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Superimposed Infection in Mandibular Osteoradionecrosis: Diagnosis and Outcomes

Hamilton, Jackson D. MD; Lai, Stephen Y. MD, PhD; Ginsberg, Lawrence E. MD

Journal of Computer Assisted Tomography: November/December 2012 - Volume 36 - Issue 6 - p 725–731
doi: 10.1097/RCT.0b013e3182702f09

Background Radiation therapy can result in osteoradionecrosis (ORN) and mucosal ulceration predisposing to infection.

Methods Fourteen patients presenting with infectious sequelae related to mandibular ORN were retrospectively reviewed.

Results In most patients, infection followed diagnosis of ORN; but in 4 patients, ORN was not diagnosed until after the time of infection and imaging. An early imaging finding of ORN was lingual cortical defects near the last molar. Pain followed by erythema, purulent drainage, and subperiosteal abscess by imaging were the most common signs of infection. In most patients, conservative management eventually failed and segmental mandibulectomies were required.

Conclusions Soft tissue infection with characteristic bone findings such as subperiosteal abscess and cortical bone erosions helps to distinguish infected ORN from recurrent tumor or sterile ORN. In patients previously treated with radiation who present with infection, pain or an avid PET scan with bone involvement, the mandible should be scrutinized.

From the University of Texas MD Anderson Cancer Center, Houston, TX.

Received for publication July 16, 2012; accepted August 21, 2012.

Reprints: Jackson D. Hamilton, MD, Department of Diagnostic Radiology, Unit 1482, The University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030 (e-mail:

This work was funded by MD Anderson Core Grant CA16672.

This work was presented at the 44th annual meeting of the American Society of Head and Neck Radiology, San Diego, California, September 8–11, 2011.

The authors have no financial interests to disclose.

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.