Bilateral Osteoradionecrosis of Mandible: A Case Report

Abstract

Osteoradionecrosis (ORN) defines exposed irradiated bone, which fails to heal over a period of 3-6 months without evidence of residual or recurrent tumor. It is a long term and serious complication of therapeutic radiotherapy for head and neck cancer. The pathogenesis of ORN has been proposed relating it to a fibroatrophic mechanism including free radical formation, endothelial dysfunction, inflammation, microvascular thrombosis leading to bone and tissue necrosis. Risk factors mainly include radiation related risk factors, surgery, tobacco and alcohol abuse. Removing of diseased teeth after radiotherapy is generally considered the main risk factor in ORN. Prevention of ORN is based on the preventive extractions of decayed or periodontally compromised teeth before radiotherapy. Based on the clinical staging various therapeutic protocols have been suggested. We here report a case of Bilateral mandibular ORN with discussion of clinical features, pathogenesis, preventive measures, and management of ORN.

Bilateral osteoradionecrosis of the jaw – A rare case report

“…The above theory was improvised by Marx suggesting it as the hypoxic, hypocellular, and hypovascular theory which states that after radiation exposure there is a formation of hypoxic-hypocellular hypovascular tissue which will cause excess collagen lysis and cellular death leading to chronic nonhealing wound and the most recent theory is the radiation fibroatrophic theory pronouncing the activation and dysregulation of fibroblastic activity of the previously radiated area which leads to progression of ORN. [31,32] Prevention of ORN is an enormously noteworthy part of the complete management of patients who undergo external beam radiation therapy to the head and neck malignancies. As per protocol, all the indicated teeth should be extracted 21 days before initiation of radiation therapy and patients should be instructed on meticulous oral hygiene and fluoride should be applied to the dentition daily via custom molded trays and should undergo weekly check-up during RT and monthly follow-ups for the first 6 months and then following early post-treatment patient should visit their dentists for every 4 months.…”