title: The management of osteoradionecrosis of the jaws--a review.
abstract: OBJECTIVE
  To review the conservative and surgical management options of osteoradionecrosis, in particular, highlighting the recent the use of anti-radiation fibrosis drugs (pentoxifylline, tocopherol and clodronate).
  
  
  METHODS
  We performed a literature review. The management options were divided into two groups, conservative and surgical management.
  
  
  RESULTS
  Over the years several treatment options have been proposed including; conservative management (antibiotics, analgesics, oral hygiene), ultrasound therapy, hyperbaric oxygen therapy, surgical resection with reconstruction and more recently the use of anti-radiation fibrosis drugs (pentoxifylline, tocopherol and clodronate). Early or low grade ORN can be managed conservatively using a combination of treatment options. In advanced or refractory cases of ORN (pathological fracture, orocutaneous fistula) surgical treatment, at present, remains the only treatment option available. A new understanding of the pathophysiology of ORN (radiation induced fibroatrophic process) has lead to the development of new therapeutic management regimes.
  
  
  CONCLUSIONS
  In advanced or refractory cases of ORN surgical treatment, including microvascular reconstructive techniques for bone and soft tissue, remains the only option available.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Oral Medicine, Oral Pathology, Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland. Electronic address: nrice@tcd.ie.
authors.forename: Niamh
authors.initials: N
authors.lastname: Rice
authors.affiliation: Department of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Polyzois
authors.affiliation: Department of Oral and Maxillofacial Surgery, Oral Medicine, Oral Pathology, Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland.
authors.forename: Kumara
authors.initials: K
authors.lastname: Ekanayake
authors.affiliation: Department of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland.
authors.forename: Osama
authors.initials: O
authors.lastname: Omer
authors.affiliation: Department of Oral and Maxillofacial Surgery, Oral Medicine, Oral Pathology, Dublin Dental University Hospital, Lincoln Place, Dublin 2, Ireland.
authors.forename: Leo F A
authors.initials: LF
authors.lastname: Stassen
mesh_terms: D000465:Algorithms; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D004002:Clodronic Acid / Q000627:therapeutic use; D005355:Fibrosis / Q000209:etiology / Q000517:prevention & control; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D006931:Hyperbaric Oxygenation; D007571:Jaw Diseases / Q000209:etiology / Q000628:therapy*; D010025:Osteoradionecrosis / Q000209:etiology / Q000628:therapy*; D010431:Pentoxifylline / Q000627:therapeutic use; D011837:Radiation-Protective Agents / Q000627:therapeutic use*; D011878:Radiotherapy / Q000009:adverse effects; D024505:Tocopherols / Q000627:therapeutic use
chemical_list: D000893:Anti-Inflammatory Agents; D011837:Radiation-Protective Agents; D004002:Clodronic Acid; D024505:Tocopherols; D010431:Pentoxifylline
keywords: Mandibular reconstruction; Osteoradionecrosis; Pathological fracture; Radiation induced fibroatrophic process