{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T13:04:27Z","timestamp":1767791067951,"version":"3.49.0"},"reference-count":30,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T00:00:00Z","timestamp":1767657600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Osteoradionecrosis (ORN) of the jaw is a severe, progressive complication of radiation therapy for head and neck malignancies. ORN features radiologically overlaps osteomyelitis and tumor recurrence. This study analyzes jaw ORN imaging characteristics and progression and proposes an ORN CT-based grading system that builds on current ClinRAD grades. Materials and Methods: A retrospective cohort study of 35 patients with biopsy-proven or clinically diagnosed ORN following radiation therapy. Initial and follow-up imaging were assessed to evaluate the radiological evolution of ORN. The imaging findings were statistically analyzed using IBM SPSS v26, and literature comparisons were made. Results: The median onset of ORN post-radiotherapy was 27\u201328 months (range: 2\u2013119 months). The most common clinical presentations included non-healing ulcers (49%), pain (34%), and discharging sinuses (31%). Mandibular involvement was predominant (51%), with focal bone alterations being more frequent (63%). CT findings at clinical suspicion of ORN included resorption (100%), erosions (100%), sclerosis (86%), and fragmentation (83%). Follow-up imaging showed increased bone erosion (77%), fragmentation (92%), and sclerosis (92%). A CT-based grading system is proposed to classify ORN progression. Conclusions: ORN follows a predictable radiological progression, beginning with trabecular resorption and cortical erosion, leading to fragmentation and sequestrum formation. The proposed grading system provides a structured approach for early diagnosis. The proposed grading system provides a structured approach for diagnosis. Larger studies of imaging analyses are required to validate these findings and refine diagnostic criteria.<\/jats:p>","DOI":"10.3390\/cancers18020187","type":"journal-article","created":{"date-parts":[[2026,1,6]],"date-time":"2026-01-06T15:09:36Z","timestamp":1767712176000},"page":"187","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Decoding Osteoradionecrosis of the Jaw: Radiological Progression and a Novel CT-Based Grading System"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4177-2547","authenticated-orcid":false,"given":"Vasundhara","family":"Patil","sequence":"first","affiliation":[{"name":"Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pritesh","family":"Shah","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6606-6537","authenticated-orcid":false,"given":"Abhishek","family":"Mahajan","sequence":"additional","affiliation":[{"name":"Department of Imaging, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool L7 8YA, UK"},{"name":"Faculty of Health and Life Sciences, University of Liverpool, Liverpool L7 8TX, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nilesh","family":"Sable","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anuradha","family":"Shukla","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gauri","family":"Bornak","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Swapnil","family":"Rane","sequence":"additional","affiliation":[{"name":"Department of Pathology, Advanced Centre for Treatment and Research in Cancer (ACTREC), Homi Bhabha National Institute, Navi Mumbai 410210, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4913-7270","authenticated-orcid":false,"given":"Sandeep","family":"Gurav","sequence":"additional","affiliation":[{"name":"Dental and Prosthetic Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarbani Ghosh","family":"Laskar","sequence":"additional","affiliation":[{"name":"Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gouri","family":"Pantvaidya","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amit","family":"Janu","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Advanced Centre for Treatment and Research in Cancer (ACTREC), Homi Bhabha National Institute, Navi Mumbai 410210, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9756-1688","authenticated-orcid":false,"given":"Suman","family":"Ankathi","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arpita","family":"Sahu","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kajari","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Advanced Centre for Treatment and Research in Cancer (ACTREC), Homi Bhabha National Institute, Navi Mumbai 410210, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nivedita","family":"Chakrabarty","sequence":"additional","affiliation":[{"name":"Department of Radiodiagnosis, Advanced Centre for Treatment and Research in Cancer (ACTREC), Homi Bhabha National Institute, Navi Mumbai 410210, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Archi","family":"Agarwal","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Advanced Centre for Treatment and Research in Cancer (ACTREC), Homi Bhabha National Institute, Navi Mumbai 410210, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9989-5534","authenticated-orcid":false,"given":"Prathamesh","family":"Pai","sequence":"additional","affiliation":[{"name":"P.D. Hinduja Hospital and Medical Research Centre, Mumbai 400052, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deepa","family":"Nair","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anuja","family":"Deshmukh","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richa","family":"Vaish","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vidisha","family":"Tuljapurkar","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asawari","family":"Patil","sequence":"additional","affiliation":[{"name":"Department of Pathology, Advanced Centre for Treatment and Research in Cancer (ACTREC), Homi Bhabha National Institute, Navi Mumbai 410210, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Munita","family":"Bal","sequence":"additional","affiliation":[{"name":"Department of Pathology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kumar","family":"Prabhash","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanita","family":"Noronha","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nandini","family":"Menon","sequence":"additional","affiliation":[{"name":"Department of Medical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vijay","family":"Patil","sequence":"additional","affiliation":[{"name":"Medical Oncology, P.D. Hinduja Hospital & Medical Research Centre, Mumbai 400052, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pankaj","family":"Chaturvedi","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery, Advanced Centre for Treatment and Research in Cancer (ACTREC), Homi Bhabha National Institute, Navi Mumbai 410210, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1111\/idj.12318","article-title":"Osteoradionecrosis of the jaws: Definition, epidemiology, staging and clinical and radiological findings. A concise review","volume":"68","author":"Chronopoulos","year":"2020","journal-title":"Int. Dent. 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