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Osteoradionecrosis of the jaw: review of its aetiology, prevention and management Faisal Alzahrani Farya Domah Raunaq Shah Salvatore Luca La Terra Faris Alabeedi Dental Update 2025 52:6, 400-406.
Authors
FaisalAlzahrani
BDS, MSc, Oral Surgeon, Ministry of Defence, Royal Armed Forces Medical Services, Saudi Arabia; Teaching Fellow, Ulster University, College of Medicine and Dentistry, Oral Surgery Department, Birmingham
BA, BDentSc(TCD), MFDS RCS(Edin), MSc Oral Surgery (Distinction) (UCLan),
BA, BDentSc, MFDS, RCS, MSc Oral Surgery (Dist), MOralSurg RCS, Oral Surgery Programme Director, College of Medicine and Dentistry, Ulster University, Birmingham, UK
BDS, MFDS, RCS, MJDF, RCS, MSc Prosthodontics (Dist), MClinDent Implantology (Dist), Senior Clinical Lecturer in Implantology, College of Medicine and Dentistry, Ulster University, Birmingham
BDS, PgDip, MMedSc, MSc, Oral Pathologist, Department of Maxillofacial Surgery and Diagnostic Sciences, Faculty of Dentistry, Najran University, Saudi Arabia
This review investigates osteoradionecrosis (ORN), a debilitating complication of head and neck radiotherapy. It explores its aetiology, prevention and diverse management approaches. High-dose radiotherapy (≥70 cGy) and tooth extractions in irradiated areas increase ORN risk. Diagnosis involves clinical presentation, imaging using OPT, CT and MRI, and biopsy. Management ranges from conservative measures to surgery (such as sequestrectomy and reconstruction). Understanding ORN is vital to minimize its occurrence and optimize patient outcomes through preventive measures and appropriate treatment strategies.
CPD/Clinical Relevance: ORN is a significant complication of head and neck radiotherapy, requiring a multidisciplinary approach for prevention, accurate diagnosis, and effective management to optimize patient outcomes.
Article
By consensus, osteoradionecrosis (ORN) is a condition that presents when exposed, debilitated bone fails to heal within 3 months after exposure to radiotherapy.1,2 As Harris noted: ‘Irradiated bone becomes devitalized and exposed through the overlying skin or mucosa, persisting without healing for 3 months in the absence of tumour recurrence.’3 ORN can present in various regions such as the femoral head, clavicle, pelvis and sternum.1,4,5 Its incidence in the jaw has increased since 1950 when head and neck radiotherapy was introduced as a treatment modality.6,7
The risk of ORN is 9% in individuals who have ionizing radiation therapy at doses over 70 cGy for the management of head or neck tumours. It affects approximately 2% of people receiving radiation doses of 60–70 cGy. The occurrence of ORN is minimal among patients who receive radiation doses below 60 cGy.
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