Osteoradionecrosis of the jaw: Current concepts in prevention and management with a case report

Osteoradionecrosis (ORN) of the jaw is a debilitating late complication of head and neck radiotherapy (RT), characterized by necrotic bone within an irradiated field, persisting without tumor recurrence. Advances in radiation techniques and preventive dental management have reduced its incidence, yet ORN remains a major cause of morbidity. This review synthesizes current understanding of ORN pathophysiology, risk factors, diagnostic strategies, and contemporary prevention and management approaches, with a focus on the updated 2024 ISOO-MASCC-ASCO guidelines. Preventive measures include pre-RT dental optimization, dose reduction to jaw bones, and avoidance of post-RT extractions when possible. Management ranges from conservative pharmacologic regimens to radical resection with vascularized flap reconstruction. Multidisciplinary care and patient education are key to minimizing risk and improving outcomes. Additionally, we report a comparable case of mandibular osteoradionecrosis in a postoperative patient with carcinoma of the buccal mucosa, which developed despite the administration of adjuvant radiotherapy using an advanced radiation delivery technique.