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Post-Radiation Microbiological Changes in Osteoradionecrosis: Investigating the Microbial Landscape.

Grace Anne Longfellow¹, Makayla R Matthews¹, Gabrielle J Adams¹

¹School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery

|October 14, 2025

Summary

Osteoradionecrosis of the jaw (ORNJ) often involves multiple bacteria and antibiotic resistance. Gram-negative infections in ORNJ predict the need for reconstructive surgery, indicating more severe cases.

Keywords:

autologous reconstruction head and neck cancer jaw necrosis osteoradionecrosis of the jaw radiotherapy

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Published on: September 30, 2022

Area of Science:

Oral and Maxillofacial Surgery
Infectious Diseases
Oncology

Background:

Osteoradionecrosis of the jaw (ORNJ) is a serious complication following radiation therapy for head and neck cancers.
Understanding the microbial landscape and resistance patterns is crucial for effective management.

Purpose of the Study:

To characterize the microbiologic features of ORNJ.
To determine antibiotic resistance patterns.
To identify clinical predictors for reconstructive surgery in ORNJ patients.

Main Methods:

Retrospective cohort study of 84 adult patients with ORNJ at a single tertiary care center.
Analysis of clinical and microbiologic data, including culture results and antibiotic susceptibility.
Logistic regression to identify predictors of autologous reconstruction and specific infections.

Main Results:

Actinomyces and Streptococcus anginosus were the most common isolates; 22.6% of infections were Gram-negative.
Gram-negative infections independently predicted autologous reconstruction (OR=14.81) and were associated with fistula presence (OR=6.57).
High resistance was noted for ampicillin and cefazolin; gentamicin showed high susceptibility. Posterior mandibular involvement and pathologic fracture reduced reconstruction odds.

Conclusions:

ORNJ presents a polymicrobial, antibiotic-resistant profile.
Gram-negative infections are key indicators for autologous reconstruction and may signify more severe ORNJ.
Integrating microbiologic data with anatomic factors is vital for optimal ORNJ treatment strategies.