Background: Mandibular osteoradionecrosis (ORN) is among the most severe and devastating complications that can occur following combined management of head and neck cancer. This study constitutes a review of 13 patients who underwent intra-oral cancer resection followed by radiotherapy, and thereafter developed ORN of the mandible. The anatomical localization of primary disease focus, malignancy type, and the time between radiotherapy termination and the clinical diagnosis of ORN were all investigated. The association between ORN, oral tissue injury and dental condition were also checked. The treatment modality used and the outcome were analysed.
Material and methods: The clinical records and treatment plans of 13 ORN patients (10 men, 3 women) treated from January 1993 through December 2003 in the Department of Maxillofacial Surgery in Katowice were analysed retrospectively.
Results: Of the 13 patients, 11 were referred for irradiation therapy for oral squamous cell carcinoma, 1 for sarcoma of the mandible, and 1 for histiocytosis. The average duration of radiation therapy, and the clinical diagnosis of ORN was 20 months (range: 1 month to 7 years). In most cases ORN resulted from an injury. Initially all patients were given conservative treatment, which turned out to be effective in 7 cases. In the remaining 6 patients, further ORN progress was observed. Thus, a segmental mandibulectomy or hemi-mandibulectomy with a simultaneous reconstruction with regional flaps was performed.
Conclusions: Mandibular osteoradionecrosis occurs mostly after associated treatment for oral squamous cell carcinoma. Each surgical intervention (such as dental extraction) in the irradiated region is the main risk factor for the development of ORN. In cases with acute and rapid progressive ORN, conservative treatment does not seem to be effective.