Surgical treatment of osteoradionecrosis of the jaw following radiotherapy for oropharyngeal cancer: A retrospective clinical analysis in a single-center

Abstract

Background/purpose Osteoradionecrosis of the jaw (ORNJ) is an intractable disease that develops within the radiation field in patients with head and neck cancer. This study aimed to investigate differences in healing rates among surgical treatments for mandibular ORN that developed after radiotherapy for oropharyngeal cancer. Materials and methods We retrospectively evaluated 318 patients who underwent radiotherapy or chemoradiotherapy for oropharyngeal cancer at our institution to determine the incidence of ORNJ. Furthermore, 16 patients (15 males and 1 female) with a mean age of 63.3 years were included in the surgical analysis. Healing was defined as the absence of symptom recurrence for 3 months after surgery. Various factors, including age, sex, use of hyperbaric oxygen therapy, type of surgical treatment, smoking history, alcohol consumption, and nutritional status, were investigated. Results Among the 318 patients, 36 developed ORNJ, resulting in an incidence rate of 11.3%. Among the 16 surgically treated patients, primary treatments included sequestrectomy in 8 cases, mandibular marginal resection in 1 case, and segmental resection in 7 cases. The overall healing rate was 50.0% (8/16). Of the 16 cases, 8 required secondary treatment. Most cases initially treated with sequestrectomy required secondary treatment, whereas segmental resection achieved the highest healing rate. Conclusion For refractory ORNJ, segmental resection with a vascularized free flap may provide reliable healing by removing necrotic tissue and restoring local blood supply to the ischemic area.