Question:  In a patient with osteoradionecrosis, what medical management options have been shown to be of some benefit? [Answer will be posted with next week's new question]

Answer to last week's question, Bad To The Bone (August 31, 2015): 

There are many classification systems.  These are some of the more commonly referenced.  The case patient's stage is indicated in bold for each of the systems below:

Marx Classification (1983):

• Type I: Develops shortly after radiation, due to synergistic effects of surgical trauma and radiation injury.
• Type II: Develops years after radiation and follows a trauma.  Generally >6 years after radiation.  Due to progressive endarteritis and vascular effusion.
• Type III: Develops spontaneously without a preceding traumatic event.  Usually between 6 months and 3 years after radiation. Due to immediate cellular damage and death due to radiation treatment.

Epstein Classification (1987)

• Stage I: Resolved/healed ORN.  A) No pathologic fracture.  B) Pathologic fracture
• Stage II: Chronic persistent and non-progressive ORN. A) No pathologic fracture, B) Pathologic fracture
• Stage III: Active progressive ORN: A) No pathologic fracture.  B) Pathologic fracture.

Yamazaki Classification (2003)

• Grade I: ORN confined to the alveolar bone.
• Grade II: ORN limited to the alveolar bone and/or mandible above the level of the inferior alveolar canal.
• Grade III: ORN involving the mandible below the level of the inferior alveolar canal and ORN with a skin fistula and/or pathologic fracture.