A Case of Pernicious Complication of Radiotherapy: Osteoradionecrosis of Mandible with Extensive Bilateral Involvement Following Dental Extraction

Osteoradionecrosis (ORN) is a condition of bone necrosis following mucosal breakdown after radiotherapy. It can lead to significant reduction in quality of life. ORN, particularly in the mandible, is a severe long-term complication of radiotherapy for head and neck cancer. ORN causes ulceration of oral mucosa with exposure of necrotic bone, pain, trismus and suppuration leading to chronic infection and non-healing wounds. Radiation-induced fibrosis, chronic infection, fistulae and necrotic tissues make the treatment challenging. We report a case of mandibular ORN in a 50-year-old female following dental extraction. Devitalised alveolar bone of the mandible was exposed intraorally through ulcerated mucosa from body-to-body region with multiple cutaneous fistulae. The necrosed bone was surgically debrided and healing was uneventful at the time of discharge. The patient was referred for Hyperbaric Oxygen Therapy (HBOT) for further management. Prevention of ORN is important for proper management of patients who undergo radiation therapy to head and neck region.