Osteoradionecrosis of the jaws: definition, epidemiology, staging and clinical and radiological findings. A concise review

Abstract

Osteoradionecrosis (ORN) of the jaws is a pernicious complication of radiation therapy for head and neck tumours. This article aims to provide an update on data related to the definition, epidemiology, staging, and clinical and radiological findings of ORN of the jaws. Using certain keywords, an electronic search was conducted spanning the period from January 1922 to April 2014 to identify the available related investigations. Pooled data were then analysed. ORN is described as exposed irradiated bone that fails to heal over a period of 3 months without evidence of persisting or recurrent tumour. The prevalence of ORN varies in the literature. Several staging or scoring systems of ORN have been proposed. Clinical findings include ulceration or necrosis of the mucosa with exposure of necrotic bone. Radiological findings are not evident in the early stages of ORN. Furthermore ORN may not be apparent in imaging even when the disease is advanced. Taking into account the severity of ORN and the difficulties in diagnosing it early and accurately, the clinician should be aware of this complex entity in order to prevent its appearance or the development of more severe complications.

Follow‐up of need for dental treatment in 126 patients who have received radiation treatment to the head and neck region

“…Without reducing the importance or discomfort associated with mucositis, caries, hyposalivation and dysgeusia, the most severe and therapy‐consuming complication from radiotherapy is osteoradionecrosis. The incidence of ORN varies considerably between studies, but a recent review concluded that most studies report an incidence between 5%‐15% . A large study conducted by Reuther et al reported an incidence of 8.2% which is comparable to our study.…”

“…However, it must be noted that the incidence of ORN in earlier studies is based on results before the introduction of IMRT. The general reduction of ORN in more recent studies can likely be attributed to the advent of megavoltage radiotherapy, increased knowledge of improved dental preventive care and also of improved radiation techniques including three‐dimensional conformal radiotherapy (3D‐CRT) and IMRT . It has also been questioned if certain malignancies are more associated with risk of developing ORN.…”

“…Osteoradionecrosis is defined as exposed irradiated bone that fails to heal over a period of 3 months without any evidence of persisting or recurrent tumour . The pathogenesis has been debated, and several theories exist involving that radiation results in hypoxic, hypovascular and hypocellular tissue, followed by tissue breakdown leading to a non‐healing wound.…”

Risk Factors for Osteoradionecrosis of the Jaw in Patients With Head and Neck Squamous Cell Carcinoma

“…Osteoradionecrosis of the jaw (ORNJ) is among the most serious late complications observed in patients with head and neck squamous cell carcinoma (HNSCC) treated with radiation therapy (RT). While ORNJ was rst described in 1922, the de nition, mechanism of pathogenesis, incidence, risk factors, and clinical staging, as well as treatment protocols associated with the disease, remain controversial [1].…”

Nanofibras poliméricas carregadas com oxitetraciclina para tratamento de alveolite seca: estudo em ratos

“…Em pacientes tratados com mais de 6000 centigreys (cGy) de radiação, a incidência de osteoradionecrose vai de 5 a 9%, porém, com a modernização das técnicas de radiação, este índice vem caindo (Hanley;Cooper, 2017;Qaisi;Montague, 2017). Sua ocorrência se deve ao fato de que a radiação dos maxilares cria um ambiente hipovascular, hipocelular e hipóxico nos tecidos ósseos e moles, causando necrose avascular no osso (Marx, 1983;Hanley;Cooper, 2017;Chronopoulos et al, 2018).…”