Mandibular osteoradionecrosis

Last revised by Craig Hacking on 25 Jan 2024

Mandibular osteoradionecrosis is more common than other forms of radiation osteonecrosis 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 osteoradionecrosis may occur in ~20% (5-37%) of patients 2,4

Mandibular osteoradionecrosis typically occurs in a patient who has received a dose of >60 Gy 4. Osteoradionecrosis 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 osteoradionecrosis

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

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