Management of mandibular osteoradionecrosis corresponding to the severity of osteoradionecrosis and the method of radiotherapy.

PURPOSE: : To demonstrate appropriate treatment methods for mandibular osteoradionecrosis (ORN) by evaluating previous results.

METHODS: : The relationship between the time interval after radiation therapy (RT) and the severity of ORN was examined. Eighty-seven patients were classified according to the extent of the lesion (grades), and the cure rates were calculated according to the RT modality, the grade, and the treatment method for ORN.

RESULTS: : The later ORN developed and the higher the dose of irradiation, particularly among the patients who received external RT, the more it progressed. The initial cure rates for conservative management, marginal, and segmental mandibulectomy were 39.7%, 50%, and 86.7%, respectively.

CONCLUSIONS: : Conservative management should be limited to early-onset ORN after brachytherapy with or without a low dose of external irradiation. Marginal mandibulectomy is appropriate for the late-onset ORN after brachytherapy with or without low-dose external irradiation. Segmental mandibulectomy is required for late-onset ORN after a high dose of external irradiation.