Clinical and radiographic characteristics and treatment outcomes of jaw osteoradionecrosis after radiotherapy for head and neck cancer
Abstract
Background: Jaw osteoradionecrosis (ORN) is a serious late complication in patients with head and neck cancer after radiotherapy, with a reported incidence of approximately 5–15%. It is characterized by devitalized irradiated jawbone exposed through the oral or cutaneous mucosa, persisting without healing and not attributable to tumour recurrence. ORN occurs predominantly in the mandible and is associated with chronic pain, infection, trismus and markedly impaired quality of life.
Methods: A prospective descriptive clinical interventional study of 25 patients diagnosed with jaw ORN and treated at the Center of Odonto-Stomatology, Hue Central Hospital, from September 2023 to September 2025. All patients had a history of radiotherapy for head and neck cancer and fulfilled the clinical diagnostic criteria for jaw ORN (exposed, necrotic jawbone within a previously irradiated field persisting for more than 3 months, with no evidence of tumour recurrence). Clinical data, imaging findings, treatment modalities and short-term outcomes were collected and analysed.
Results: The mean patient age was 58 years, and 72% were male; nasopharyngeal carcinoma was the most common primary tumour. Most cases were diagnosed at an advanced stage of radiation-induced jaw osteoradionecrosis, predominantly involving the mandible, with the majority presenting with pain, mucosal ulceration, bone exposure and fistula formation. Radiographically, all patients showed irregular, moth-eaten bone destruction. All were treated surgically; at 6-month follow-up, treatment outcomes were classified as good in 28%, fair in 64% and poor in 8% of patients, and 28% required reoperation.
Conclusions: Jaw osteoradionecrosis after radiotherapy occurs predominantly in the mandible, with typical clinical features and a chronic, progressive course. Surgical removal of necrotic bone is the mainstay of treatment and can achieve favourable outcomes in most patients when the condition is recognized and managed early. Attention to adverse prognostic factors—such as outdated radiotherapy techniques, poor oral hygiene and long-standing disease—is essential for planning prevention and more aggressive treatment strategies to reduce recurrence.
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References
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