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Decoding Osteoradionecrosis of the Jaw: Radiological Progression and a Novel CT-Based Grading System.

Vasundhara Patil1, Pritesh Shah1, Abhishek Mahajan2,3

  • 1Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India.

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|January 28, 2026
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Summary

Osteoradionecrosis (ORN) of the jaw progresses predictably on CT scans, from resorption to fragmentation. A new CT-based grading system aids early diagnosis of this radiation therapy complication.

Keywords:
bone necrosishead and neck cancerjawmandiblemaxillaoral cancerosteoradionecrosis of jawradiotherapy complications

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Area of Science:

  • Radiology
  • Oncology
  • Oral and Maxillofacial Surgery

Background:

  • Osteoradionecrosis (ORN) of the jaw is a severe complication following radiation therapy for head and neck cancers.
  • ORN imaging findings can mimic osteomyelitis or tumor recurrence, complicating diagnosis.
  • Current grading systems lack specificity for ORN progression.

Purpose of the Study:

  • To analyze the imaging characteristics and progression of jaw Osteoradionecrosis (ORN).
  • To propose a novel Computed Tomography (CT)-based grading system for ORN.
  • To build upon existing ClinRAD grading criteria for improved ORN assessment.

Main Methods:

  • Retrospective cohort study of 35 patients with biopsy-proven or clinically diagnosed ORN.
  • Assessment of initial and follow-up imaging to evaluate radiological evolution.
  • Statistical analysis of CT findings and comparison with literature.

Main Results:

  • Median ORN onset was 27-28 months post-radiotherapy; common symptoms included ulcers, pain, and sinuses.
  • Mandibular involvement was predominant (51%), with focal bone alterations.
  • CT findings showed progressive resorption, erosion, sclerosis, and fragmentation, with 92% showing increased fragmentation and sclerosis on follow-up.

Conclusions:

  • Jaw Osteoradionecrosis (ORN) demonstrates a predictable radiological progression.
  • The proposed CT-based grading system offers a structured approach for early ORN diagnosis.
  • Further research with larger imaging studies is needed to validate the grading system and refine diagnostic criteria.