Skip to main content
SpringerLink
Log in

Surgical Factors and Progression of Osteoradionecrosis of Mandible: An Institutional Experience and Recommendations

  • Original Article
  • Published:
Indian Journal of Surgical Oncology Aims and scope Submit manuscript

Abstract

The severe complication in oral cancer patients receiving radiation therapy is osteoradionecrosis. The reported incidence of ORN is highly variable, ranging from 0 to 37.5%. Diverse treatment protocols underscore the complexity of managing ORN. This study aims to address the surgical factors and their association with the formation of ORN in patients with oral squamous cell carcinoma undergoing surgery. Data of 17 patients who received definitive surgery and post-operative adjuvant radiotherapy (using the 3D CRT technique alone) to the head and neck from January 2016 to December 2023 presented with post-operative changes, which shows clinical evidence of ORN confirmed by radiographic investigations collected. Among 17 patients, 10 patients (58.8%) had posterior segmental mandibulectomy and seven patients (41.1%) had undergone marginal mandibulectomy with coronoidectomy respectively. Only two patients (11.7%) had regional flap reconstruction using PMMC flap, and for one patient (5.8%), surgical defect closed primarily; the remaining 14 (82.3%) patients underwent free flap reconstruction. Among free flaps, six patients (35.2%) had fibula and seven patients had radial forearm (41.1%) reconstruction. Only one patient (5.8%) underwent reconstruction using an anterolateral thigh flap. Along with consideration of radiation dose, dental extraction, oral hygiene, etc. do anticipate ORN and contemplate surgical risk factors during surgical planning in the management of head and neck cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  1. Monnier Y et al (2011) Mandibular osteoradionecrosis in squamous cell carcinoma of the oral cavity and oropharynx: incidence and risk factors. Otolaryngol-Head Neck Surg 144(5):726–732. https://doi.org/10.1177/0194599810396290

    Article  PubMed  Google Scholar 

  2. Oh HK et al (2009) Osteoradionecrosis of the mandible: treatment outcomes and factors influencing the progress of osteoradionecrosis. J Oral Maxillofac Surg 67(7):1378–1386. https://doi.org/10.1016/j.joms.2009.02.008

    Article  PubMed  Google Scholar 

  3. Sathasivam HP et al (2018) Predictive factors for osteoradionecrosis of the jaws: a retrospective study. Head Neck 40(1):46–54. https://doi.org/10.1002/hed.24907

    Article  PubMed  Google Scholar 

  4. Owosho AA et al (2017) The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): the memorial Sloan Kettering Cancer Center experience. Oral Oncol 64:44–51. www.ncbi.nlm.nih.gov/pubmed/28024723, https://doi.org/10.1016/j.oraloncology.2016.11.015. Accessed 8 Mar 2019

  5. Goldwaser BR et al (2007) Risk factor assessment for the development of osteoradionecrosis. J Oral Maxillofac Surg 65(11):2311–2316. https://doi.org/10.1016/j.joms.2007.05.021

    Article  PubMed  Google Scholar 

  6. Mendenhall WM (2004) Mandibular osteoradionecrosis. J Clin Oncol 22(24):4867–4868. https://doi.org/10.1200/JCO.2004.09.959

    Article  PubMed  Google Scholar 

  7. Owosho AA et al (2015) Radiographic osteoradionecrosis of the jaw with intact mucosa: proposal of clinical guidelines for early identification of this condition. Oral Oncol 51(12):e93–e96. https://doi.org/10.1016/j.oraloncology.2015.09.009

    Article  PubMed  PubMed Central  Google Scholar 

  8. Marx RE (1983) Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg 41(5):283–288. https://doi.org/10.1016/0278-2391(83)90294-X

    Article  CAS  PubMed  Google Scholar 

  9. He Y et al (2015) Retrospective analysis of osteoradionecrosis of the mandible: proposing a novel clinical classification and staging system. Int J Oral Maxillofac Surg 44(12):1547–1557. https://doi.org/10.1016/j.ijom.2015.04.006

    Article  CAS  PubMed  Google Scholar 

  10. Chronopoulos A et al (2015) Osteoradionecrosis of the mandible: a ten year single-center retrospective Study. J Cranio-Maxillofac Surg 43(6):837–846. https://doi.org/10.1016/j.jcms.2015.03.024

    Article  Google Scholar 

  11. Nguyen JD, Duong H. Anatomy, head and neck: inferior alveolar arteries. [Updated 2023 Aug 14]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. Available from: https://www.ncbi.nlm.nih.gov/books/NBK547736/

  12. You ZH (1991) A study of maxillary and mandibular vasculature in relation to orthognathic surgery. Zhonghua Kou Qiang Yi Xue Za Zhi 26(5):263–6, 316. Chinese

  13. Juodzbalys G et al (2010) Anatomy of mandibular vital structures. Part I: mandibular canal and inferior alveolar neurovascular bundle in relation with dental implantology. J Oral Maxillofac Res 1(1). https://doi.org/10.5037/jomr.2010.1102

  14. Gazyakan E et al (2016) Minimizing osteoradionecrosis after mandibular reconstruction and radiation in advanced head and neck cancer patients: OPAC flap for mandibular reconstruction. J Surg Oncol 114(4):399–404. https://doi.org/10.1002/jso.24321

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Plastic and Reconstructive Surgery, HCG Manavata Cancer Centre, Near Mylan Circle, Mumbai Naka, Nashik, Maharashtra, 422002, India

    Rajendra Dhondge

  2. Department of Head and Neck Surgical Oncology, HCG Manavata Cancer Centre, Near Mylan Circle, Mumbai Naka, Nashik, Maharashtra, 422002, India

    Reju Sathar & Koustabh Kumar

  3. Department of Robotics and Surgical Oncology, HCG Manavata Cancer Centre, Near Mylan Circle, Mumbai Naka, Nashik, Maharashtra, 422002, India

    Raj Nagarkar

Authors
  1. Rajendra Dhondge
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Reju Sathar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Koustabh Kumar
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Raj Nagarkar
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Reju Sathar.

Ethics declarations

Conflict of Interest

The authors declare no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Dhondge, R., Sathar, R., Kumar, K. et al. Surgical Factors and Progression of Osteoradionecrosis of Mandible: An Institutional Experience and Recommendations. Indian J Surg Oncol (2024). https://doi.org/10.1007/s13193-024-01944-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s13193-024-01944-8

Keywords

Search

Navigation