title: Surgical management of osteoradionecrosis of the jaws.
abstract: OBJECTIVE
  The objective of this study is to evaluate our 10-year clinical experience in surgical management of patients with osteoradionecrosis (ORN) unresolved with conservative nonoperative treatment.
  
  
  METHODS
  The medical records of 120 patients who had been surgically treated for ORN during a 10-year period (January 2003 to January 2013) were retrospectively reviewed.
  
  
  RESULTS
  The most predilection ORN site was mandible (82.5%), followed by the maxilla (11.7%). ORN developed within initial 12 months in 39.2% and within the first 3 years in 68.3%. The median radiation dose was 68.1 Gy (range, 35-148 Gy), but 51 patients (42.5%) experienced ORN even though radiation doses were controlled under 60 Gy. Surgical trauma, as we believed, was the most important factor leading to this result. Among all the patients, 12 (10.0%) patients were found ineligible for operative treatment due to comorbid systematic diseases whereas none healed or improved. In terms of surgical management of the rest of the 108 patients, 90 (75.0%) patients underwent radical resection (4 patients unhealed), and 18 (15.0%) patients underwent mild surgical procedures such as sequestrectomy or debridement (1 patient unhealed). Of the 90 radical resection patients, 58 patients underwent radical resections and immediate microvascular flap reconstruction (19 bone flaps and 39 soft flaps), and 32 patients only experience radical resection (5 patients received second-stage reconstruction). According to follow-up information, 55 patients were free of disease.
  
  
  CONCLUSIONS
  Though priority should be given to surgical treatment for the patient whose ORN does not respond to conservative nonoperative treatment, we may as well take into account more individualized regimens based on ORN severity. A hard lesson learned from our article is that the oral maxillofacial surgeon should minimize the trauma for jaws as possible as he can, especially to patients who need to receive postoperative radiotherapy.
authors.affiliation: From the *Department of Oromaxillofacial Head and Neck Oncology, Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai; and †Department of Oral Radiology, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
authors.forename: Tianguo
authors.initials: T
authors.lastname: Dai
authors.forename: Zhuowei
authors.initials: Z
authors.lastname: Tian
authors.forename: Zhonghe
authors.initials: Z
authors.lastname: Wang
authors.forename: Weiliu
authors.initials: W
authors.lastname: Qiu
authors.forename: Zhiyuan
authors.initials: Z
authors.lastname: Zhang
authors.forename: Yue
authors.initials: Y
authors.lastname: He
mesh_terms: D000328:Adult; D000368:Aged; D016025:Bone Transplantation / Q000379:methods; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000601:surgery*; D008439:Maxillary Diseases / Q000601:surgery*; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000532:radiotherapy; D020360:Neoadjuvant Therapy; D010025:Osteoradionecrosis / Q000601:surgery*; D010610:Pharyngeal Neoplasms / Q000532:radiotherapy; D011879:Radiotherapy Dosage; D019651:Plastic Surgery Procedures / Q000379:methods; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000637:transplantation