Immediate Onset of Osteoradionecrosis Post-radiotherapy in Postoperated Oral Squamous Cell Carcinoma Patient: A Case Report

Osteoradionecrosis (ORN) of the jaws is a severe complication of radiotherapy for head and neck cancers and is characterised as hypovascular, hypocellular and hypoxic tissue. ORN is more commonly seen in the mandible and only occasionally in the maxilla and zygomatic bone. The present case describes atypical features of ORN that developed in the zygomatic bone in a relatively young patient after Intensity-Modulated Radiation Therapy (IMRT). A 42-year-old male with squamous cell carcinoma of the right buccal mucosa underwent IMRT (60 Gy in 30 fractions). Ten days after radiotherapy, he presented with extraoral wound dehiscence, purulent discharge and severe pain. Clinical examination revealed erythema and inflammation, with a 7.8 mm oro-cutaneous fistula near the maxillectomy site. Histopathology showed necrotic bone with bacterial invasion and culture identified MethicillinSusceptible Staphylococcus Aureus (MSSA). Conservative management with antibiotics and local wound care was initiated because there was no evidence of severe necrosis or a pathologic fracture. Hyperbaric Oxygen Therapy (HBOT) was unavailable, but the patient responded well. Sequestrectomy was planned, illustrating that early-stage ORN can be managed conservatively when HBO is inaccessible. The present case highlights the need for personalised management plans and underscores close surveillance in the initial stages of ORN. The report discusses early diagnosis, culture-guided antibiotics and an individualised approach to treatment for patients with ORN.