Clinico-therapeutic management of osteoradionecrosis: a literature review and update.

In the management of head and neck cancer, radiotherapy is usually a coadjuvant to surgery, or is applied on a palliative basis. The most important complication of such radiotherapy is osteoradionecrosis, which manifests as an area of exposed necrotic bone in the maxillae or mandible that fails to heal during at least three months. In most cases osteoradionecrosis gradually progresses, becoming more extensive and painful, and its late manifestations comprise infection and pathological fracture. The present study provides a literature review and update on the risk factors underlying osteoradionecrosis, its clinical and diagnostic particulars, prevention, and most widely accepted treatment options, as well as new possibilities relating to clinical management of the disorder. Lastly, a new early management protocol is proposed based on the current consensus criteria relating to maxillary osteonecrosis secondary to treatment with bisphosphonates, together with the adoption of new therapies supported by increased levels of evidence.