Classification of craniofacial osteoradionecrosis: the addition of “end stage disease”

Craniofacial osteoradionecrosis (ORN) is a late complication of radiotherapy that has been used to treat cancer of the head and neck. Traditionally, mandibular ORN refers to radiotherapy-related necrosis of the mandible and subsequent exposure of the bone for at least three months, in the absence of recurrence.1 There is increasing evidence of long-term tissue damage from chemoradiation,2,3 and while most cases are diagnosed between one and two years after radiotherapy, the risk is lifelong.2 Caparrotti et al recently reported that the actuarial rate of ORN of the mandible was 3% at one year, 5% at three years, and 7% at five years (in 1196 patients who had curative radiotherapy for squamous cell carcinoma of the oropharynx, with or without concomitant systemic treatment, from January 2005 to December 2014).

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