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Parameters Associated With Mandibular Osteoradionecrosis

Mendenhall, William M., MD*; Suárez, Carlos, MD, PhD†,‡; Genden, Eric M., MD§; de Bree, Remco, MD, PhD; Strojan, Primož, MD, PhD; Langendijk, Johannes A., MD, PhD#; Mäkitie, Antti A., MD, PhD**; Smee, Robert, MB, BS, FRANZ††; Eisbruch, Avraham, MD‡‡; Lee, Anne W.M., MD, FRCR, FHKCR, FHKAM§§; Rinaldo, Alessandra, MD, FRCSEd ad hominem, FRCS (Eng, Ir) ad eundem, FRCSGlasg∥∥; Ferlito, Alfio, MD, DLO, DPath, FRCSEd (Eng, Glasg, Ir) ad eundem, FDSRCS ad eudem, FACS, FHKCORL, FRCPath, FASCP, IFCAP¶¶

American Journal of Clinical Oncology: December 2018 - Volume 41 - Issue 12 - p 1276–1280
doi: 10.1097/COC.0000000000000424
Review Articles

The objective of this review is to discuss factors related to the risk of osteoradionecrosis (ORN) and how to minimize the likelihood of this complication. A PubMed search for publications pertaining to ORN within the last 3 years was conducted revealing 44 publications. The bibliographies of these publications were reviewed to identify additional references spanning a longer time period. The incidence of ORN is 5% to 10% with a median latency period of 1 to 2 years or less. The likelihood of ORN depends on a number of factors including primary site and extent of disease, dental status, treatment modality, radiotherapy (RT) dose, volume of mandible included in the planning target volume, RT fractionation schedule and technique, and teeth extractions. The risk of ORN may be reduced by limiting the RT dose and volume of mandible irradiated without increasing the risk of a local-regional recurrence due to a marginal miss.

*Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL

Health Research Institute of the Principality of Asturias and CIBERONC, ISCIII

University Institute of Oncology of the Principality of Asturias University of Oviedo, Oviedo, Spain

§Department of Otolaryngology–Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, NY

Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht

#Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands

Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia

**Department of Otorhinolaryngology—Head and Neck Surgery,University of Helsinki and Helsinki University Hospital, Helsinki, Finland

††Department of Radiation Oncology, The Prince of Wales Cancer Centre, Sydney, NSW, Australia

‡‡Department of Radiation Oncology, University of Michigan, Ann Arbor, MI

§§Center of Clinical Oncology, University of Hong Kong—Shenzhen Hospital, Shenzhen, China

∥∥Department of Otolaryngology, University of Udine School of Medicine

¶¶International Head and Neck Scientific Group, Udine, Italy

This article was written by members and invitees of the International Head and Neck Scientific Group (

The authors declare no conflicts of interest.

Reprints: William M. Mendenhall, MD, 2000 SW Archer Rd, P.O. Box 100385, Gainesville, FL 32610-0385. E-mail:

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