Osteoradionecrosis of the maxillofacial region: contemporary treatment after radiotherapy (a literature review)

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Abstract

Introduction. Osteoradionecrosis (ORN), a severe and potentially deadly bone complication arising from radiation therapy in the head and neck region, is defined by exposed, irradiated bone that fails to alleviate within three months, with no signs of remaining tumor or cancer recurrence. Research into more effective, less invasive, and safer treatments for ORN is of great importance, highlighting the need for Maxillofacial surgeons and oncologists to carefully select the most suitable treatment plan based on the disease’s advancement. Considering the central role of the RANKL-RANK system in the remodelling and resorbing processes of the bone, new therapies with denosumab and bisphosphonate have been used recently with promising results.

Aim. To evaluate modern conservative and surgical methods in treatment of ORN in the maxillofacial region, based on literature review.

Materials and methods. This study employed a retrospective review of articles and publications from 2018 to 2024, utilizing databases such as Google Scholar, PubMed, Springer Link, and Science Direct. A comprehensive search, utilizing the keywords such as: “jaw osteoradionecrosis”, “head and neck cancer”, “radiotherapy”, “denosumab”, “bisphosphonates”, yielded 318 articles. These articles were then meticulously screened based on their conclusions, and those deemed irrelevant to the research topic were excluded such as experiments conducted on non-human subjects, as well as treatments with unfavourable prognoses and recovery rates. Following a comprehensive analysis of the remaining publications, 47 articles were selected for inclusion in this review.

Conclusion. The management of ORN is dependent on the severity and progression stage of the condition. Early stages of ORN have demonstrated responsiveness to treatments such as PENTOCLO and ozone therapy. In contrast, stages II and III of ORN require more invasive surgical approaches. The integration of surgical methods with non-invasive therapies has been associated with enhanced patient outcomes.

About the authors

A. B. Dymnikov

RUDN Universtiy

Email: ant.sharapo@yandex.ru
ORCID iD: 0000-0001-8980-6235
Russian Federation, 6 Miklukho-Maklaya St., Moscow 117198

I. A. Zaderenko

RUDN Universtiy

Email: ant.sharapo@yandex.ru
ORCID iD: 0000-0003-0183-4827
Russian Federation, 6 Miklukho-Maklaya St., Moscow 117198

B. C. Mabhurasi

RUDN Universtiy

Email: ant.sharapo@yandex.ru
ORCID iD: 0009-0002-5694-8493
Russian Federation, 6 Miklukho-Maklaya St., Moscow 117198

H. Alsayed Hachem

RUDN Universtiy

Email: ant.sharapo@yandex.ru
ORCID iD: 0009-0006-3364-1287
Russian Federation, 6 Miklukho-Maklaya St., Moscow 117198

A. S. Sharapo

RUDN Universtiy

Author for correspondence.
Email: ant.sharapo@yandex.ru
ORCID iD: 0000-0002-3963-505X
Russian Federation, 6 Miklukho-Maklaya St., Moscow 117198

C. Manenji

RUDN Universtiy

Email: ant.sharapo@yandex.ru
ORCID iD: 0009-0000-1927-2098
Russian Federation, 6 Miklukho-Maklaya St., Moscow 117198

S. Dagher

RUDN Universtiy

Email: ant.sharapo@yandex.ru
ORCID iD: 0009-0004-1950-4011
Russian Federation, 6 Miklukho-Maklaya St., Moscow 117198

S. Yu. Ivanov

RUDN Universtiy

Email: ant.sharapo@yandex.ru
ORCID iD: 0000-0001-5458-0192
Russian Federation, 6 Miklukho-Maklaya St., Moscow 117198

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Copyright (c) 2026 Dymnikov A.B., Zaderenko I.A., Mabhurasi B.C., Alsayed Hachem H., Sharapo A.S., Manenji C., Dagher S., Ivanov S.Y.

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