Patient and Treatment-Related Risk Factors for Osteoradionecrosis of the Jaw in Patients With Head and Neck Cancer

Oral Surg Oral Med Oral Pathol Oral Radiol. 2016 Mar;121(3):215-21.e1. doi: 10.1016/j.oooo.2015.10.006. Epub 2015 Oct 22.


Objective: The purpose of this study was to evaluate risk factors for and the incidence of osteoradionecrosis (ORN) of the jaw in patients with head and neck cancer.

Study design: This study was a retrospective analysis of the risk for ORN and outcome for 149 of 540 patients with head and neck cancer of the oral cavity (65%), oropharynx (26%), or other head and neck sites (9%) treated with radiotherapy between 2004 and 2009. ORN was graded according to Late Effects of Normal Tissues/Somatic Objective Management Analytic Scale (LENT/SOMA) criteria.

Results: Within a median follow-up of 41 months (95% confidence interval: 27.4-54.6), 38 patients (25.5%) had developed ORN, 37 patients (25%) had a local recurrence, and 53 patients (36%) had died. The median time to diagnosis of ORN was 14.5 months (range: 3-80), and 79% were diagnosed within 2 years of RT. Eleven of these patients had undergone previous mandibular surgery. Univariate significant risk factors for ORN were any comorbidity, poor oral hygiene, pre-radiotherapy osteotomy, close tumor-to-bone proximity, post-radiotherapy dentoalveolar surgery (DAS), DAS without sufficient wound closure, alcohol consumption, and denture pressure sores. In multivariate analysis, comorbidities, pre-radiotherapy mandibular surgery, poor oral hygiene, and insufficient DAS remained significant.

Conclusions: Reducing the risk of ORN calls for maintaining optimal oral hygiene, ensuring good denture fit, receiving proper training in DAS, and helping patients to stop drinking and smoking.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Female
  • Germany
  • Head and Neck Neoplasms / pathology
  • Head and Neck Neoplasms / radiotherapy*
  • Humans
  • Incidence
  • Jaw Diseases / epidemiology
  • Jaw Diseases / etiology*
  • Jaw Diseases / surgery*
  • Male
  • Middle Aged
  • Neoplasm Staging
  • Osteoradionecrosis / epidemiology
  • Osteoradionecrosis / etiology*
  • Osteoradionecrosis / surgery*
  • Risk Factors
  • Treatment Outcome