Osteoradionecrosis of the mandible: a microradiographic study of cortical bone.

We undertook a microradiographic study in osteoradionecrotic mandibular bone to estimate the number of vascular channels in the compact bone, number of resorption areas, and number of regeneration areas. Normal mandibles had a similar number of vascular channels/vision field compared with compact bone in other parts of the body. Irradiation itself did not significantly alter this number. After osteoradionecrosis had developed in the mandible, the number of vascular channels increased (p = 0.02). Treatment with hyperbaric oxygen further increased the number of vascular channels/vision field (p < 0.003). The normal mandible had no resorptive or regenerative areas, either before or after radiotherapy. The osteoradionecrotic mandible, however, had an increased number of resorptive as well as regenerative areas/vision field. Fluorescence as an indication of incorporation of tetracycline was seen in the regenerative areas of all osteoradionecrotic specimens treated with doxycycline. The process started from the vascular channels, periosteum, and endosteum. We conclude that the compact bone of mandibular osteoradionecrosis has high metabolic activity with active resorption and regeneration of bone and the limitation of the blood supply through cortical vascular channels, seems to be only one of many important factors.