Diagnostic Challenges in Osteoradionecrosis of the Jaw

Osteoradionecrosis of the jaws (ORNJ) is a severe radiotherapy (RT) complication that occurs in 2% to 22% of individuals with head and neck cancers (HNC) who are treated with RT or concurrent chemo-RT. The accurate diagnosis of ORNJ is crucial for appropriate and prompt management. On the other hand, various ORNJ stages can resemble osteomyelitis, medication-related osteonecrosis of the jaw (MRONJ), and tumor recurrences. This challenging situation is primarily due to the clinical and radiologic similarities between ORNJ and these non-RT-related conditions. Image analysis techniques such as panoramic imaging (PI), computed tomography (CT), magnetic resonance imaging (MRI), bone scintigraphy, positron emission tomography (PET), and single photon emission CT (SPECT) might help to avoid diagnostic obstacles. Despite the fact that the general characteristics of ORNJ have been reported in the literature, there is no clear consensus on its definitive diagnosis. Therefore, the current review aims to address ORNJ and its clinical and radiological aspects, as well as provide evidence to inform on the approaches to be used in removing the complexity in diagnosis, with a specific focus on radiological and nuclear medicine techniques.