[Osteoradionecrosis. A review of the literature]

Osteoradionecrosis is a severe complication of radiotherapy characterized by the following sequence: radiation, trauma, bone exposure. The radiation reduces the vascularization potential of the tissues which leads to a hypoxic state that jeopardizes cellular activity and collagen formation. The diagnosis of osteoradionecrosis relies on the clinical examination of chronically exposed bone. Although this type of lesion is not limited to the jaws, the ratio between mandible and maxilla is 24:1. The severity of the lesion is a function of the radiation dosage. The main etiological factors of osteoradionecrosis are related to dental and periodontal pathology as well as to tooth extraction performed after, during or shortly before radiotherapy. Edentulous patients are less exposed to osteoradionecrosis than dentulous patients. Local treatment and antibiotic therapy are initially performed in mild cases. Surgical measures with hemiresection or block resection are indicated depending on the severity of the lesion. Some authors regard hyperbaric oxygen treatment as an efficient therapeutic and preventive technique. Prevention is of major concern. It requires a careful evaluation of soft and hard tissues of the oral cavity as well as the organization of an intensive prophylaxis program. Patient compliance is a prerequisite. This article is a literature review on osteoradionecrosis with its symptoms, incidence, pathogenesis, treatment and prevention.