Mandibular osteoradionecrosis
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Updates to Article Attributes
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.
Epidemiology
Mandibular ORNosteoradionecrosis may occur in ~20% (5-37%) of patients 2,4.
Pathology
Mandibular ORNosteoradionecrosis typically occurs in a patient who has received a dose of >60 Gy 4.Osteoradionecrosis
Radiographic features
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
ORNosteoradionecrosis
Treatment and prognosis
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.
Given dental extractions increase the patients risk of developing mandibular osteoradionecrosis It is not uncommon to perform an OPG prior to treatment to rule out any potential dental abnormalities 5.
Complications
infection
radiation-induced neoplasia
Differential diagnosis
-<p><strong>Mandibular osteoradionecrosis (ORN)</strong> is more common after radiation therapy for head and neck malignancies due to the superficial position of the <a href="/articles/mandible">mandible</a>, which exposes it 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 a patient who has 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 features</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>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</li>- +<p><strong>Mandibular osteoradionecrosis</strong> is more common after <a href="/articles/radiotherapy-2" title="Radiation therapy">radiation therapy</a> for head and neck malignancies due to the superficial position of the <a href="/articles/mandible">mandible</a>, which exposes it to high radiation. The maxilla can also be involved, but this is less frequent. </p><h4>Epidemiology</h4><p>Mandibular <a href="/articles/osteoradionecrosis" title="Osteoradionecrosis">osteoradionecrosis</a> may occur in ~20% (5-37%) of patients <sup>2,4</sup>. </p><h4>Pathology</h4><p>Mandibular osteoradionecrosis typically occurs in a patient who has received a dose of >60 Gy <sup>4</sup>. Osteoradionecrosis changes may occur within a year of therapy.</p><h4>Radiographic features</h4><p>Features include <sup>2,4</sup>:</p><ul>
- +<li><p>cortical destruction that is ill-defined resulting in a mixed sclerotic-lucent pattern</p></li>
- +<li><p>sequestration, especially of the buccal bone</p></li>
- +<li><p>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 osteoradionecrosis</p></li>
-<li><a href="/articles/pathological-fracture">pathological fractures</a></li>-<li>infection </li>-<li>radiation-induced neoplasia</li>- +<li><p><a href="/articles/pathological-fracture">pathological fractures</a></p></li>
- +<li><p>infection </p></li>
- +<li><p>radiation-induced neoplasia</p></li>
-<li><a href="/articles/medication-related-osteonecrosis-of-the-jaw">medication-related osteonecrosis of the jaw (MRONJ)</a></li>-<li><a href="/articles/chronic-osteomyelitis-1">chronic osteomyelitis</a></li>-<li>malignancy</li>- +<li><p><a href="/articles/medication-related-osteonecrosis-of-the-jaw">medication-related osteonecrosis of the jaw (MRONJ)</a></p></li>
- +<li><p><a href="/articles/chronic-osteomyelitis-1">chronic osteomyelitis</a></p></li>
- +<li><p>malignancy</p></li>
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