Surgical management of mandibular osteoradionecrosis: risk factors, timeline and surgical outcomes

Surgery is the preferred treatment option for those with severe or refractory osteoradionecrosis (ORN). This retrospective cohort study evaluated surgical management outcomes for mandibular ORN in 36 patients treated at The Royal Melbourne Hospital between 2017 and 2024. Most patients were male (mean age 67.9 years) with Notani Stage III ORN (81%). Common risk factors included radiation >60 Gy (83.6%), smoking (66.6%), and alcohol use (77.8%). A total of 59 surgeries were performed: 46 debridement and 13 segmental mandibulectomies. ORN was associated with high morbidity and mortality (19% died during follow up). Debridement gave long-term relief in 13% of patients, delaying second and third surgeries by 10 and 23 months, respectively. Segmental resections were significantly associated with ORN healing (odds ratio = 10.7, P < 0.001). Segmental mandibulectomy provided sustained relief in 62% and was 10 times more effective than debridement in achieving healed ORN. Debridement and segmental mandibulectomy both have a role in management of mandibular ORN. Debridement provides more time for tissues to recover post-radiotherapy, to exit the high-risk period for cancer recurrence and to allow medical interventions, e.g., smoking cessation.