title: Patient and treatment-related risk factors for osteoradionecrosis of the jaw in patients with head and neck cancer.
abstract: OBJECTIVE
  The purpose of this study was to evaluate risk factors for and the incidence of osteoradionecrosis (ORN) of the jaw in patients with head and neck cancer.
  
  
  METHODS
  This study was a retrospective analysis of the risk for ORN and outcome for 149 of 540 patients with head and neck cancer of the oral cavity (65%), oropharynx (26%), or other head and neck sites (9%) treated with radiotherapy between 2004 and 2009. ORN was graded according to Late Effects of Normal Tissues/Somatic Objective Management Analytic Scale (LENT/SOMA) criteria.
  
  
  RESULTS
  Within a median follow-up of 41 months (95% confidence interval: 27.4-54.6), 38 patients (25.5%) had developed ORN, 37 patients (25%) had a local recurrence, and 53 patients (36%) had died. The median time to diagnosis of ORN was 14.5 months (range: 3-80), and 79% were diagnosed within 2 years of RT. Eleven of these patients had undergone previous mandibular surgery. Univariate significant risk factors for ORN were any comorbidity, poor oral hygiene, pre-radiotherapy osteotomy, close tumor-to-bone proximity, post-radiotherapy dentoalveolar surgery (DAS), DAS without sufficient wound closure, alcohol consumption, and denture pressure sores. In multivariate analysis, comorbidities, pre-radiotherapy mandibular surgery, poor oral hygiene, and insufficient DAS remained significant.
  
  
  CONCLUSIONS
  Reducing the risk of ORN calls for maintaining optimal oral hygiene, ensuring good denture fit, receiving proper training in DAS, and helping patients to stop drinking and smoking.
authors.affiliation: Department of Oral and Maxillofacial Surgery, Charité University Medicine, Berlin, Germany.
authors.forename: Jan-Dirk
authors.initials: JD
authors.lastname: Raguse
authors.affiliation: Department of Oral and Maxillofacial Surgery, Charité University Medicine, Berlin, Germany.
authors.forename: Jaber
authors.initials: J
authors.lastname: Hossamo
authors.affiliation: Department of Radiation Oncology and Radiotherapy, Charité University Medicine, Berlin, Germany.
authors.forename: Ingeborg
authors.initials: I
authors.lastname: Tinhofer
authors.affiliation: Department of Oral and Maxillofacial Surgery, Charité University Medicine, Berlin, Germany.
authors.forename: Bodo
authors.initials: B
authors.lastname: Hoffmeister
authors.affiliation: Department of Radiation Oncology and Radiotherapy, Charité University Medicine, Berlin, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Budach
authors.affiliation: Department of Radiation Oncology and Radiotherapy, Charité University Medicine, Berlin, Germany; Praxis für Strahlentherapie, Klinikum Frankfurt Oder, Frankfurt, Germany.
authors.forename: Basil
authors.initials: B
authors.lastname: Jamil
authors.affiliation: Department of Pathology, Charité University Medicine, Berlin, Germany.
authors.forename: Korinna
authors.initials: K
authors.lastname: Jöhrens
authors.affiliation: Department of Radiology, Charité University Medicine, Berlin, Germany.
authors.forename: Nadine
authors.initials: N
authors.lastname: Thieme
authors.affiliation: Department of Oral and Maxillofacial Surgery, Charité University Medicine, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Doll
authors.affiliation: Department of Oral and Maxillofacial Surgery, Charité University Medicine, Berlin, Germany.
authors.forename: Susanne
authors.initials: S
authors.lastname: Nahles
authors.affiliation: Department of Oral and Maxillofacial Surgery, Charité University Medicine, Berlin, Germany.
authors.forename: Stefan T
authors.initials: ST
authors.lastname: Hartwig
authors.affiliation: Department of Radiation Oncology and Radiotherapy, Charité University Medicine, Berlin, Germany. Electronic address: Carmen.stromberger@charite.de.
authors.forename: Carmen
authors.initials: C
authors.lastname: Stromberger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005858:Germany; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D015994:Incidence; D007571:Jaw Diseases / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010025:Osteoradionecrosis / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery*; D012307:Risk Factors; D016896:Treatment Outcome