{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T10:08:23Z","timestamp":1791972503858,"version":"4.3.4"},"reference-count":94,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T00:00:00Z","timestamp":1727395200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["aao-hnsfjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Otolaryngol.--head neck surg."],"published-print":{"date-parts":[[2025,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Mandibular osteoradionecrosis (MORN) is a morbid complication of head and neck radiation therapy. Recent advances in surgical and medical therapies underscore the need for a shift in traditional treatment paradigms and a disease grading system that can guide appropriate management.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources<\/jats:title><jats:p>Pubmed\/MEDLINE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Review Methods<\/jats:title><jats:p>We conducted a detailed review of publications related to MORN, specifically focusing on its staging and management techniques. Articles meeting inclusion criteria were synthesized into a final narrative review.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>There has been a paradigm shift away from hyperbaric oxygen therapy in the management of MORN. Growing evidence for the efficacy of pentoxifylline and tocopherol in early\u2010stage disease and novel surgical techniques to manage moderate and late\u2010stage disease warrant an updated staging stratification which is proposed.<\/jats:p><\/jats:sec><jats:sec><jats:title>Implications for Practice<\/jats:title><jats:p>This review summarizes the clinical efficacy of established and novel therapeutic modalities currently available in treating MORN, emphasizing the significant advances achieved over the last decade. It introduces a contemporary staging and treatment algorithm which incorporates traditional, evidence\u2010supported surgical and medical management with effective early intervention strategies.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ohn.990","type":"journal-article","created":{"date-parts":[[2024,9,27]],"date-time":"2024-09-27T03:03:44Z","timestamp":1727406224000},"page":"406-418","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Managing Mandibular Osteoradionecrosis"],"prefix":"10.1002","volume":"172","author":[{"given":"Michael A.","family":"Fritz","sequence":"first","affiliation":[{"name":"Division of Facial Plastic and Microvascular Surgery, Head and Neck Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4336-1776","authenticated-orcid":false,"given":"Khashayar","family":"Arianpour","sequence":"additional","affiliation":[{"name":"Division of Facial Plastic and Microvascular Surgery, Head and Neck Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara W.","family":"Liu","sequence":"additional","affiliation":[{"name":"Division of Facial Plastic and Microvascular Surgery, Head and Neck Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric D.","family":"Lamarre","sequence":"additional","affiliation":[{"name":"Division of Facial Plastic and Microvascular Surgery, Head and Neck Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dane J.","family":"Genther","sequence":"additional","affiliation":[{"name":"Division of Facial Plastic and Microvascular Surgery, Head and Neck Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter J.","family":"Ciolek","sequence":"additional","affiliation":[{"name":"Division of Facial Plastic and Microvascular Surgery, Head and Neck Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrick J.","family":"Byrne","sequence":"additional","affiliation":[{"name":"Division of Facial Plastic and Microvascular Surgery, Head and Neck Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon L.","family":"Prendes","sequence":"additional","affiliation":[{"name":"Division of Facial Plastic and Microvascular Surgery, Head and Neck Institute Cleveland Clinic Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,9,27]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.27024"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2019.07.006"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.29709"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.30315"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2023.1089"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/idj.12318"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2010.03.017"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.moo.0000170527.59017.ff"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/0278-2391(83)90294-X"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10006-009-0198-9"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2004.08.021"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2004.06.010"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.3389\/froh.2022.980786"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clon.2016.03.002"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2015.07.008"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1259\/0007-1285-56-671-851"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/0266-4356(86)90018-5"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/0278-2391(87)90399-5"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/0167-8140(95)01583-3"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-2391(97)90542-5"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2273.2000.00367.x"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000421-200204000-00013"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.10171"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.surge.2014.07.003"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21537"},{"key":"e_1_2_10_27_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0347(199708)19:5<406::AID-HED7>3.0.CO;2-3"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2005.12.068"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/archotol.129.1.72"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.1121"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/SAP.0000000000000270"},{"key":"e_1_2_10_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.21463"},{"issue":"1","key":"e_1_2_10_33_1","first-page":"17","article-title":"Infectious diseases of the jaws","volume":"28","author":"Meyer I","year":"1970","journal-title":"J Oral Surg"},{"key":"e_1_2_10_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0278-2391(83)80005-6"},{"key":"e_1_2_10_35_1","doi-asserted-by":"publisher","DOI":"10.14219\/jada.archive.1985.0074"},{"key":"e_1_2_10_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/odi.14058"},{"key":"e_1_2_10_37_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2018.08.007"},{"key":"e_1_2_10_38_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcms.2020.09.008"},{"key":"e_1_2_10_39_1","doi-asserted-by":"publisher","DOI":"10.1172\/JCI118804"},{"key":"e_1_2_10_40_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.1999.17.10.3283"},{"key":"e_1_2_10_41_1","doi-asserted-by":"publisher","DOI":"10.1002\/hed.20121"},{"key":"e_1_2_10_42_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2010.03.029"},{"key":"e_1_2_10_43_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2010.11.017"},{"key":"e_1_2_10_44_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2014.02.017"},{"key":"e_1_2_10_45_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anorl.2013.11.006"},{"key":"e_1_2_10_46_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2020.12.027"},{"key":"e_1_2_10_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcmm.13366"},{"key":"e_1_2_10_48_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/471035"},{"key":"e_1_2_10_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oooo.2018.02.004"},{"key":"e_1_2_10_50_1","doi-asserted-by":"publisher","DOI":"10.4317\/medoral.25729"},{"key":"e_1_2_10_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2015.01.026"},{"key":"e_1_2_10_52_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-007-0384-2"},{"key":"e_1_2_10_53_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00228-010-0822-5"},{"key":"e_1_2_10_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jormas.2019.06.007"},{"key":"e_1_2_10_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/0165-0327(87)90009-7"},{"key":"e_1_2_10_56_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00232-011-9346-x"},{"key":"e_1_2_10_57_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2005.05.514"},{"key":"e_1_2_10_58_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2016-0298"},{"key":"e_1_2_10_59_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.2004.09.006"},{"issue":"6","key":"e_1_2_10_60_1","first-page":"690","article-title":"Evaluation of hyperbaric oxygen therapy for the osteoradionecrosis of the jaws: meta\u2010analysis","volume":"39","author":"Yin Y","year":"2021","journal-title":"Hua Xi Kou Qiang Yi Xue Za Zhi"},{"key":"e_1_2_10_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radonc.2021.11.021"},{"key":"e_1_2_10_62_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2019.02.044"},{"key":"e_1_2_10_63_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2010.02.005"},{"key":"e_1_2_10_64_1","doi-asserted-by":"publisher","DOI":"10.1111\/cxo.12203"},{"key":"e_1_2_10_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2014.01.003"},{"key":"e_1_2_10_66_1","doi-asserted-by":"publisher","DOI":"10.1200\/JCO.23.02750"},{"key":"e_1_2_10_67_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2019.01.028"},{"key":"e_1_2_10_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2019.06.007"},{"key":"e_1_2_10_69_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijom.2022.05.006"},{"key":"e_1_2_10_70_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2020.11.026"},{"key":"e_1_2_10_71_1","doi-asserted-by":"publisher","DOI":"10.1016\/0007-1226(89)90142-2"},{"key":"e_1_2_10_72_1","doi-asserted-by":"publisher","DOI":"10.1001\/2013.jamafacial.5"},{"key":"e_1_2_10_73_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0037-1602245"},{"issue":"3","key":"e_1_2_10_74_1","first-page":"2356","article-title":"Fascia lata free flap reconstruction of limited hard palate defects","volume":"10","author":"Kerr RP","year":"2018","journal-title":"Cureus"},{"key":"e_1_2_10_75_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2021.103226"},{"key":"e_1_2_10_76_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamafacial.2014.447"},{"key":"e_1_2_10_77_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.31168"},{"key":"e_1_2_10_78_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.30785"},{"key":"e_1_2_10_79_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599821990682"},{"key":"e_1_2_10_80_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oraloncology.2022.105878"},{"key":"e_1_2_10_81_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oooo.2022.12.002"},{"key":"e_1_2_10_82_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijrobp.2005.10.021"},{"key":"e_1_2_10_83_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00520-004-0659-5"},{"key":"e_1_2_10_84_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0b013e318199f6c6"},{"key":"e_1_2_10_85_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clinbiomech.2008.02.014"},{"issue":"6","key":"e_1_2_10_86_1","first-page":"767","article-title":"Comparison of intraoral donor sites for onlay grafting prior to implant placement","volume":"12","author":"Misch CM","year":"1997","journal-title":"Int J Oral Maxillofac Implants"},{"key":"e_1_2_10_87_1","doi-asserted-by":"publisher","DOI":"10.1111\/jcpe.13058"},{"key":"e_1_2_10_88_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.joms.2020.01.037"},{"key":"e_1_2_10_89_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jormas.2023.101472"},{"key":"e_1_2_10_90_1","doi-asserted-by":"publisher","DOI":"10.1097\/SCS.0000000000009300"},{"key":"e_1_2_10_91_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jormas.2021.06.005"},{"key":"e_1_2_10_92_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12015-020-10034-5"},{"key":"e_1_2_10_93_1","doi-asserted-by":"publisher","DOI":"10.47391\/JPMA.AKUS-12"},{"key":"e_1_2_10_94_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anorl.2021.06.006"},{"key":"e_1_2_10_95_1","doi-asserted-by":"publisher","DOI":"10.3402\/jom.v2i0.5072"}],"container-title":["Otolaryngology\u2013Head and Neck Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ohn.990","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T14:43:42Z","timestamp":1760971422000},"score":1,"resource":{"primary":{"URL":"https:\/\/aao-hnsfjournals.onlinelibrary.wiley.com\/doi\/10.1002\/ohn.990"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,9,27]]},"references-count":94,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2025,2]]}},"alternative-id":["10.1002\/ohn.990"],"URL":"https:\/\/doi.org\/10.1002\/ohn.990","archive":["Portico"],"relation":{},"ISSN":["0194-5998","1097-6817"],"issn-type":[{"value":"0194-5998","type":"print"},{"value":"1097-6817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,9,27]]},"assertion":[{"value":"2024-05-02","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-14","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-09-27","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}