Tag Archives: Mirjana Popovska

Osteoradionecrosis of the Mandible: A Case Report

[btn url=”http://balkandentaljournal.com/wp-content/uploads/2016/04/Osteoradionecrosis-of-the-Mandible.pdf” text_color=”#ffffff” bg_color=”#81d742″ icon=”fa-file-pdf-o” icon_position=”start” size=”14″ id=”” target=”NewWindow”]Download Article[/btn]

Danica Popovik-Monevska1 / Ilijana Muratovska2 / Mirjana Popovska3 / Suzana Dvojakovska1 / 4

1Ss. Cyril and Methodius University of Skopje, Faculty of Dentistry, Skopje, FYROM, Department for Maxillofacial Surgery
2Ss. Cyril and Methodius University of Skopje, Faculty of Dentistry, Skopje, FYROM, Department for Restorative Dentistry and Endodontics
3Ss. Cyril and Methodius University of Skopje, Faculty of Dentistry, Skopje, FYROM, Department for Periodontics and Oral Medicine
4Ss. Cyril and Methodius University of Skopje, Faculty of Dentistry Skopje Majka Tereza 17 1000, FYROM, Department for Maxillofacial Surgery Skopje FYR Macedonia


Osteoradionecrosis (ORN) of the jaws is a serious complication of radiotherapy of head and neck malignancies. Different assumptions about its occurring, risk factors and possible therapeutical modalities exist, but the clinical outcome of such patients is still not on the desired level. This article presents a clinical case of ORN of the mandible, occurring with exposed and infected bone, necrotic process that extended through all the mandible body, as well as cutaneous fistula. The first site of ORN was detected 2 years after radiotherapy for oral cancer, with the second one detected 3 and a half years after radiotherapy. In both, the reason for exposing the bone was local trauma due to tooth extraction. Due to the stage of the condition, a decision for surgical treatment accompanied with antibiotics was made.

It is very important and critical for irradiated patients and patients with osteoradionecrosis to perform appropriate oral hygiene and frequent dental checks. Establishing protocols for prevention and treatment, but involving some new strategies regarding to this condition, are strongly recommended.

Keywords: Osteoradionecrosis; Mandible; Radiotherapy


  1. Beumer J, Harrison R, Sanders B, Kurrasch M. Osteoradionecrosis: predisposing factors and outcomes of therapy. Head Neck Surg, 1984; 6:819-827. [Crossref]
  2. Chrcanovic BR, Reher P, Sousa AA, Harris M. Osteoradionecrosis of the jaws – a current overview. Part 1: Physiopathology and risk and predisposing factors. Oral Maxillofac Surg, 2010; 14(1):3-16.
  3. Marx RE. Osteoradionecrosis; a new concept of its pathophysiology. J Oral Maxillofac Surg, 1983; 41:283-288.
  4. Marx RE. A new concept in the treatment of osteoradionecrosis. J Oral Maxillofac Surg, 1983; 41:351-357.
  5. Teng MS, Futran ND. Osteoradionecrosis of the mandible. Curr Opin Otolaryngol Head Neck Surg, 2005; 13(4):217-221. [Web of Science] [Crossref]
  6. Curi MM, Dib LL. Osteoradionecrosis of the jaws: a retrospective study of the background factors and treatment in 104 cases. J Oral Maxillofac Surg, 1997; 55(6):540-544.
  7. Tsai CJ, Hofstede TM, Sturgis EM, Garden AS, Lindberg ME, Wei Q, et al. Osteora-dionecrosis and radiation dose to the mandible in patients with oropharyngeal cancer. Int J Radiat Oncol Biol Phys, 2013; 1:415-420. [Web of Science] [Crossref]
  8. Guimarães EP, Rafaelly de Oliveira Pedreira F, Correia Jham B, de Carli ML, Pereira AAC, Hanemann JAC. Clinical Management of Suppurative Osteomyelitis, Bisphosphonate-Related Osteonecrosis, and Osteoradionecrosis: Report of Three Cases and Review of the Literature. Case Rep Dent. ID 2013402096, 2013.
  9. Goldwaser BR, Chuang SK, Kaban LB, August M. Risk factor assessment for the development of osteoradionecrosis. J Oral Maxillofac Surg, 2007; 65(11):2311-2316.
  10. Oh HK, Chambers MS, Martin JW, Lim HJ, Park HJ. Osteoradionecrosis of the mandible: treatment outcomes and factors influencing the progress of osteoradionecrosis. J Oral Maxillofac Surg, 2009; 67(7):1378-1386.
  11. Vanderpuye V, Goldson A. Osteoradionecrosis of the mandible. A case report. J Natl Med Assoc, 2009; 92:579-584.
  12. Myers R, Marx RE. Use of hyperbaric oxygen in postradiation head and neck surgery. Natl Cancer Inst Monogr, 1990; pp 151-157.
  13. Rice N, Polyzois I, Ekanayake K, et al. The management of osteoradionecrosis of the jaws – a review. Surgeon, 2015; 13:101-109. [Crossref]
  14. Peterson DE, Doerr W, Hovan A, et al. Osteoradionecrosis in cancer patients: the evidence base for treatmentdependent frequency, current management strategies, and future studies. Support Care Cancer, 2010; 18:1089-1098. [Crossref]
  15. Shaw RJ, Dhanda J. Hyperbaric oxygen in the management of late radiation injury to the head and neck. Part I: Treatment. Br J Oral Maxillofac Surg, 2011; 49(1):2-8.
  16. Jereczek-Fossa BA, Orecchia R. Radiotherapy-induced mandibular bone complications. Cancer Treat Rev, 2002; 28:65-74. [Crossref]
  17. Reuther T, Schuster T, Mende U, Kübler A. Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients. A report of a thirty year retrospective review. Int J Oral Maxillofac Surg, 2003; 32:289-295.
  18. Studer G, Gratz KW, Glanzmann C. Osteoradionecrosis of the mandible in patients treated with different fractionations. Strahlenther Onkol, 2004; 180:233-240. [Crossref]
  19. Niewald M, Fleckenstein J, Mang K, Holtmann H, Spitzer WJ, Rübe C. Dental status, dental rehabilitation procedures, demographic and oncological data as potential risk factors for infected osteoradionecrosis of the lower jaw after radiotherapy for oral neoplasms: a retrospective evaluation. Radiat Oncol, 2013; 8:227. [Crossref]
  20. Silverstein P. Smoking and wound healing. Am J Med, 1992; 93:225-245. [Crossref]
  21. Guo S, DiPietro LA. Factors affecting wound healing. J Dent Res, 2010; 89:219-229. [Crossref]
  22. Gevorgyan A, Wong K, Poon I, Blanas N, Enepekides DJ, Higgins KM. Osteoradionecrosis of the mandible: a case series at a single institution. J Otolaryngol Head Neck Surg, 2013; 42:46-52. [Web of Science] [Crossref]
  23. Delanian S, Lefaix JL. The radiation-induced fibroatrophic process: therapeutic perspective via antioxidant pathway. Radiother Oncol, 2004; 73:119-131. [Crossref]
  24. Robarda L, Louisb M-Y, Blanchardb D, Babina E, Delanianc S. European Annals of Otorhinolaryngology, Head and Neck Diseases, 2014; 131:333-338.
  25. Rice N, Polyzios I, Ekanayake K, Osama O, Stassen LFA. The management of osteoradionecrosis of the jaws. A review the surgeon. 2015; 13:101-109.
Citation Information: Balkan Journal of Dental Medicine. Volume 20, Issue 1, Pages 54–58, ISSN (Online) 2335-0245, DOI: https://doi.org/10.1515/bjdm-2016-0009, April 2016