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Osteoradionecrosis
Patricia A. Hudgins, MD, FACR
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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

                                                1. Deshpande SS et al: Osteoradionecrosis of the mandible: through a radiologist's eyes. Clin Radiol. 70(2):197-205, 2015
                                                2. 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
                                                3. Gevorgyan A et al: Osteoradionecrosis of the mandible: a case series at a single institution. J Otolaryngol Head Neck Surg. 42:46, 2013
                                                4. 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
                                                5. Dholam KP et al: Dental implants in irradiated jaws: a literature review. J Cancer Res Ther. 8 Suppl 1:S85-93, 2012
                                                6. Hamilton JD et al: Superimposed infection in mandibular osteoradionecrosis: diagnosis and outcomes. J Comput Assist Tomogr. 36(6):725-31, 2012
                                                7. 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
                                                8. 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
                                                9. 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
                                                10. O'Dell K et al: Osteoradionecrosis. Oral Maxillofac Surg Clin North Am. 23(3):455-64, 2011
                                                11. Tamplen M et al: Standardized analysis of mandibular osteoradionecrosis in a rat model. Otolaryngol Head Neck Surg. 145(3):404-10, 2011
                                                12. 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
                                                13. Bak M et al: Contemporary reconstruction of the mandible. Oral Oncol. 46(2):71-6, 2010
                                                14. 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
                                                15. Jacobson AS et al: Reconstruction of bilateral osteoradionecrosis of the mandible using a single fibular free flap. Laryngoscope. 120(2):273-5, 2010
                                                16. 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
                                                17. Scully C et al: Hot topics in special care dentistry. 10. Osteoradionecrosis/radiotherapy. Dent Update. 37(2):127, 2010
                                                18. 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
                                                19. 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
                                                20. Almazrooa SA et al: Bisphosphonate and nonbisphosphonate-associated osteonecrosis of the jaw: a review. J Am Dent Assoc. 140(7):864-75, 2009
                                                21. 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
                                                22. 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
                                                23. 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
                                                24. Hanasono MM et al: Reconstruction of extensive head and neck defects with multiple simultaneous free flaps. Plast Reconstr Surg. 122(6):1739-46, 2008
                                                25. 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
                                                26. Pitak-Arnnop P et al: Management of osteoradionecrosis of the jaws: an analysis of evidence. Eur J Surg Oncol. 34(10):1123-34, 2008
                                                27. Chambers MS et al: Osteoradionecrosis. Werning JW (ed): Oral Cancer: Diagnosis, Management, and Rehabilitation. New York: Thieme Medical Publishers. 296-303, 2007
                                                28. 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
                                                29. Goldwaser BR et al: Risk factor assessment for the development of osteoradionecrosis. J Oral Maxillofac Surg. 65(11):2311-6, 2007
                                                30. 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
                                                31. 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
                                                32. 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
                                                33. Støre G et al: Mandibular osteoradionecrosis: clinical behaviour and diagnostic aspects. Clin Otolaryngol Allied Sci. 25(5):378-84, 2000
                                                Related Anatomy
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                                                Related Differential Diagnoses
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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

                                                                                              1. Deshpande SS et al: Osteoradionecrosis of the mandible: through a radiologist's eyes. Clin Radiol. 70(2):197-205, 2015
                                                                                              2. 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
                                                                                              3. Gevorgyan A et al: Osteoradionecrosis of the mandible: a case series at a single institution. J Otolaryngol Head Neck Surg. 42:46, 2013
                                                                                              4. 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
                                                                                              5. Dholam KP et al: Dental implants in irradiated jaws: a literature review. J Cancer Res Ther. 8 Suppl 1:S85-93, 2012
                                                                                              6. Hamilton JD et al: Superimposed infection in mandibular osteoradionecrosis: diagnosis and outcomes. J Comput Assist Tomogr. 36(6):725-31, 2012
                                                                                              7. 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
                                                                                              8. 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
                                                                                              9. 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
                                                                                              10. O'Dell K et al: Osteoradionecrosis. Oral Maxillofac Surg Clin North Am. 23(3):455-64, 2011
                                                                                              11. Tamplen M et al: Standardized analysis of mandibular osteoradionecrosis in a rat model. Otolaryngol Head Neck Surg. 145(3):404-10, 2011
                                                                                              12. 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
                                                                                              13. Bak M et al: Contemporary reconstruction of the mandible. Oral Oncol. 46(2):71-6, 2010
                                                                                              14. 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
                                                                                              15. Jacobson AS et al: Reconstruction of bilateral osteoradionecrosis of the mandible using a single fibular free flap. Laryngoscope. 120(2):273-5, 2010
                                                                                              16. 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
                                                                                              17. Scully C et al: Hot topics in special care dentistry. 10. Osteoradionecrosis/radiotherapy. Dent Update. 37(2):127, 2010
                                                                                              18. 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
                                                                                              19. 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
                                                                                              20. Almazrooa SA et al: Bisphosphonate and nonbisphosphonate-associated osteonecrosis of the jaw: a review. J Am Dent Assoc. 140(7):864-75, 2009
                                                                                              21. 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
                                                                                              22. 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
                                                                                              23. 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
                                                                                              24. Hanasono MM et al: Reconstruction of extensive head and neck defects with multiple simultaneous free flaps. Plast Reconstr Surg. 122(6):1739-46, 2008
                                                                                              25. 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
                                                                                              26. Pitak-Arnnop P et al: Management of osteoradionecrosis of the jaws: an analysis of evidence. Eur J Surg Oncol. 34(10):1123-34, 2008
                                                                                              27. Chambers MS et al: Osteoradionecrosis. Werning JW (ed): Oral Cancer: Diagnosis, Management, and Rehabilitation. New York: Thieme Medical Publishers. 296-303, 2007
                                                                                              28. 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
                                                                                              29. Goldwaser BR et al: Risk factor assessment for the development of osteoradionecrosis. J Oral Maxillofac Surg. 65(11):2311-6, 2007
                                                                                              30. 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
                                                                                              31. 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
                                                                                              32. 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
                                                                                              33. Støre G et al: Mandibular osteoradionecrosis: clinical behaviour and diagnostic aspects. Clin Otolaryngol Allied Sci. 25(5):378-84, 2000