Complication of radiation therapy (XRT) with necrosis of bone and failure to heal
IMAGING
General Features
Imaging Recommendations
Radiographic Findings
CT Findings
MR Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Law B et al: Autogenous free fat graft combined with platelet-rich fibrin heals a refractory mandibular osteoradionecrosis. Clin Ter. 171(2):e110-13, 2020
Aarup-Kristensen S et al: Osteoradionecrosis of the mandible after radiotherapy for head and neck cancer: risk factors and dose-volume correlations. Acta Oncol. 58(10):1373-7, 2019
El-Rabbany M et al: Interventions for preventing osteoradionecrosis of the jaws in adults receiving head and neck radiotherapy. Cochrane Database Syst Rev. 2019(11), 2019
Verbo EV et al: [Determination of the lesions volume in patients with radionecrosis of the jaws.] Stomatologiia (Mosk). 98(6):33-8, 2019
Deshpande SS et al: Osteoradionecrosis of the mandible: through a radiologist's eyes. Clin Radiol. 70(2):197-205, 2015
Mitsimponas KT et al: Osteo-radio-necrosis (ORN) and bisphosphonate-related osteonecrosis of the jaws (BRONJ): the histopathological differences under the clinical similarities. Int J Clin Exp Pathol. 7(2):496-508, 2014
Gevorgyan A et al: Osteoradionecrosis of the mandible: a case series at a single institution. J Otolaryngol Head Neck Surg. 42:46, 2013
Armin BB et al: Brachytherapy-mediated bone damage in a rat model investigating maxillary osteoradionecrosis. Arch Otolaryngol Head Neck Surg. 138(2):167-71, 2012
Curé JK et al: Radiopaque jaw lesions: an approach to the differential diagnosis. Radiographics. 32(7):1909-25, 2012
Dholam KP et al: Dental implants in irradiated jaws: a literature review. J Cancer Res Ther. 8 Suppl 1:S85-93, 2012
Hamilton JD et al: Superimposed infection in mandibular osteoradionecrosis: diagnosis and outcomes. J Comput Assist Tomogr. 36(6):725-31, 2012
Tchanque-Fossuo CN et al: Amifostine remediates the degenerative effects of radiation on the mineralization capacity of the murine mandible. Plast Reconstr Surg. 129(4):646e-55e, 2012
Cannady SB et al: Free flap reconstruction for osteoradionecrosis of the jaws--outcomes and predictive factors for success. Head Neck. 33(3):424-8, 2011
Nabil S et al: Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review. Int J Oral Maxillofac Surg. 40(3):229-43, 2011
O'Dell K et al: Osteoradionecrosis. Oral Maxillofac Surg Clin North Am. 23(3):455-64, 2011
Tamplen M et al: Standardized analysis of mandibular osteoradionecrosis in a rat model. Otolaryngol Head Neck Surg. 145(3):404-10, 2011
Thariat J et al: [Revisiting the dose-effect correlations in irradiated head and neck cancer using automatic segmentation tools of the dental structures, mandible and maxilla.] Cancer Radiother. 15(8):683-90, 2011
Bak M et al: Contemporary reconstruction of the mandible. Oral Oncol. 46(2):71-6, 2010
Chrcanovic BR et al: Osteoradionecrosis of the jaws--a current overview--part 1: Physiopathology and risk and predisposing factors. Oral Maxillofac Surg. 14(1):3-16, 2010
Jacobson AS et al: Reconstruction of bilateral osteoradionecrosis of the mandible using a single fibular free flap. Laryngoscope. 120(2):273-5, 2010
Jegoux F et al: Radiation effects on bone healing and reconstruction: interpretation of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 109(2):173-84, 2010
Scully C et al: Hot topics in special care dentistry. 10. Osteoradionecrosis/radiotherapy. Dent Update. 37(2):127, 2010
Spiegelberg L et al: Hyperbaric oxygen therapy in the management of radiation-induced injury in the head and neck region: a review of the literature. J Oral Maxillofac Surg. 68(8):1732-9, 2010
Suh JD et al: Disease relapse after segmental resection and free flap reconstruction for mandibular osteoradionecrosis. Otolaryngol Head Neck Surg. 142(4):586-91, 2010
Almazrooa SA et al: Bisphosphonate and nonbisphosphonate-associated osteonecrosis of the jaw: a review. J Am Dent Assoc. 140(7):864-75, 2009
Bagan JV et al: Osteonecrosis of the jaws by intravenous bisphosphonates and osteoradionecrosis: a comparative study. Med Oral Patol Oral Cir Bucal. 14(12):e616-9, 2009
Gal TJ et al: Reconstruction of the through-and-through oral cavity defect with the fibula free flap. Otolaryngol Head Neck Surg. 140(4):519-25, 2009
Lee IJ et al: Risk factors and dose-effect relationship for mandibular osteoradionecrosis in oral and oropharyngeal cancer patients. Int J Radiat Oncol Biol Phys. 75(4):1084-91, 2009
Hanasono MM et al: Reconstruction of extensive head and neck defects with multiple simultaneous free flaps. Plast Reconstr Surg. 122(6):1739-46, 2008
Lyons A et al: Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg. 46(8):653-60, 2008
Pitak-Arnnop P et al: Management of osteoradionecrosis of the jaws: an analysis of evidence. Eur J Surg Oncol. 34(10):1123-34, 2008
Chambers MS et al: Osteoradionecrosis. Werning JW (ed): Oral Cancer: Diagnosis, Management, and Rehabilitation. New York: Thieme Medical Publishers. 296-303, 2007
Ferguson HW et al: Advances in head and neck radiotherapy to the mandible. Oral Maxillofac Surg Clin North Am. 19(4):553-63, vii, 2007
Goldwaser BR et al: Risk factor assessment for the development of osteoradionecrosis. J Oral Maxillofac Surg. 65(11):2311-6, 2007
Lye KW et al: The effect of prior radiation therapy for treatment of nasopharyngeal cancer on wound healing following extractions: incidence of complications and risk factors. Int J Oral Maxillofac Surg. 36(4):315-20, 2007
Hansen T et al: Infected osteoradionecrosis of the mandible: follow-up study suggests deterioration in outcome for patients with Actinomyces-positive bone biopsies. Int J Oral Maxillofac Surg. 35(11):1001-4, 2006
Peleg M et al: The treatment of osteoradionecrosis of the mandible: the case for hyperbaric oxygen and bone graft reconstruction. J Oral Maxillofac Surg. 64(6):956-60, 2006
Støre G et al: Mandibular osteoradionecrosis: clinical behaviour and diagnostic aspects. Clin Otolaryngol Allied Sci. 25(5):378-84, 2000
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Top Differential Diagnoses
Pathology
Clinical Issues
Diagnostic Checklist
TERMINOLOGY
Abbreviations
Osteoradionecrosis (ORN)
Definitions
Complication of radiation therapy (XRT) with necrosis of bone and failure to heal
IMAGING
General Features
Imaging Recommendations
Radiographic Findings
CT Findings
MR Findings
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
Staging, Grading, & Classification
Gross Pathologic & Surgical Features
Microscopic Features
CLINICAL ISSUES
Presentation
Demographics
Natural History & Prognosis
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Reporting Tips
Selected References
Law B et al: Autogenous free fat graft combined with platelet-rich fibrin heals a refractory mandibular osteoradionecrosis. Clin Ter. 171(2):e110-13, 2020
Aarup-Kristensen S et al: Osteoradionecrosis of the mandible after radiotherapy for head and neck cancer: risk factors and dose-volume correlations. Acta Oncol. 58(10):1373-7, 2019
El-Rabbany M et al: Interventions for preventing osteoradionecrosis of the jaws in adults receiving head and neck radiotherapy. Cochrane Database Syst Rev. 2019(11), 2019
Verbo EV et al: [Determination of the lesions volume in patients with radionecrosis of the jaws.] Stomatologiia (Mosk). 98(6):33-8, 2019
Deshpande SS et al: Osteoradionecrosis of the mandible: through a radiologist's eyes. Clin Radiol. 70(2):197-205, 2015
Mitsimponas KT et al: Osteo-radio-necrosis (ORN) and bisphosphonate-related osteonecrosis of the jaws (BRONJ): the histopathological differences under the clinical similarities. Int J Clin Exp Pathol. 7(2):496-508, 2014
Gevorgyan A et al: Osteoradionecrosis of the mandible: a case series at a single institution. J Otolaryngol Head Neck Surg. 42:46, 2013
Armin BB et al: Brachytherapy-mediated bone damage in a rat model investigating maxillary osteoradionecrosis. Arch Otolaryngol Head Neck Surg. 138(2):167-71, 2012
Curé JK et al: Radiopaque jaw lesions: an approach to the differential diagnosis. Radiographics. 32(7):1909-25, 2012
Dholam KP et al: Dental implants in irradiated jaws: a literature review. J Cancer Res Ther. 8 Suppl 1:S85-93, 2012
Hamilton JD et al: Superimposed infection in mandibular osteoradionecrosis: diagnosis and outcomes. J Comput Assist Tomogr. 36(6):725-31, 2012
Tchanque-Fossuo CN et al: Amifostine remediates the degenerative effects of radiation on the mineralization capacity of the murine mandible. Plast Reconstr Surg. 129(4):646e-55e, 2012
Cannady SB et al: Free flap reconstruction for osteoradionecrosis of the jaws--outcomes and predictive factors for success. Head Neck. 33(3):424-8, 2011
Nabil S et al: Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review. Int J Oral Maxillofac Surg. 40(3):229-43, 2011
O'Dell K et al: Osteoradionecrosis. Oral Maxillofac Surg Clin North Am. 23(3):455-64, 2011
Tamplen M et al: Standardized analysis of mandibular osteoradionecrosis in a rat model. Otolaryngol Head Neck Surg. 145(3):404-10, 2011
Thariat J et al: [Revisiting the dose-effect correlations in irradiated head and neck cancer using automatic segmentation tools of the dental structures, mandible and maxilla.] Cancer Radiother. 15(8):683-90, 2011
Bak M et al: Contemporary reconstruction of the mandible. Oral Oncol. 46(2):71-6, 2010
Chrcanovic BR et al: Osteoradionecrosis of the jaws--a current overview--part 1: Physiopathology and risk and predisposing factors. Oral Maxillofac Surg. 14(1):3-16, 2010
Jacobson AS et al: Reconstruction of bilateral osteoradionecrosis of the mandible using a single fibular free flap. Laryngoscope. 120(2):273-5, 2010
Jegoux F et al: Radiation effects on bone healing and reconstruction: interpretation of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 109(2):173-84, 2010
Scully C et al: Hot topics in special care dentistry. 10. Osteoradionecrosis/radiotherapy. Dent Update. 37(2):127, 2010
Spiegelberg L et al: Hyperbaric oxygen therapy in the management of radiation-induced injury in the head and neck region: a review of the literature. J Oral Maxillofac Surg. 68(8):1732-9, 2010
Suh JD et al: Disease relapse after segmental resection and free flap reconstruction for mandibular osteoradionecrosis. Otolaryngol Head Neck Surg. 142(4):586-91, 2010
Almazrooa SA et al: Bisphosphonate and nonbisphosphonate-associated osteonecrosis of the jaw: a review. J Am Dent Assoc. 140(7):864-75, 2009
Bagan JV et al: Osteonecrosis of the jaws by intravenous bisphosphonates and osteoradionecrosis: a comparative study. Med Oral Patol Oral Cir Bucal. 14(12):e616-9, 2009
Gal TJ et al: Reconstruction of the through-and-through oral cavity defect with the fibula free flap. Otolaryngol Head Neck Surg. 140(4):519-25, 2009
Lee IJ et al: Risk factors and dose-effect relationship for mandibular osteoradionecrosis in oral and oropharyngeal cancer patients. Int J Radiat Oncol Biol Phys. 75(4):1084-91, 2009
Hanasono MM et al: Reconstruction of extensive head and neck defects with multiple simultaneous free flaps. Plast Reconstr Surg. 122(6):1739-46, 2008
Lyons A et al: Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg. 46(8):653-60, 2008
Pitak-Arnnop P et al: Management of osteoradionecrosis of the jaws: an analysis of evidence. Eur J Surg Oncol. 34(10):1123-34, 2008
Chambers MS et al: Osteoradionecrosis. Werning JW (ed): Oral Cancer: Diagnosis, Management, and Rehabilitation. New York: Thieme Medical Publishers. 296-303, 2007
Ferguson HW et al: Advances in head and neck radiotherapy to the mandible. Oral Maxillofac Surg Clin North Am. 19(4):553-63, vii, 2007
Goldwaser BR et al: Risk factor assessment for the development of osteoradionecrosis. J Oral Maxillofac Surg. 65(11):2311-6, 2007
Lye KW et al: The effect of prior radiation therapy for treatment of nasopharyngeal cancer on wound healing following extractions: incidence of complications and risk factors. Int J Oral Maxillofac Surg. 36(4):315-20, 2007
Hansen T et al: Infected osteoradionecrosis of the mandible: follow-up study suggests deterioration in outcome for patients with Actinomyces-positive bone biopsies. Int J Oral Maxillofac Surg. 35(11):1001-4, 2006
Peleg M et al: The treatment of osteoradionecrosis of the mandible: the case for hyperbaric oxygen and bone graft reconstruction. J Oral Maxillofac Surg. 64(6):956-60, 2006
Støre G et al: Mandibular osteoradionecrosis: clinical behaviour and diagnostic aspects. Clin Otolaryngol Allied Sci. 25(5):378-84, 2000
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