Surgical management of refractory osteoradionecrosis
Reviewed by Stuart Clark

This is a French single-centre, 10-year experience of 55 surgical resection and reconstruction procedures. They claim an overall effectiveness rate of 92.3%. A total of 36 segmental and 19 marginal mandibulectomies were performed. A variety of free flaps were used, with soft tissue only used in 16 of the 55 cases. Complication rate was 51% with three instances of mortality and seven of total flap necrosis. They considered their approach of early surgical treatment of refractory osteoradionecrosis as justified by the progressive nature of the condition and the risk of underlying neoplastic lesions, the aim being to restore function or maintain bone integrity. They consider it important to determine whether osteolysis is above or below the alveolar canal. They outline that since 15% of the long-term complications related to poor tolerance of osteosynthesis, material integrity was a significant consideration. They concluded that revascularisation is the only therapy of proven efficiency in advanced or refractory osteoradionecrosis despite its technical difficulties and high complication rate.

The value of reconstructive surgery in the management of refractory jaw osteoradionecrosis: a single-center 10-year experience.
Bettoni J, Olivetto M, Duisit J, et al.
INTERNATIONAL JOURNAL OF ORAL & MAXILLOFACIAL SURGERY
2019;48(11):1398-404.