title: Management of osteoradionecrosis of the jaws: an analysis of evidence.
abstract: OBJECTIVE
  To review and discuss the management of jaw bone osteoradionecrosis (JORN) based on levels of evidence.
  
  
  METHODS
  The Medline/PUBMED and Cochrane search was performed to identify all studies on the management of JORN, published in English, French, and German during January 1975-October 2007. Only clinical researches were identified and classified into four levels of evidence before being examined. All references of the retrieved articles were analysed.
  
  
  RESULTS
  Seventy three articles and their additional 45 citations were evaluated. Most of the eligible literature provided observational evidence. Hyperbaric oxygen therapy (HBOT) is an adjunct; however, its clinical usefulness remains controversial. A conservative approach should be limited to early-onset JORN, while radical surgery is indicated for an advanced or refractory lesion. Free tissue transfer is the reconstruction of choice for large defects without the need of HBOT. Some new technologies have also been studied, including ultrasound, biological molecules, distraction osteogenesis and antioxidant agents.
  
  
  CONCLUSIONS
  Most of the reports on the treatment of JORN offer weak evidence. Current information seems insufficient for establishing the definite treatment guideline; thus, well-designed studies with long-term clinical data are encouraged.
authors.affiliation: Department of Maxillofacial Surgery, Faculty of Medicine, Pitié-Salpêtrière University Hospital, University Paris 6, Pierre et Marie Curie, Paris, France. poramate.pitakarnnop@gmail.com
authors.forename: P
authors.initials: P
authors.lastname: Pitak-Arnnop
authors.forename: R
authors.initials: R
authors.lastname: Sader
authors.forename: K
authors.initials: K
authors.lastname: Dhanuthai
authors.forename: P
authors.initials: P
authors.lastname: Masaratana
authors.forename: C
authors.initials: C
authors.lastname: Bertolus
authors.forename: A
authors.initials: A
authors.lastname: Chaine
authors.forename: J-C
authors.initials: JC
authors.lastname: Bertrand
authors.forename: A
authors.initials: A
authors.lastname: Hemprich
mesh_terms: D001847:Bone Diseases / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D019317:Evidence-Based Medicine; D006801:Humans; D006931:Hyperbaric Oxygenation; D007568:Jaw; D007571:Jaw Diseases / Q000601:surgery / Q000628:therapy*; D056948:Orthognathic Surgical Procedures; D010025:Osteoradionecrosis / Q000601:surgery / Q000628:therapy*