Clinical symptoms include the following:
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Pain
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Swelling
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Trismus
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Exposed bone
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Pathologic fracture
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Malocclusion
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Oral cutaneous fistula formation
On physical examination, missing hair follicles, surface texture changes, and color changes are common findings that assist clinicians in assessment of the area of radiation injury.
In a histologic study of irradiated osteoradionecrotic mandibles, several characteristic changes were noted. The inferior alveolar artery (the predominant arterial blood supply to the body of the mandible) and periosteal arteries had significant intimal fibrosis and thrombosis. Normal marrow was replaced by dense fibrous tissue with loss of osteocytes. Finally, the study noted buccal cortical necrosis with sequestrum formation and periosteal fibrosis with a tendency to detach from the cortex.[4] In the elderly, the inferior alveolar artery’s flow to the mandible diminishes and the periosteum and muscle attachments predominate as the primary blood supply. The thrombosis of the inferior alveolar artery and surgical disruption of this soft tissue blood supply may contribute to the development of osteoradionecrosis (ORN)
