Radiation injuries to the facial skeleton and teeth following irradiation of oral carcinoma

After investigation of 183 patients receiving radiotherapy for carcinoma of the lower lip and of the mucous membrane of the mouth, osteomyelitis of the mandible was found in ten of these patients. Five of them also showed spreading of the recurring tumor into bone, in which case an infiltrating mass, adherent to bone, could be detected clinically. If radiation osteomyelitis alone is present as a result of radiation injury to the mandible, further irradiation is ruled out. If a clinical picture of osteomyelitis and recurrence of the tumor simultaneously is found, further radiotherapy of the tumor may be necessary. The correct interpretation of the changes observed is thus extremely important, for it determines the plan of further treatment. The development of radiation osteomyelitis of the mandible is facilitated by retention of carious teeth during the period of radiotherapy, and also by trauma of the tissues as a result of extraction of a tooth or any type of operation on the irradiated jaw. It must be borne in mind that radiation injury of the teeth is always accompanied by osteolysis of the alveolar border of the mandible at the same level, and this in turn is a factor that contributes to the development of osteomyelitis in the irradiated jaw