Current Concepts in Osteoradionecrosis after Head and Neck Radiotherapy

Area of Science:

• Oncology
• Oral and Maxillofacial Surgery
• Radiotherapy

Background:

• Osteoradionecrosis (ORN) of the jaws is a significant complication following head and neck radiotherapy.
• ORN presents challenges in incidence estimation due to varied definitions and classifications.
• Rising head and neck cancer incidence may increase the vulnerable population despite advances in radiotherapy techniques.

Purpose of the Study:

• To provide a comprehensive overview of osteoradionecrosis (ORN) of the jaws.
• To discuss the impact of varying definitions and classifications on ORN incidence and evidence interpretation.
• To explore current and emerging strategies for ORN prevention and management.

Main Methods:

• Literature review and synthesis of existing research on ORN.
• Analysis of radiotherapy techniques and their influence on ORN.
• Examination of different pathophysiological theories and treatment modalities.

Main Results:

• Variations in ORN definition and classification complicate incidence assessment.
• Newer radiotherapy techniques may reduce ORN risk but are counterbalanced by increasing cancer incidence.
• Multiple theories explain ORN pathophysiology, including radiation-induced osteomyelitis and fibroatrophic changes.

Conclusions:

• Effective ORN prevention involves restorative dentistry and precise radiation planning.
• Treatment approaches for ORN range from conservative management to radical surgery.
• The role of hyperbaric oxygen therapy in ORN management remains controversial, necessitating further research.