Free omental transfer for osteoradionecrosis of the mandible

Osteoradionecrosis (ORN) of the mandible can arise following therapeutic radiotherapy for head and neck cancer. The incidence is quoted as 10-15%. Conservative and surgical therapies used for ORN have included vascularized osteocutaneous flap transfers, hyperbaric oxygen and ultrasound therapy. We have used an omental transfer for ORN without a segmental resection. We wrapped the affected mandible within the omentum in order to promote revascularization and neocellularity. Four patients suffering from ORN have undergone omental transfers. Two cases developed pathologic fractures postoperatively that were successfully treated by conservative management. In all cases, the patients' intractable pain improved, and no patient showed recurrence of ORN or wound dehiscence. Postoperative bone scintigrams showed the same degree of accumulation in the lesion as in normal adjacent bone. These results demonstrate the effectiveness of omental transfer and suggest that omental transfer has a promising place in the management of ORN.