Volume 14, Number 1, March 2002

Osteoradionecrosis of the Mandible — Factors Influencing Severity

Ken-ichi Notani,1 Yutaka Yamazaki,1 Shingo Moriya,1 Noriyuki Sakakibara,1 Hiroyuki Nakamura,2 Masaaki Watanabe,3 Hiroshi Fukuda1
1Oral Diagnosis and Medicine, Department of Oral Pathobiological Science, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Japan
2Department of Dental & Oral Surgery, Nippon Telegraph and Telephone East Corporation Sapporo Hospital, Japan
3Department of Dental & Oral Surgery, Tomakomai City General Hospital, Japan

Abstract
Objectives: To examine the factors influencing the severity of mandibular osteoradionecrosis to provide helpful data for the management of this condition.
Patients and Methods: From 1963 to 1997, eighty seven patients with mandibular osteoradionecrosis who had received brachytherapy alone, combined radiotherapy and brachytherapy, or external radiotherapy alone were managed by conservative and/or surgical treatment. The time interval from completion of radiotherapy to the onset of osteoradionecrosis, the incidence of osteoradionecrosis with regard to the radiotherapy modality and the dose of external radiotherapy and brachytherapy used, and the factors involved in initiating osteoradionecrosis were examined.
Results: There was a long term irreversible detrimental effect of irradiation. Most cases of osteoradionecrosis developed spontaneously within 36 months. External radiotherapy had greater detrimental effects on the development of osteoradionecrosis than did brachytherapy. When the onset of osteoradionecrosis was delayed and patients received a high dose of external irradiation, severe osteoradionecrosis developed.
Conclusion: Conservative treatment or radical surgery should be selected for patients with osteoradionecrosis of the mandible by considering the previous radiotherapy modality and the time interval before the onset of osteoradionecrosis, as well as the dose of irradiation.

Key words: Osteoradionecrosis, Mandible, Risk factors

Asian J Oral Maxillofac Surg. 2002;14:5-9.
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