title: Analysis of surgical margins in cases of mandibular osteoradionecrosis that progress despite extensive mandible resection and free tissue transfer.
abstract: BACKGROUND
  Approximately 1 of 4 patients with osteoradionecrosis (ORN) of the mandible develop ongoing disease despite extensive mandible resection to margins determined by the presence of bleeding bone at the time of surgery.
  
  
  OBJECTIVE
  To determine whether pathologic examination of bony margins in assessing for the presence of necrotic edges is correlated with ongoing ORN.
  
  
  METHODS
  Resected mandible specimens from 34 patients with severe mandibular ORN were examined histologically for the presence of necrotic margins and compared with clinical outcome of ORN persistence at follow-up.
  
  
  RESULTS
  Median follow-up was 17.4 months. Eight specimens had histologic evidence of necrotic, nonviable bone at the margins of resections; however, there was no progression of disease among patients in this group. Twenty-six specimens were clear of necrotic margins; however, 8 patients from this group developed persistent disease.
  
  
  CONCLUSIONS
  Irradiated mandible is susceptible to ORN progression even if clinical and final histopathologic assessments confirm complete resection of necrotic bone margins. Progression of disease in ORN is not related to inadequate resection of necrotic bone.
authors.affiliation: Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, Los Angeles, CA 90095-1624, USA. szaghi@mednet.ucla.edu
authors.forename: Soroush
authors.initials: S
authors.lastname: Zaghi
authors.forename: Mia
authors.initials: M
authors.lastname: Miller
authors.forename: Keith
authors.initials: K
authors.lastname: Blackwell
authors.forename: Beth
authors.initials: B
authors.lastname: Palla
authors.forename: Chi
authors.initials: C
authors.lastname: Lai
authors.forename: Vishad
authors.initials: V
authors.lastname: Nabili
mesh_terms: D016371:Cranial Irradiation / Q000009:adverse effects; D005500:Follow-Up Studies; D058752:Free Tissue Flaps; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D008334:Mandible / Q000601:surgery*; D008336:Mandibular Diseases / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D063175:Mandibular Reconstruction / Q000379:methods*; D010025:Osteoradionecrosis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome