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Osteoradionecrosis: New concepts and a proposed classification


This summary is based on the article published in the British Journal of Oral and Maxillofacial Surgery: Osteoradionecrosis—A review of current concepts in defining the extent of the disease and a new classification proposal (May 2014)

Andrew Lyons, Jona Osher, Elinor Warner, Ravi Kumar, Peter A. Brennan


Osteoradionecrosis (ORN) is potentially a debilitating and serious consequence of radiotherapy to the head and neck. Although it is oftendefined as an area of exposed bone that does not heal, it can also exist without breaching the mucosa or the skin.

Currently, 3 classifica-tions of ORN are in use, but they depend on the use of hyperbaric oxygen or are too complicated to be used as a simple aide-mémoire,and include features that do not necessarily influence its clinical management.

Purpose of the Review

To propose a new classification to cover these shortcomings and to take into account the increasingly widespread use of antifibrotic medical treatment.

Key Messages

Classification of Osteoradionecrosis

Osteoradionecrosis Table

  • Outcomes of the review show that ORN was stable in patients with early stage disease and it did not progress to higher stages during follow-up periods of at least 3 months.
  • Still, it is not possible to categorically state that early stage disease will notprogress during a patient’s lifetime, but the proportion wouldbe very small.
  • The same is not true of stage 3 disease, whichin a few patients progressed to stage 4. Most of those withstage 4 disease required and consented to serious operationswith reconstruction.
  • It is not known whether the medication stopped thecondition progressing in the earlier stages. ORN may heal,regress, and stabilise spontaneously, and it is remarkablehow few patients in other series have required reconstructivesurgery for disease that has progressed.
  • In conclusion, although ORN is a heterogeneous condi-tion, the simple 4-stage classification seems to be validatedby the cases presented in this series and by the treatmentreported by other authors. While it cannot be used in everycase, in most it is considered it to be a helpful aid to managementand the collection of data.


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