The management of osteoradionecrosis of the jaws--a review

Abstract

Purpose: To review the conservative and surgical management options of osteoradionecrosis, in particular, highlighting the recent the use of anti-radiation fibrosis drugs (pentoxifylline, tocopherol and clodronate).

Material and methods: We performed a literature review. The management options were divided into two groups, conservative and surgical management.

Results: Over the years several treatment options have been proposed including; conservative management (antibiotics, analgesics, oral hygiene), ultrasound therapy, hyperbaric oxygen therapy, surgical resection with reconstruction and more recently the use of anti-radiation fibrosis drugs (pentoxifylline, tocopherol and clodronate). Early or low grade ORN can be managed conservatively using a combination of treatment options. In advanced or refractory cases of ORN (pathological fracture, orocutaneous fistula) surgical treatment, at present, remains the only treatment option available. A new understanding of the pathophysiology of ORN (radiation induced fibroatrophic process) has lead to the development of new therapeutic management regimes.

Conclusion: In advanced or refractory cases of ORN surgical treatment, including microvascular reconstructive techniques for bone and soft tissue, remains the only option available.

Keywords: Mandibular reconstruction; Osteoradionecrosis; Pathological fracture; Radiation induced fibroatrophic process.