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Updated: Apr 5, 2026
A Postoperative Evaluation Guideline for Computer-Assisted Reconstruction of the Mandible
Published on: January 28, 2020
Risk profile for osteoradionecrosis of the mandible in the IMRT era
Gabriela Studer1, Marius Bredell2, Stephan Studer2
1Department of Radiation Oncology, Head Neck Cancer Center, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland. gabriela.studer@usz.ch.
Background:
The risk for osteoradionecrosis (ORN) of the mandible is positively related to bone volume exposed to > ~ 60 Gy. We hypothesized that in combined treatment, surgery may also be a risk factor.
Patients And Methods:
The impact of mandibular surgery on ORN in locally disease-free IMRT cohorts was retrospectively analyzed.
Results:
Between October 2002 and October 2013, 531 of 715 patients with oral cavity cancer (OCC), mesopharyngeal cancer (MC), or salivary gland tumor were treated with the mandible bone exposed to ~ > 60 Gy (mean follow-up, 38 months; 7-143 months). Of the 531 patients, 36 developed ORN (7 %; 1.5 % with grade 3-4). The ORN rate in definitive IMRT MC (16/227) and in postoperative IMRT OCC patients with no mandibular surgery (3/46) was 7 % each; in OCC patients with mandibular surgery the rate was 29 % (15/60, p = 0.002). Marginal or periosteal bone resection was found to be a high risk factor (39 %, vs. 7 % followed by segmental or no resection, p < 0.0001).
Conclusion:
Marginal or periosteal bone resection of the mandible was identified as the highest ORN risk factor in our IMRT cohort.
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