Surgical predictors of osteoradionecrosis in irradiated head and neck cancer patients: Jaw resection increases risk whereas neck dissection does not - 02/10/25

Doi : 10.1016/j.jormas.2025.102538

Julius Hirsch ^a,^b, Inga Krause ^a, Chatpong Tangmanee ^c, Hilke Vorwerk ^d, Boris Stuck ^e, Poramate Pitak-Arnnop ^f,^g,^{^{†
Equal contribution.},}^{^{‡
Given her role as Editorial Board Member, Poramate Pitak-Arnnop had no involvement in the peer-review of this article and has no access to information regarding its peer-review. Full responsibility for the editorial process for this article was delegated to another journal editor},}^⁎ , Andreas Neff ^a,^{^{†
Equal contribution.},}^⁎
^a Department of Oral and Craniomaxillofacial Plastic Surgery, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
^b Oral and Maxillofacial Surgery Private Practice “Dr. Hirsch & Söhne”, Ulm, Germany
^c Department of Statistics, Chulalongkorn University Business School, Bangkok, Thailand
^d Department of Radiation Therapy and Oncology, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
^e Department of Otolaryngology, Head and Neck Surgery, Phonetics, and Paediatric Audiology, UKGM GmbH, University Hospital Marburg, Faculty of Medicine, Philipps-University of Marburg, Marburg, Germany
^f Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, Bayreuth Medical Centre, Faculty of Medicine, Campus Oberfranken, Friedrich-Alexander University of Erlangen-Nuremberg, Bayreuth, Germany
^g Department of Oral, Craniomaxillofacial and Plastic Surgery, Brandenburg Medical School, Brandenburg an der Havel, Germany

^⁎Corresponding author at: Klinik für Plastische, Rekonstruktive, Ästhetische und Handchirurgie, Klinikum Bayreuth, Medizincampus Oberfranken, Preuschwitzer Straße 101, 95445 Bayreuth, Germany.Klinik für PlastischeRekonstruktiveÄsthetische und HandchirurgieKlinikum BayreuthMedizincampus OberfrankenPreuschwitzer Straße 101Bayreuth95445Germany^⁎⁎Corresponding author at: Klinik und Poliklinik für Mund-, Kiefer- und Plastische Gesichtschirurgie, UKGM GmbH, Universitätsklinikum Marburg, Baldingerstraße, 35043 Marburg, Germany,Klinik und Poliklinik für Mund-, Kiefer- und Plastische GesichtschirurgieUKGM GmbH, Universitätsklinikum MarburgBaldingerstraßeMarburg35043Germany

Abstract

Introduction

This study investigated the impact of jaw resection (JR) and neck dissection (ND) on the incidence of jaw osteoradionecrosis (JORN) in patients with head and neck cancer (HNC) who underwent head and neck radiotherapy (HNR) involving the jawbone with/without ablative surgery. Evidence on this association remains scarce.

Materials and methods

This retrospective study examined irradiated HNC patients treated at a German university hospital between 2007 and 2022, with follow-up until December 2024. The predictor variables were JR and ND, with JORN as the main outcome. Appropriate statistics were computed with a significance level of P ≤ 0.005.

Results

Of 510 subjects (22.9 % female; mean age 61.8 ± 11.1 years [range, 14-92]), 14.7 % developed JORN. JR and ND significantly increased JORN occurrence (P < 0.0001; odds ratio [OR], 3.67 [95 % confidence interval [CI], 2.02-6.65]; number needed to harm [NNH], 7.05; post hoc power, 99.7 %). After adjusting for confounders, only JR remained an independent predictor for JORN (OR, 1.16 [95 % CI, 1.08-1.24]; P = 0.0005; Pearson’s r for JR = 0.18; Pearson’s r for ND = 0.17). JORN rates rose from 6.7 % with HNR alone to 16.5-42.9 % with additional JR and/or ND.

Conclusions

JR increases the likelihood of JORN by up to 16 % compared with HNR alone. Approximately one in seven irradiated HNC patients with ablative surgery develops JORN (NNH, 7.05). Increasing the extent of JR and/or ND does not meaningfully affect the risk of JORN (Pearson’s r < 0.3).

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Keywords : Jaw disease, Osteoradionecrosis, Surgery

Abbreviations : HNC, HNR, IMRT, JORN, JR, ND, NNH, OCMFPS, OR, SRMA, STROBE, 95 % CI

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Vol 127 - N° 1

Article 102538- février 2026 Retour au numéro

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Surgical predictors of osteoradionecrosis in irradiated head and neck cancer patients: Jaw resection increases risk whereas neck dissection does not - 02/10/25

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