Surgical Factors and Progression of Osteoradionecrosis of Mandible: An Institutional Experience and Recommendations

The severe complication in oral cancer patients receiving radiation therapy is osteoradionecrosis. The reported incidence of ORN is highly variable, ranging from 0 to 37.5%. Diverse treatment protocols underscore the complexity of managing ORN. This study aims to address the surgical factors and their association with the formation of ORN in patients with oral squamous cell carcinoma undergoing surgery. Data of 17 patients who received definitive surgery and post-operative adjuvant radiotherapy (using the 3D CRT technique alone) to the head and neck from January 2016 to December 2023 presented with post-operative changes, which shows clinical evidence of ORN confirmed by radiographic investigations collected. Among 17 patients, 10 patients (58.8%) had posterior segmental mandibulectomy and seven patients (41.1%) had undergone marginal mandibulectomy with coronoidectomy respectively. Only two patients (11.7%) had regional flap reconstruction using PMMC flap, and for one patient (5.8%), surgical defect closed primarily; the remaining 14 (82.3%) patients underwent free flap reconstruction. Among free flaps, six patients (35.2%) had fibula and seven patients had radial forearm (41.1%) reconstruction. Only one patient (5.8%) underwent reconstruction using an anterolateral thigh flap. Along with consideration of radiation dose, dental extraction, oral hygiene, etc. do anticipate ORN and contemplate surgical risk factors during surgical planning in the management of head and neck cancer.