionecrosis: a literature review and update. Med Oral Patol Oral Cir Bucal 16(7):e900–e904
Pasquier D, Hoelscher T, Schmutz J et al (2004) Hyperbaric oxygen therapy in the treatment of radio-induced lesions in normal tissues: a literature review. Radiother Oncol 72:1–13
Ben-David et al (2007) Lack of osteoradionecrosis of the mandible after IMRT for head and neck cancer: likely contributions of both dental care and improved dose distributions. Int J Radiat Oncol Biol Phys 68(2):396–402
Wong JK et al (1997) Conservative management of osteoradionecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endodontol 84:16–21
Mcleod NMH et al (2012) Pentoxifylline and tocopherol in the management of patients with osteoradionecrosis: the Portsmouth experience. Br J Oral Maxillofac Surg 50:41–44
Kaur J et al (2009) Retrospective audit of the use of the Marx Protocol for prophylactic hyperbaric oxygen therapy in managing patients requiring dental extractions following radiotherapy to the head and neck. N Z D J 105(2):47–50
Bennett MH, Feldmeier J, Hampson N, Smee R, Milross C (2012) Hyperbaric oxygen therapy for late radiation tissue injury. Cochrane Database Syst Rev 5:(CD005005). doi:10.1002/14651858.CD005005.pub3.
Doan N et al (1999) In vitro effects of therapeutic ultrasound on cell proliferation, protein synthesis, and cytokine production by human fibroblasts, osteoblasts, and monocytes. J Oral Maxillofac Surg 57:409–419
Ang E, Black C (2003) Reconstructive options in the treatment of osteoradionecrosis of the craniomaxillofacial skeleton. Br J Plast Surg 56:92–99
Rehem Peter (1999) Treatment of mandibular osteoradionecrosis by cancellous bone grafting. Oral Maxiilofac Surg 57:942–943
Madrid C, Abarca M, Bouferrache K (2010) Osteoradionecrosis: an update. Oral Oncol 46:471–474
Monson et al (2012) The effects of high dose and highly fractionated radiation on distraction osteogenesis in the murine mandible. Radiation Oncology 7:15
Hellstein JW et al (2006) Systematic review: bisphosphonates and osteonecrosis of the jaws. Ann Intern Med 144:753–761
Shaw RJ, Dhanda J (2010) Hyperbaric oxygen in the management of late radiation injury to the head and neck. Part I: treatment. Br J Oral Maxillofac Surg 49(1):2–8
Epstein et al (1997) Postradiation osteonecrosis of the mandible, a long-term follow-up study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 83:657–662
Lyons A et al (2014) Osteoradionecrosis—a review of current concepts in defining the extent of the disease and a new classification proposal. Br J Oral Maxillofac Surg 52:392–395
McLeod NM et al (2011) Bisphosphonate osteonecrosis of the jaw: a literature review of UK policies versus international policies on the management of bisphosphonate osteonecrosis of the jaw. Br J Oral Maxillofac Surg 49:335–342
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Nadella, K.R., Kodali, R.M., Guttikonda, L.K. et al. Osteoradionecrosis of the Jaws: Clinico-Therapeutic Management: A Literature Review and Update. J. Maxillofac. Oral Surg. 14, 891–901 (2015). https://doi.org/10.1007/s12663-015-0762-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12663-015-0762-9