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Review
. 2015 Dec;14(4):891-901.
doi: 10.1007/s12663-015-0762-9. Epub 2015 Mar 10.

Osteoradionecrosis of the Jaws: Clinico-Therapeutic Management: A Literature Review and Update

Koteswara Rao Nadella  1 , Rama Mohan Kodali  1 , Leela Krishna Guttikonda  1 , Ashok Jonnalagadda  1
Affiliations
Review

Osteoradionecrosis of the Jaws: Clinico-Therapeutic Management: A Literature Review and Update

Koteswara Rao Nadella et al. J Maxillofac Oral Surg. 2015 Dec.

Abstract

Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment. It is a severe delayed radiation-induced injury, characterized by bone tissue necrosis and failure to heal for at least 3 months. In most cases osteoradionecrosis gradually progresses, becoming more extensive and painful that leads to infection and pathological fracture. The present paper provides a literature review and update on the risk factors underlying osteoradionecrosis, its clinical and diagnostic particulars, prevention and most widely accepted treatment options including the latest treatment modalities. Lastly, a new early management protocol is proposed based on the current clinical criteria relating to osteonecrosis secondary to treatment with bisphosphonates, together with the adoption of new therapies supported by increased levels of evidence.

Keywords: Bisphosphonate osteonecrosis; Etiology; Osteoradionecrosis; Pathophysiology; Risk factors; Treatment options.

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Figures

Fig. 1
Fig. 1
Incidence of ORN among various sites of maxilla and mandible [8]
Fig. 2
Fig. 2
Algorithm of ORN pathophysiology [16]
Fig. 3
Fig. 3
Pathophysiology of ORN according to Marx [1]
Fig. 4
Fig. 4
Pathophysiology of ORN according to radiation induced fibro-atrophic theory [1]
Fig. 5
Fig. 5
Protocol for patients who require dental extractions after radiotherapy [1]
Fig. 6
Fig. 6
Analysis showing primary outcomes of Marx protocol (1999) [29, 22]
See this image and copyright information in PMC

References

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