Osteoradionecrosis of the Jaw-Thinking Outside the Box, a Review of Emerging Treatment Paradigms

Osteoradionecrosis (ORN) of the jaw occurs due to the damaging effects of ionizing radiation used in the treatment of head and neck cancer, including oral cavity or oropharyngeal, nasopharyngeal, and salivary gland sites. Medical treatments for ORN have limited effectiveness in advanced cases, often necessitating resection of affected bone with microvascular reconstruction using a bone-containing free flap in advanced cases. Surgical innovations in minimally invasive free fascial and periosteal flaps have shown promise in restoring blood supply and halting disease progression, although they are not universally successful. In addition, novel cell-mediated regenerative treatments for osteoradionecrosis, including the use of adipose-derived and bone marrow-derived stem cells in craniomaxillofacial defects, have also demonstrated potential. The management of intermediate ORN remains a subject of debate, leading to a review of novel approaches to address this challenging condition. This review evaluates the efficacy of a range of treatment options, including new cell-based treatments for osteoradionecrosis (ORN) by analyzing literature from Medline, PubMed, and Embase databases using search terms such as “osteoradionecrosis,†“stem cells,†“therapy,†“radiation,†and “reconstructive surgery.†Relevant papers for this review were triaged by abstract and title, categorized by topic or procedure, and subsequently read and summarized. Experimental studies of cell-based treatments for ORN in human patients and animal models show promise and support further exploration of this emerging treatment strategy.