Clinical presentation and risk factors of osteoradionecrosis

Introduction: Osteoradionecrosis (ORN) of the jaws is defined as
exposed irradiated bone that fails to heal over a period of 3
months without the evidence of a persisting or recurrent tumor. In
the previous decades, numerous factors were associated with the
risk of ORN development and severity. Aims: The purposes of this
study were to present the data of the patients that were treated
for ORN in the Department of Oral and Maxillofacial Surgery in
Munich (LMU), to detect factors that contributed to the onset of
ORN, to identify risk factors associated with the severity of ORN
and finally, to delineate and correlate these factors with the
personal, health and treatment characteristics of the patients.
Material and Methods: A retrospective study was conducted during
the period from January 2003 until December 2012 that included all
ORN cases having been treated in the Department of Oral and
Maxillofacial Surgery in Munich (LMU). The total sample was
categorized in three groups according to stage and several
variables were evaluated in an attempt to identify possible
correlations between them and the necrosis severity. Results: One
hundred and fifty three cases of ORN were documented. Among them,
23 (15.1%) cases were stage I, 31 (20.2%) were stage II and 99
(64.7%) were stage III and all localised in the mandible. There was
a predominance of the disease in the posterior region when compared
to the anterior region. The majority of cases was addicted to
alcohol and tobacco abuse and was suffering from Diabetes Mellitus
(DM). All cases were treated with RT and 80.4% of them with
concomitant chemotherapy. The initial tumor was predominantly
located in the floor of the mouth, the tongue and the pharynx.
Αpproximately two thirds of the cases occured either after dental
treatment or due to a local pathological condition. Logistic
regression analysis identified Diabetes Mellitus (OR: 4.955, 95%
Cl: 1.965-12.495), active smoking (OR: 13.542, 95% Cl:
2.085-87.947), excessive alcohol consumption (OR: 5.428, 95% Cl:
1.622-18.171) and dental treatment/ local pathological condition
(OR: 0.237, 95% Cl: 0.086-0.655) as significant predictors for
stage III necrosis. Tumor size (T) (p