2021 Volume 33 Issue 3 Pages 91-97
Osteoradionecrosis of the jaw （ORN） is a serious late adverse event after radiation therapy for head and neck cancer. Surgical treatment has been avoided because bone and soft tissue at the irradiation site are strongly damaged. We conducted a clinical study of 20 patients with ORN in our Department （6 maxillas, 13 mandibles, 1 both）. As an initial treatment, conservative therapy was performed in 18 patients （20 jaws） and surgery in 2 patients （2 jaws）. Only one patient （one jaw） was cured by conservative therapy. Surgical method and treatment outcome was examined in 2 patients （2 jaws） undergoing surgery as an initial therapy and 13 patients （15 jaws） undergoing surgery later due to poor progress of conservative therapy. Healing was obtained in all 3 jaws with maxillary bones by removal of sequester. In 12 jaws with mandibular bones, 8 jaws were cured by a single surgery （removal of sequester in one jaw, marginal mandibulectomy in 4 jaws, and segmental mandibulectomy in 3 jaws）, 3 jaws were cured by multiple surgery （2 surgeries in 2 jaws, 4 surgeries in 1 jaw）, and one jaw recurred after the first surgery and re-operation is currently planned. In patients undergoing multiple surgeries, more than segmental mandibulectomy was finally performed in all cases. In these cases, 14 of the 15 jaws that underwent surgery were finally cured. Since the cure rate of conservative therapy is low and the lesions tend to expand during conservative therapy, selecting surgical therapy as the initial treatment in patients who can undergo surgery may be one of the future options.
