Osteoradionecrosis of the Mandible Workup

  • Author: Remy H Blanchaert, Jr, DDS, MD; Chief Editor: Arlen D Meyers, MD, MBA   more...
 
Updated: Jun 15, 2010
 

Laboratory Studies

  • Rule out recurrence or second primary malignancy through biopsy where indicated.
  • Obtain the radiation oncology treatment summary to determine the method of treatment, total dose, and radiation portal.
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Imaging Studies

  • Plain radiography of the mandible, or Panorex, depicts areas of local decalcification, osteolysis (see the images below) or sclerosis. An absence of healing is evident in this radiograpAn absence of healing is evident in this radiograph following extraction of a tooth within a field of radiation therapy. Osteoradionecrosis developed in the patient seen iOsteoradionecrosis developed in the patient seen in the image above. Osteolysis is clearly evident. Pathologic fracture has developed in this case of Pathologic fracture has developed in this case of osteoradionecrosis (ORN). This constitutes, by definition, stage III disease. This is the same patient seen in the 2 images above.
  • CT scanning and MRI may allow early diagnosis of osteoradionecrosis (ORN) and better delineate the extent of disease.
    • MRI depicts ORN with reduced bone marrow signal intensity on T1-weighted images and increased signal intensity on T2-weighted images.
    • Absence of marrow signal on MRI can be used to identify significant radiation injury in the mandible. This abnormal bone must be excised in the definitive treatment.
    • Panoramic radiography and CT scan images can be used to determine sites of significant bone injury. Alteration in trabeculation, cortical thinning, and sclerosis are common findings in sites of injury.
  • Single-photon emission computed tomography (SPECT) imaging may have a role in the future as more experience is gained with this modality.
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Contributor Information and Disclosures
Author

Remy H Blanchaert, Jr, DDS, MD  Consulting Staff, Wesley Medical Center

Remy H Blanchaert, Jr, DDS, MD is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons, American Dental Association, and American Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

Christopher M Harris, MD, DMD  Residency Program Director, Department of Oral and Maxillofacial Surgery, Maxillofacial Tumor and Reconstruction, Naval Medical Center Portsmouth

Christopher M Harris, MD, DMD is a member of the following medical societies: American Association of Oral and Maxillofacial Surgeons and American Dental Association

Disclosure: Nothing to disclose.

Specialty Editor Board

William M Lydiatt, MD  Professor and Division Director, Head and Neck Surgical Oncology, Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center

William M Lydiatt, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, American Head and Neck Society, and Nebraska Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Nader Sadeghi, MD, FRCS(C)  Professor of Surgery, Director of Head and Neck Surgery, George Washington University School of Medicine and Health Sciences

Nader Sadeghi, MD, FRCS(C) is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Head and Neck Society, Federation of Medical Specialists in Quebec, and Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Christopher L Slack, MD  Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders

Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association

Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA  Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine

Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society

Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo Consulting; Medvoy Ownership interest Management position; Cerescan Imaging Honoraria Consulting; GYRUS ACMI Honoraria Consulting

References

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This patient developed osteoradionecrosis (ORN) following radical radiotherapy. His primary tumor was located in the floor of mouth. An orocutaneous fistula is demonstrated here. A pathologic fracture was evident on examination. Biopsies were negative for carcinoma.
This is the panoramic radiograph of the patient seen in the image above. Bone necrosis and pathologic fracture are evident.
This patient developed ORN following tooth extractions. Sequential debridement was attempted prior to patient referral.
The patient seen in the image above developed a pathologic fracture at the mandibular angle. He underwent resection of the area of the fracture. At the time of surgery, surgeons thought the patient had bleeding bone, but further ORN is evident.
An absence of healing is evident in this radiograph following extraction of a tooth within a field of radiation therapy.
Osteoradionecrosis developed in the patient seen in the image above. Osteolysis is clearly evident.
Pathologic fracture has developed in this case of osteoradionecrosis (ORN). This constitutes, by definition, stage III disease. This is the same patient seen in the 2 images above.
 
 
 
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