Osteoradionecrosis of the Jaw

Question 1

What is osteoradionecrosis?

Answer 1

Area of exposed necrotic irradiated bone that fails to heal over a period of 3-6 months in the absence of local neoplastic osteitis

Question 2

What are the risk factors of osteoradionecrosis?

Answer 2

• Hyper-fractional radiation regime (high total dose)
• Trauma and surgery (Dental extraction)
• Pre-irradiation and post-irradiation dental extractions
• Poor oral hygiene with periodontal disease
• Tobacco and alcohol use

Question 3

What are the signs of osteoradionecrosis?

Answer 3

• Non healing necrotic bone, which may or may not be exposed
• Infected teeth or gums
• Extra-oral draining sinus
• Lymphadenopathy

Question 4

What are some unusual features seen with intra-oral exam of someone with osteoradionecrosis?

Answer 4

Examine any exposed bone surfaces and adjacent dental and periodontal tissues.

Palpate to examine for continuity of the lower border of the mandible.

Check for lip numbness and sensation in soft tissues.

Check for draining sinuses or scars

Question 5

How do we prevent osteo-radionecrosis?

Answer 5

Dental treatment prior to radiation therapy.
All extractions all done 3-6 weeks prior to initiation to allow for adequate healing.
Eliminate sharp bony projections.
Avoid invasive procedures.

Question 6

What is the treatment of osteoradionecrosis?

Answer 6

• Perform minor debridement
• Eliminating sharp bone edges & sharp tooth surfaces
• Advise patient to maintain local hygiene of the area of exposed bone with topical antibacterial agents
• Amoxicillin 500mg 3 times a day
• NSAIDs every 4 hours