Osteoradionecrosis

Osteoradionecrosis
Guided by :
Dr. Krushna pateria,
Dr. Pooja wankhade
Presented by :
Mohammad Naved

Contents :
 Introduction
 Definition
 Etiology
 Clinical features
 Radiographic examination & features
 Differential diagnosis
 Management
 Prevention

Introduction
 This is inflammatory condition of bone.
 The high doses of radiation used in radiotherapy
reduce drastically the vascularity and reparative
powers of bone. The mandible is particularly
susceptible.
 Subsequent trauma (e.g. tooth extraction)
or infection may produce osteomyelitis with
rapid destruction of the irradiated bone,
sequestra formation and poor healing.

 It is characterized by presence of exposed bone for a
period of at least 3 months occurring at any time after
delivery of the radiation therapy.

Definition
 Osteoradionecrosis refers to an inflammatory
condition of bone (osteomyelitis) that occurs after the
bone has been exposed to therapeutic doses of
radiation usually given for a malignancy of the head
and neck region.

Etiology
 Doses above 50 Gy usually are required to cause this
irreversible damage.
 Bone that has been irradiated is hypocellular and
hypovascular.
 Dental extraction and denture trauma after radiation
therapy.

Clinical features
 Mandible is commonly affected than maxilla due to
microanatomy & less vasculature.
 Posterior mandible is commonly affected than anterior
portion because of radiation treatment for tumors in
this region.

 Loss of mucosal covering & exposed bone are hallmark
of Osteoradionecrosis.
 Pain may or may not be present with swelling and
drainage extraorally..
 The exposed bone become necrotic as result of loss of
vascularity from periosteum & sequestra.

Radiographic Features
 CT imaging is modality of choice.
 Early changes in bone: is well defined area of bone
resorption within the outer cortical plate of
mandible.

 Later changes: lytic or sclerotic or mixture
 Location : Commonly posterior mandible
 Periphery : ill defined
 Internal structure : A range of bone formation and
resorption occur. The bone pattern is granular.

 Effects on surrounding structures : in rare cases
stimulated periosteal bone formation resulting in
bone formation on outer cortex.
 In the alveolar processes of maxilla and mandible there
is irregular widening of periodontal membrane space.

Differential diagnosis
 Bone resorption stimulated by high level irradiation :
Differentiated by absence of exposed bone.
 Chronic osteomyelitis : history of radiation therapy.

Management
1. Conservative approach to maintain the integrity of
inferior border of mandible, keeping the site free of
infection , and patient free of pain is more successful.
 Adminstration of Antibiotics , rinisng
 Sequestrectomy, local debridement
 Use of narcotic analgesics , hydration, nutrition
 Ultrasound therapy can be used.

2. Radical method
 HBO therapy
 Local debridement , sequestrectomy
 Mouth rinsing

3. Hyperbaric O2 therapy : breathing 100 % oxygen
through facemask at 2.4 absolute atmospheric
pressure for 90 minutes 5 days week.
HBO reduced the hypoxia and increase healing by
increase in arterial and venous O2 tension.

Prevention of ORN
 Pre irradiation care :
Extraction of periodontally compromised tooth which
is in direct beam of radiation.
 During therapy : mouth rinse with 0.2 %
chlorhexidine.
 Post irradiation care :
Avoidance of denture use. Use of salivary substitutes.

Summary
 Osteoradionecrosis is caused by bone exposed to
irradiation therapy above 50 Gy.
 It is a radiation induced, non healing, hypoxic wound.
 Its prevention and treatment are possible.
 HBO therapy , Sequestrectomy are some methods of
treatment.

References
1. White and pharoh
2. Rajiv M borle. Textbook of oral and maxillofacial
surgery. Jaypee. 1st edition 2014.

Osteoradionecrosis

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