Mandibular osteoradionecrosis
Updates to Article Attributes
Body
was changed:
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 may occur within a year of therapy.
Radiographic appearance
Features include 2,4
- cortical destruction that is ill-defined resulting in a mixed sclerotic-lucent pattern
- sequestration, especially of 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
- drug related osteonecrosis, e.g. bisphosphonate-related osteonecrosis of the jaw (BRONJ)
- chronic osteomyelitis
- malignancy
-<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>drug related osteonecrosis, e.g. <a href="/articles/medication-related-osteonecrosis-of-the-jaw">bisphosphonate-related osteonecrosis of the jaw</a> (BRONJ)</li>
Images Changes:
Image 5 CT (bone window) ( create )
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