Osteoradionecrosis of the Jaws

Osteoradionecrosis of the jaws (ORNJ) is a serious complication occurring after radiotherapy of oral, maxillofacial, head and neck tumors, with an incidence ranging from 5% to 15%. ORNJ is often characterized by chronic necrosis and infection [1]. The clinical manifestations consist of local redness, pain, limitation of mouth opening, dysphagia, chewing and language disorders, pyorrhea of facial soft tissue fistula and inability to heal, exposure to dead bones, and even pathological fractures in severe cases. The pathogenesis of ORNJ is still unclear. The basic research and preliminary clinical translational research based on different theoretical hypotheses are in their infancy. Whether antifibrotic therapy can achieve clinical benefits and improve patients’ quality of life while reducing the rate of ORNJ progression, the results of prospective clinical studies still need to be confirmed. ORNJ treatment plan should be comprehensively considered according to lesion classification and stages, the patient’s age, occupation and compliance, comprehensive hospital conditions, clinical skills of doctors, and other factors to make an individual choice [2–4]. Due to the rich maxillary blood supply, it generally rarely appears to have widespread necrosis [5–10]. Therefore, there are some differences in its clinical manifestations and management methods compared with the necrosis of the jaws. It generally takes conservative treatment, curettage of necrotic jaw and so on, relatively conservative surgical methods [9–22]. For dead bones with clear boundaries, it is also feasible with vascularized bone tissue or soft tissue flap repair [23–34]. As for osteoradionecrosis of the jaws, we recommend the corresponding treatment according to BS classification and staging [2, 11, 23].