Risk factors and treatment outcomes in osteoradionecrosis in head and neck cancer patients: a retrospective analysis

Objectives: Osteoradionecrosis of the jaw (ORNJ) is a serious late complication in patients with head and neck cancer who have undergone radiation therapy. This study aimed to identify clinical and treatment-related risk factors associated with the development of ORNJ and to evaluate the therapeutic outcomes across various treatment modalities. Materials and Methods: A retrospective analysis was performed on 80 patients diagnosed with ORNJ following radiotherapy (RT) for head and neck malignancies. Patient demographics, oncologic characteristics, and treatment histories were reviewed. Clinical outcomes of conservative therapy, sequestrectomy, and partial mandibulectomy were assessed. Ordinal logistic regression analysis was conducted to determine associations between treatment modality and disease course (improved, stable, or progressed). Results: Most ORNJ cases developed spontaneously within 48 months post-RT. Surgical intervention was performed in 73.8% of patients, with sequestrectomy being the most frequently applied procedure. Overall outcomes were classified as improved in 26.3%, stable in 37.5%, and progressed in 36.3% of cases. Ordinal logistic regression revealed that conservative treatment (odds ratio [OR]=4.64, P=0.041) and sequestrectomy (OR=4.92, P=0.022) were significantly associated with poorer outcomes compared to partial mandibulectomy. This association remained significant in Stage III ORNJ, whereas no statistically significant differences were observed in Stages I and II, although trends varied depending on treatment type. Conclusion: This study underscores the prognostic relevance of treatment modality in ORNJ management. Partial mandibulectomy appears to confer more favorable outcomes in advanced-stage ORNJ, although its invasive nature necessitates individualized treatment planning. Future prospective studies incorporating dosimetric parameters and long-term follow-up are warranted to establish evidence-based guidelines for ORNJ treatment.