title: Current Concepts in Osteoradionecrosis after Head and Neck Radiotherapy.
abstract: Osteoradionecrosis (ORN) of the jaws is a feared complication of head and neck radiotherapy. ORN causes significant morbidity for patients and controversy among clinicians. This overview considers the variations in definition and classification of the condition that affect estimates of incidence and also the interpretation of evidence. The influence of newer radiotherapy techniques in reducing ORN through reduced dose and xerostomia is balanced against a probable increase in a vulnerable population through a rising head and neck cancer incidence. Theories of pathophysiology of ORN include radiation-induced osteomyelitis, hypoxic and hypovascular theory and fibroatrophic theory. Prevention strategies include restorative dentistry and radiation planning techniques. Treatments range from conservative 'watch and wait' through to more radical surgical strategies. Newer medical management strategies are available with a limited evidence base. The use of hyperbaric oxygen therapy remains controversial and the background and need for newer hyperbaric oxygen trials is discussed.
authors.affiliation: Department of Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, UK. Electronic address: jagdhanda@me.com.
authors.forename: J
authors.initials: J
authors.lastname: Dhanda
authors.affiliation: Academic Department of Radiation Oncology, Centre O. Lambret, Lille, CRIStAL UMR CNRS 9189, France.
authors.forename: D
authors.initials: D
authors.lastname: Pasquier
authors.affiliation: Department of Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, UK.
authors.forename: L
authors.initials: L
authors.lastname: Newman
authors.affiliation: Department of Molecular and Clinical Cancer Medicine, North West Cancer Research Centre, The University of Liverpool Cancer Research Centre, Liverpool, UK.
authors.forename: R
authors.initials: R
authors.lastname: Shaw
mesh_terms: D006258:Head and Neck Neoplasms / Q000150:complications*; D006801:Humans; D006931:Hyperbaric Oxygenation; D010025:Osteoradionecrosis / Q000209:etiology* / Q000517:prevention & control
keywords: Classification; definition; osteoradionecrosis; pathophysiology; treatment