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Osteoradionecrosis
Guided by :
Dr. Krushna pateria,
Dr. Pooja wankhade
Presented by :
Mohammad Naved
Contents :
 Introduction
 Definition
 Etiology
 Clinical features
 Radiographic examination & features
 Differential...
Introduction
 This is inflammatory condition of bone.
 The high doses of radiation used in radiotherapy
reduce drastical...
 It is characterized by presence of exposed bone for a
period of at least 3 months occurring at any time after
delivery o...
Definition
 Osteoradionecrosis refers to an inflammatory
condition of bone (osteomyelitis) that occurs after the
bone has...
Etiology
 Doses above 50 Gy usually are required to cause this
irreversible damage.
 Bone that has been irradiated is hy...
Clinical features
 Mandible is commonly affected than maxilla due to
microanatomy & less vasculature.
 Posterior mandibl...
 Loss of mucosal covering & exposed bone are hallmark
of Osteoradionecrosis.
 Pain may or may not be present with swelli...
Radiographic Features
 CT imaging is modality of choice.
 Early changes in bone: is well defined area of bone
resorption...
 Later changes: lytic or sclerotic or mixture
 Location : Commonly posterior mandible
 Periphery : ill defined
 Intern...
 Effects on surrounding structures : in rare cases
stimulated periosteal bone formation resulting in
bone formation on ou...
EARLY LATER
Differential diagnosis
 Bone resorption stimulated by high level irradiation :
Differentiated by absence of exposed bone....
Management
1. Conservative approach to maintain the integrity of
inferior border of mandible, keeping the site free of
inf...
2. Radical method
 HBO therapy
 Local debridement , sequestrectomy
 Mouth rinsing
3. Hyperbaric O2 therapy : breathing 100 % oxygen
through facemask at 2.4 absolute atmospheric
pressure for 90 minutes 5 d...
Prevention of ORN
 Pre irradiation care :
Extraction of periodontally compromised tooth which
is in direct beam of radiat...
Summary
 Osteoradionecrosis is caused by bone exposed to
irradiation therapy above 50 Gy.
 It is a radiation induced, no...
References
1. White and pharoh
2. Rajiv M borle. Textbook of oral and maxillofacial
surgery. Jaypee. 1st edition 2014.
Thank you
Osteoradionecrosis
Osteoradionecrosis
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ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.

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Osteoradionecrosis

  1. 1. Osteoradionecrosis Guided by : Dr. Krushna pateria, Dr. Pooja wankhade Presented by : Mohammad Naved
  2. 2. Contents :  Introduction  Definition  Etiology  Clinical features  Radiographic examination & features  Differential diagnosis  Management  Prevention
  3. 3. Introduction  This is inflammatory condition of bone.  The high doses of radiation used in radiotherapy reduce drastically the vascularity and reparative powers of bone. The mandible is particularly susceptible.  Subsequent trauma (e.g. tooth extraction) or infection may produce osteomyelitis with rapid destruction of the irradiated bone, sequestra formation and poor healing.
  4. 4.  It is characterized by presence of exposed bone for a period of at least 3 months occurring at any time after delivery of the radiation therapy.
  5. 5. Definition  Osteoradionecrosis refers to an inflammatory condition of bone (osteomyelitis) that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancy of the head and neck region.
  6. 6. Etiology  Doses above 50 Gy usually are required to cause this irreversible damage.  Bone that has been irradiated is hypocellular and hypovascular.  Dental extraction and denture trauma after radiation therapy.
  7. 7. Clinical features  Mandible is commonly affected than maxilla due to microanatomy & less vasculature.  Posterior mandible is commonly affected than anterior portion because of radiation treatment for tumors in this region.
  8. 8.  Loss of mucosal covering & exposed bone are hallmark of Osteoradionecrosis.  Pain may or may not be present with swelling and drainage extraorally..  The exposed bone become necrotic as result of loss of vascularity from periosteum & sequestra.
  9. 9. Radiographic Features  CT imaging is modality of choice.  Early changes in bone: is well defined area of bone resorption within the outer cortical plate of mandible.
  10. 10.  Later changes: lytic or sclerotic or mixture  Location : Commonly posterior mandible  Periphery : ill defined  Internal structure : A range of bone formation and resorption occur. The bone pattern is granular.
  11. 11.  Effects on surrounding structures : in rare cases stimulated periosteal bone formation resulting in bone formation on outer cortex.  In the alveolar processes of maxilla and mandible there is irregular widening of periodontal membrane space.
  12. 12. EARLY LATER
  13. 13. Differential diagnosis  Bone resorption stimulated by high level irradiation : Differentiated by absence of exposed bone.  Chronic osteomyelitis : history of radiation therapy.
  14. 14. Management 1. Conservative approach to maintain the integrity of inferior border of mandible, keeping the site free of infection , and patient free of pain is more successful.  Adminstration of Antibiotics , rinisng  Sequestrectomy, local debridement  Use of narcotic analgesics , hydration, nutrition  Ultrasound therapy can be used.
  15. 15. 2. Radical method  HBO therapy  Local debridement , sequestrectomy  Mouth rinsing
  16. 16. 3. Hyperbaric O2 therapy : breathing 100 % oxygen through facemask at 2.4 absolute atmospheric pressure for 90 minutes 5 days week. HBO reduced the hypoxia and increase healing by increase in arterial and venous O2 tension.
  17. 17. Prevention of ORN  Pre irradiation care : Extraction of periodontally compromised tooth which is in direct beam of radiation.  During therapy : mouth rinse with 0.2 % chlorhexidine.  Post irradiation care : Avoidance of denture use. Use of salivary substitutes.
  18. 18. Summary  Osteoradionecrosis is caused by bone exposed to irradiation therapy above 50 Gy.  It is a radiation induced, non healing, hypoxic wound.  Its prevention and treatment are possible.  HBO therapy , Sequestrectomy are some methods of treatment.
  19. 19. References 1. White and pharoh 2. Rajiv M borle. Textbook of oral and maxillofacial surgery. Jaypee. 1st edition 2014.
  20. 20. Thank you
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ORN is an inflammatory condition of bone that occurs after the bone has been exposed to therapeutic doses of radiation usually given for a malignancies.

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