Advances in head and neck radiotherapy to the mandible

Management of radiation-exposed bone in the mandible is a dilemma many oral and maxillofacial surgeons must confront and manage. Current advances in radiotherapy techniques using pin-point computerized accuracy in combination with other advances, such as morphed imaging, fractionalization protocols, minimization of scatter, and pretreatment dental examinations, have greatly decreased the late effects of radiation and osteoradionecrosis. The intent of this article is to provide a brief overview of the following topics: radiotherapy physics and radiobiology, effects of radiotherapy on normal tissues, including the pathogenesis of osteoradionecrosis, and advances in contemporary radiotherapy treatment.