Progressive Necrosis Research Articles

Mechanisms Underlying Medication‐Related Osteonecrosis of the Jaw

ABSTRACTObjectiveMedication‐related osteonecrosis of the jaw (MRONJ) is a rare but debilitating disease characterized by a progressive necrosis of jaw bones in patients who have received anti‐resorptive or anti‐angiogenic therapies. Unfortunately, we still have no validated preventive or pharmaceutical interventions to help these patients, primarily due to our limited understanding of MRONJ pathogenesis. Here, we offer an extensive review of recent studies relevant to MRONJ pathogenesis. We present a hypothesis regarding the coupling of bone resorption and angiogenesis that relies on osteoblast‐derived, matrix‐bound vascular endothelial growth factors to explain why ONJ is associated with both anti‐resorptive and anti‐angiogenic agents.MethodsA narrative review was conducted by searching databases, including PubMed, Scopus, Google Scholar, and Web of Science, to retrieve relevant reports.ResultsReduced bone resorption leads to reduced angiogenesis, and vice versa, creating a vicious cycle that ultimately results in ischemic necrosis of the jaw. Additionally, we suggest that reduced angiogenesis, induced by anti‐resorptive or anti‐angiogenic agents, aggravates bacterial infection‐induced bone necrosis, explaining why the jaw bone is particularly susceptible to necrosis.ConclusionOur novel hypothesis will facilitate the advancement of future research and the development of more targeted approaches to managing MRONJ.

Reprint-Necrotizing Fasciitis: A Case Report and A Review of the Literature

Necrotizing fasciitis is a soft-tissue infection characterized by extensive necrosis of subcutaneous fat, neurovascular structures, and fascia. In general, fascial necrosis precedes muscle and skin involvement, hence its namesake. Initially, this uncommon and rapidly progressive disease process can present as a form of cellulitis or superficial abscess. However, the high morbidity and mortality rates associated with necrotizing fasciitis suggest a more serious, ominous condition. Diagnosis may be delayed because of the initial minimal skin cellulitis, even as the subcutaneous tissue suffers extensive necrosis and pronounced systemic toxicity develops. A delay in diagnosis can result in progressive advancement highlighted by widespread infection, multiple-organ involvement, and, ultimately, death. Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) might be useful in cases where signs are equivocal or diagnosis is in doubt. Computed tomography scans are estimated to have a sensitivity of 80% for detecting necrotizing soft tissue infections. We present a case of limb salvage in a 52-year-old patient with misunderstood type 2 diabetes mellitus and progressive fascial necrosis. A detailed review of the literature is presented, and current treatment modalities are described. Aggressive surgical debridement, comprehensive medical management of the sepsis and comorbidities, and timely closure of the resultant wound or wounds are essential for a successful outcome. Necrotizing fasciitis is a soft tissue infection characterized by extensive necrosis of subcutaneous fat, neurovascular structures and fascia. Background: the characteristic of this case was aggression and rapid extension. Case presentation: a 59-year-old woman was observed in a very serious condition, with fever and a large necrotic area that smelled of the right inguinal-femoral region in extension to the thigh. No history of illness. Obesity. Diagnosis may be delayed due to minimal initial cutaneous cellulite. A delay in diagnosis can lead to the progression of the disease shown by shock, multiple organ failure and, ultimately, death. Computed tomography and Magnetic Resonance Imaging could be useful in cases where the signs are equivocal or the diagnosis is in doubt. A detailed review of the literature is presented and the current treatment modalities are described. In this case, the aggressive surgical debridement, the complete medical management of sepsis and comorbidities and the timely closure of the wound by dermo-epidermal grafting were essential for a positive result. Conclusions: necrotizing fasciitis is an uncommon life-threatening soft tissue infection, which spreads rapidly and progressively along the deep fascia. The prognosis depends on accurate diagnosis and immediate treatment.

Preliminary study of a new magnetic compression technique for circumcision in dogs: An experimental animal model

IntroductionTraditional/ritual/medical circumcision can be associated with considerable intraoperative blood loss and a prolonged postoperative healing course. This study investigated the feasibility of the magnetic compression technique (MCT) for circumcision in beagle dogs. MethodsA set of magnetic rings including a daughter magnetic ring (DMR) and a parent magnetic ring (PMR) were designed for circumcision. In eight beagle dogs as the animal model, the DMR was placed between the penis and the foreskin through the glans, and then the PMR was placed outside the penis. The DMR and PMR automatically attracted together to compress the foreskin. The necrosis of the prepuce of the anterior penis was observed daily. The operation time and time to magnetic ring shedding were recorded. Healing of the foreskin stump was visually observed. ResultsThe magnetic rings were successfully installed in all eight dogs, and the operation process was without complication. The average operation time was 3.13 ± 0.92 min (range, 2–4.5 min). Postoperative X-rays showed good attraction of the magnetic rings. Daily post-operative observation showed progressive ischemic necrosis of the anterior foreskin and mild edema of the proximal foreskin. The dogs were generally in good condition and urinated freely. The magnetic rings fell off spontaneously 8–12 days after the operation, and the stump of the foreskin healed well. ConclusionThe MCT may be a new approach for circumcision in a canine model, which suggests its potential for use in humans.

Harm reduction nursing and the path toward developing best practice: Lessons from caring for people with xylazine-associated wounds in Philadelphia, PA

Xylazine-associated wounds are a distinct, novel clinical entity characterized by co-occurrence with substance use, progressive necrosis of skin, muscle, tendon, and bone, and slow healing. In Philadelphia, the specter of limb loss, stigma, and shame has hung over hospital-based care for xylazine-associated wounds among people who use drugs (PWUD) and kept many people away from engaging in care. Continued engagement in harm reduction wound care nursing, however, offers an opportunity for PWUD to address their wounds and their fears with members of the medical world. In the absence of established best practices, harm reduction’s model of risk-reductive care offers a way forward for patients and practitioners alike. Here, “harm reduction” describes an ethic of practical, trauma-informed, patient-centered care. It is this integration of harm reduction into medicine and public health that effectively promotes the safety, survival, and recovery of PWUD across all spectrums of drug use habits and housing stability.

Necrotizing Fascitis of the Neck: Rare Case Report

Introduction: necrotizing fasciitis corresponds to a bacterial infection of soft tissues, characterized by diffuse and rapidly progressive necrosis of the subcutaneous cellular tissue and musculoaponeurotic system, accompanied by marked systemic septic involvement. Clinical case: the case of a 63-year-old patient, former smoker, pack year 10, clinical picture of approximately 4 days is presented, characterized by generalized facial edema without improvement with pharmacological treatment, accompanied by unquantified thermal increases, intense pain. neck, general condition assessment and appearance of signs of phlogosis and ampullary lesions in zone 3 and 4 of the right neck. The diagnosis of necrotizing fasciitis of the neck with no apparent cause was established. A necrectomy was performed and the patient was admitted. Discussion: in this particular case, the unusual location of necrotizing fasciitis in the anterior region of the neck is striking; it generally occurs in people with diabetes mellitus and immunocompromised people and in this case it occurs without apparent cause. Conclusion: necrotizing fasciitis of the anterior region of the neck without apparent cause, rare infection, rapidly progressive and difficult to diagnose in the early stage.

Challenges and diagnosis in therapy of secondary amenorrhoea in caesarean section patient with postpartum haemorrhage B-lynch sutures: a case report

Introduction and importance: International Federation of Gynecology and Obstetrics (FIGO) and WHO report the incidence of postpartum haemorrhage (PPH) reaches 1–10% and contributes to an increase in postpartum maternal mortality with uterine atony as the most common cause. B-Lynch method is a suturing technique to overcome PPH. Although this method has proven useful as an emergency life-saving measure, the post-procedure complications are still able to occur. Presentation of case: The patient was not menstruating for 14 months after giving birth through caesarean section with B-Lynch due to PPH. Before pregnancy, she had regular menstruation cycle and normal menstrual duration. Her general and gynaecological status were normal. Ultrasound showed the impression of uterine hypoplasia and endometrium that were difficult to assess while both ovaries were normal. Diagnostic hysteroscopy showed a severe degree of Asherman’s syndrome. The results of FSH, LH and estradiol were normal. Discussion: B-lynch suture is performed as a method to stop PPH in uterine atony. Secondary amenorrhoea occurs as a complication of B-lynch. Compression action of B-lynch can cause progressive myometrium necrosis resulting in synechiae and blockade of uterine blood flow. This will interfere with the development of the uterus. Intrauterine adhesions and amenorrhoea with normal levels of FSH, LH, and estradiol support the diagnosis of Asherman’s syndrome. Conclusion: This case shows that the B-Lynch procedure, which is the worldwide recommended method for treating postpartum haemorrhage due to its high success rate, can cause complications of Asherman’s syndrome and cause secondary amenorrhoea.

Timed sulfonylurea modulation improves locomotor and sensory dysfunction following spinal cord injury.

Traumatic spinal cord injury (SCI) results in immediate tissue necrosis and delayed secondary expansion of neurological damage, often resulting in lifelong paralysis, neurosensory dysfunction, and chronic pain. Progressive hemorrhagic necrosis (PHN) and excessive excitation are the main sources of secondary neural injury. Recent approaches to attenuate PHN by glibenclamide can improve locomotor function after SCI. However, use of glibenclamide can exacerbate development of SCI-induced chronic pain by inhibiting KATP channels to increase neuronal excitation and glial activation. In this study, we explored a treatment strategy involving administration of glibenclamide, which suppresses PHN, and diazoxide, which protects against neuronal excitation and inflammation, at different time intervals following spinal cord contusion. Our goal was to determine whether this combined approach enhances both sensory and motor function. Contusive SCI was induced at spinal segment T10 in adult rats. We found that KATP channels opener, diazoxide, decreased the hyperexcitability of primary sensory neurons after SCI by electrophysiology. Timed application of glibenclamide and diazoxide following contusion significantly improved locomotor function and mitigated development of SCI-induced chronic pain, as shown by behavioral evidence. Finally, we found that timed application of glibenclamide and diazoxide attenuates the inflammatory activity in the spinal cord and increases the survival of spinal matters following SCI. These preclinical studies introduce a promising potential treatment strategy to address SCI-induced dysfunction.

Progressive lesion necrosis is related to increasing aphasia severity in chronic stroke

BackgroundVolumetric investigations of cortical damage resulting from stroke indicate that lesion size and shape continue to change even in the chronic stage of recovery. However, the potential clinical relevance of continued lesion growth has yet to be examined. In the present study, we investigated the prevalence of lesion expansion and the relationship between expansion and changes in aphasia severity in a large sample of individuals in the chronic stage of aphasia recovery. MethodsRetrospective structural MRI scans from 104 S survivors with at least 2 observations (k = 301 observations; mean time between scans = 31 months) were included. Lesion demarcation was performed using an automated lesion segmentation software and lesion volumes at each timepoint were subsequently calculated. A linear mixed effects model was conducted to investigate the effect of days between scan on lesion expansion.Finally, we investigated the association between lesion expansion and changes on the Western Aphasia Battery (WAB) in a group of participants assessed and scanned at 2 timepoints (N = 54) using a GLM. ResultsMost participants (81 %) showed evidence of lesion expansion. The mixed effects model revealed lesion volumes significantly increase, on average, by 0.02 cc each day (7.3 cc per year) following a scan (p < 0.0001).Change on language performance was significantly associated with change in lesion volume (p = 0.025) and age at stroke (p = 0.031). The results suggest that with every 10 cc increase in lesion size, language performance decreases by 0.9 points, and for every 10-year increase in age at stroke, language performance decreases by 1.9 points. ConclusionsThe present study confirms and extends prior reports that lesion expansion occurs well into the chronic stage of stroke. For the first time, we present evidence that expansion is predictive of longitudinal changes in language performance in individuals with aphasia. Future research should focus on the potential mechanisms that may lead to necrosis in areas surrounding the chronic stroke lesion.

Symptomatic radionecrosis after postoperative but not preoperative stereotactic radiosurgery in a single patient: illustrative case.

Standard of care for brain metastases involves stereotactic radiosurgery (SRS). For cases that also require surgery because of lesion size, edema, or neurological symptoms, whether to provide pre- or postoperative SRS has become a prevalent debate. Herein, the unique case of a patient with brain metastases of the same pathology and similar size in two different brain locations at two different times is described. The patient underwent surgery with preoperative SRS for the first lesion and surgery with postoperative SRS for the second lesion. Although both treatments resulted in successful local control, the location that received postoperative SRS developed symptomatic and rapidly progressive radiation necrosis (RN) requiring a third craniotomy. Large randomized controlled trials are ongoing to compare pre- versus postoperative SRS for the treatment of symptomatic brain metastases (e.g., study NRG-BN012). Recent interest in preoperative SRS has emerged from its theoretical potential to decrease rates of postoperative RN and leptomeningeal disease. This valuable case in which both therapies were applied in a single patient with a single pathology and similar lesions provides evidence supportive of preoperative SRS.

Peripheral ulcerative keratitis in a child – An unusual presentation

Peripheral ulcerative keratitis (PUK) is an inflammatory disorder of the cornea characterized by crescent-shaped destructive inflammation of the juxtalimbal corneal stroma with the associated epithelial defect. It leads to progressive necrosis of corneal stroma leading to perforation and blindness. Since PUK is more common in people with collagen vascular disorders, it is more common in middle-aged females. We discuss a unique case of a 6-year-old male child who presented as a unilateral PUK. Systemic investigations were inconclusive of any cause. The child was treated with medical therapy in the form of topical steroids and an immunomodulator, to which he responded well.

ANT-dependent MPTP underlies necrotic myofiber death in muscular dystrophy.

Mitochondrial permeability transition pore (MPTP) formation contributes to ischemia-reperfusion injury in the heart and several degenerative diseases, including muscular dystrophy (MD). MD is a family of genetic disorders characterized by progressive muscle necrosis and premature death. It has been proposed that the MPTP has two molecular components, the adenine nucleotide translocase (ANT) family of proteins and an unknown component that requires the chaperone cyclophilin D (CypD) to activate. This model was examined in vivo by deleting the gene encoding ANT1 (Slc25a4) or CypD (Ppif) in a δ-sarcoglycan (Sgcd) gene-deleted mouse model of MD, revealing that dystrophic mice lacking Slc25a4 were partially protected from cell death and MD pathology. Dystrophic mice lacking both Slc25a4 and Ppif together were almost completely protected from necrotic cell death and MD disease. This study provides direct evidence that ANT1 and CypD are required MPTP components governing in vivo cell death, suggesting a previously unrecognized therapeutic approach in MD and other necrotic diseases.

Güncel Tanı ve Tedavi Yaklaşımlarıyla MRONJ

ABSTRACT&#x0D; Osteonecrosis of the jaw bones is a persistent and rare pathology that develops with progressive bone destruction and bone necrosis as a result of impaired blood supply in the mandible and maxilla. The key point to the prevention and treatment of MRONJ is screening high-risk patients (eg, AAOMS stage 0) predisposed to the disease to detect it at an early stage to effectively prevent the risk of progression and occurrence. Although no exposed bone is seen in clinical examination, osteonecrosis can be diagnosed early by radiographic examination. Therefore, advanced imaging techniques such as MR, SPECT/PET and VELscope are important in the early diagnosis of MRONJ. There is no defined gold standard treatment in the literature and the treatment of MRONJ is often very difficult. Treatment strategies are mainly focused on minimizing the progression or formation of bone necrosis, eliminating pain, controlling infection and optimizing the patient's quality of life. The AAOMS recommends stage-based treatment planning in MRONJ patients. In addition to the treatment methods recommended by the AAOMS, there are research showing that some adjuvant treatments have a positive effect on recovery in MRONJ patients. For example, the use of platelet-rich plasma/fibrin in addition to surgical treatment increasing the success of surgery is one of them. Alternative treatment options are low-level laser therapy, surgical debridement with laser, surgical debridement under the guidance of fluorescent staining method, use of platelet concentrates, ozone and hyperbaric oxygen therapy, pentoxifylline, alpha-tocopherol, photo-bio modulation, use of parathormone or stem cell transplantation into the lesion. In this review, we aimed to update the knowledge, attitudes and behaviors of dentists about MRONJ and to shape the approach to MRONJ with the guidance of current literature.

An Ayurvedic Regime in the Management of Necrotizing Fasciitis: A Case Study

Necrotizing fasciitis is a fulminant and life-threatening condition characterized by progressive gangrene of the soft tissues affecting commonly abdominal wall and perineal region cause of which is polymicrobial infection. Necrotising fasciitis is a rapidly spreading infection that produces necrosis of the subcutaneous tissues and overlying skin. It is a surgical emergency that, usually necessitates immediate surgical debridement. High mortality rates are seen in necrotizing fasciitis involving perineum and external genitals especially in males range from 6.3 to 50%, which indicates that the variable outcome of patients with the disease is multifactorial. Infective microorganisms involve in sepsis in anorectal region are difficult to control as antimicrobials used to treat such infections have little penetration in tissues in anorectal region. Panchavalkala decoction shows properties like antiseptic, anti-inflammatory, immune-modulatory, antioxidant, antibacterial, antimicrobial wound purifying and healing, astringent properties in Dustavrana. We are presenting here a case of 32-year-old gentleman who was initially diagnosed as ischiorectal abscess having no history of diabetes and any chronic illness and visited in anorectal OPD of our hospital with severe pain in perineal region and fever in the past 6-7 days. He was treated as a surgical emergency with proper wound debridement and post-operative wound management was done with cleaning with decoction of Panchvalakala, dressing with Jatyadi oil and oral Ayurvedic medications.

Medication-Related Osteonecrosis of the Jaws: A Comparison of SICMF-SIPMO and AAOMS Guidelines.

(1) Background: Medication-related osteonecrosis of the jaws (MRONJ) is an adverse drug reaction characterized by progressive bone disruption and necrosis in the mandibular and/or maxillary bones. It occurs in individuals who have received antiresorptive drugs without prior radiotherapy. Since its first reported cases in the USA in 2003, extensive literature has emerged worldwide, leading to significant advancements in understanding MRONJ's pathogenesis and management. (2) Results: This article aims to compare the current national recommendations provided by the Italian Society of Maxillofacial Surgery (SICMF)/Italian Society of Oral Pathology and Medicine (SIPMO) and the American Association of Oral and Maxillofacial Surgeons (AAOMS). (3) Conclusions: Historically, the AAOMS advocated for a more conservative approach compared to the Italian guidelines. However, in their 2022 update, the AAOMS adopted a different perspective based on reported evidence, highlighting the advantages of early surgical treatment. Despite resolving some initial controversies, differences still exist between the two sets of recommendations, particularly regarding diagnosis and staging.

Case Report: A Rare Case of Marchiafava Bignami Disease

Marchiafava-Bignami illness is a rare toxic disease that mostly affects chronic alcoholics and causes progressive demyelination and necrosis of the corpus callosum. The process may spread laterally into surrounding white matter and, on rare occasions, into the subcortical areas. We describe the MR imaging findings in two individuals who presented with acute alcohol-related disorders and discuss the hallmarks of the disease and other acute alcohol-related diseases.

Anaesthetic management of an infant with severe protein C deficiency and septal cardiac defects—a case report

BackgroundProtein C deficiency is a rare genetic disorder with varying severity of symptoms and disease. The disorder may vary in presentation from a complete symptomless state to a less severe form like venous thromboembolism. The most severe form of disease is a rare condition called neonatal purpura fulminans (NPF) which is characterized with sudden progressive dermal hemorrhage and necrosis due to vascular thrombosis and disseminated intravascular coagulation. In contrast, congenital atrial and ventricular septal defects are the commonest congenital heart diseases found in pediatric population. An infant presenting with systemic vascular thromboembolism secondary to protein C deficiency along with the cardiac septal defects posted for surgery will be a very challenging task to manage in perioperative period. Also, physiological mechanisms during perioperative period and surgery will promote thromboembolism leading to worsening of the situation further. So, perioperative management of such patient pose a great challenge to the anaesthesiologist. Due to rarity of the condition, there is very limited literature available.Case presentationWe report the perioperative management of a 2-month-old child suffering with neonatal purpura fulminans with atrial and ventricular septal cardiac defect, scheduled for bilateral foot amputation. The patient was a diagnosed with complete occlusion of abdominal aorta leading to foot gangrene. After initiation of anticoagulant therapy, symptoms were relieved and patient was posted for amputation of gangrenous feet.ConclusionsThere could be an increased risk of thromboembolism and bleeding due to protein C abnormality along with the chances of shunt reversal, paradoxical embolism, and other cardiac morbidities secondary to septal defects. Wise selection of anaesthetic agents like limiting the use of nitrous oxide, ketamine as much as possible to be considered. Conditions like tachycardia, hypotension, and hypothermia should also be prevented perioperatively as these could increase the chances of thrombosis.

AVASCULAR NECROSIS AS A MANIFESTATION OF POST-COVID SYNDROME IN ROUTINE PRACTICE OF RHEUMATOLOGIST

Avascular necrosis as a part of post-COVID syndrome requires increased attention of physicians due to significant misfunction of musculoskeletal system, increased disability, and frequently requires surgical intervention. It is known that hypercoagulation, thrombosis as well as systemic corticosteroid therapy during severe coronavirus infection play an important role in the development of avascular necrosis. A case report of progressive avascular necrosis in multiple loci accompanied by polyarthritis in a young man developed after severe COVID-19 is reported below

The rare complication of vascular malformations of the limb after sclerotherapy: a report of 3 cases and brief literature review

BackgroundVascular malformations are common but complicated types of disease in infants, with unclear causes and lack of effective prevention. The symptoms usually do not disappear and tend to progress without medical intervention. It is extremely necessary to choose correct treatment options for different types of vascular malformations. A large number of studies have confirmed that sclerotherapy has a tendency to become the first-line treatment in near future, but it is also associated with mild or severe complications. Furthermore, to our knowledge, the serious adverse event of progressive limb necrosis has not been systematically analyzed and reported in the literature.Case presentationThree cases (two females and one male) were presented who were all diagnosed as vascular malformations and were treated by several sessions of interventional sclerotherapy. Their previous medical records showed the use of several sclerosants in different sessions including Polidocanol and Bleomycin. The sign of limb necrosis did not occur during the first sclerotherapy, but after the second and third sessions. Furthermore, the short-term symptomatic treatment could improve the necrosis syndrome, but could not change the outcome of amputation.ConclusionSclerotherapy undoubtedly tends to be the first-line treatment in near future, but the adverse reactions still remain major challenges. Awareness of progressive limb necrosis after sclerotherapy and timely management by experts in centers of experience of this complication can avoid amputation.

Reduction in productivity of soybean plants infested with Neohyadatothrips variabilis (Thysanoptera: Thripidae) with and without soybean vein necrosis virus

Soybean thrips, Neohyadatothrips variabilis (Beach), a vector of Soybean Vein Necrosis Virus (SVNV), has been recognized as a widespread pest of soybean [Glycine max (L.) Merr.] in USA and Canada. Several experiments investigated the effect on soybean when infested with soybean thrips with and without SVNV. Experiment 1 compared soybean infested at V1 and V5 growth stages (GS) with soybean thrips without SVNV and noninfested plants. For plants infested at GS V1, plant height, number of seeds, and seed weights were reduced by 50, 80, and 75%, respectively. When plants were infested at GSs V1 and V5, the counts of soybean thrips peaked at 1,803 and 4,214 per plant 4 weeks after infestation (WAI), respectively. Experiment 2 used SVNV-infected soybean thrips and compared soybean infested versus control at GS V1 and V5. For plants infested at GS V1, plant height was reduced 77.8%, and plants died before setting pods. For plants infested at GS V5, height, number of seeds, and seed weights were reduced 56, 78, and 92%, respectively. When plants were infested at GSs V1 and V5, the counts of soybean thrips peaked at 282 and 883 per plant 2 WAI, respectively. Experiment 3, five soybean genotypes were infested with SVNV-infected thrips at GS V1. Number and weight of seeds per plant were higher and with lower visual disease ratings (progressive chlorosis, necrosis and rugosity) for the more resistant genotypes Merschman Kennedy and plant introduction (PI) 171451 than for the more susceptible genotypes: soybean breeding line LD12-12734a (Rag1/2), cv Williamsfield Illini 3509N, and PI 417136.

The Progress in Reconstruction of Mandibular Defect Caused by Osteoradionecrosis.

Osteoradionecrosis (ORN) is described as a disease with exposed, nonviable bone that fails to heal spontaneously or by means of conservative treatment after radiotherapy in at least 3 months. Though traditional theories in the early stage including hypoxic-hypocellular-hypovascular and fibro-atrophic in addition to new findings such as ferroptosis were put forward to explain the mechanisms of the osteoradionecrosis, the etiology of ORN is still unclear. With the high rate of occurrence in the head and neck area, especially in the mandible, this disease can disrupt the shape and function of the irradiated area, leading to a clinical presentation ranging from stable small areas of asymptomatic exposed bone to severe progressive necrosis. In severe cases, patients may experience pain, xerostomia, dysphagia, facial fistulas, and even a jaw defect. Consequently, sequence therapy and sometimes extensive surgery and reconstructions are needed to manage these sequelae. Treatment options may include pain medication, antibiotics, the removal of sequesters, hyperbaric oxygen therapy, segmental resection of the mandible, and free flap reconstruction. Microanastomosed free-flaps are considered to be promising choice for ORN reconstruction in recent researches, and new methods including three-dimensional (3-D) printing, pentoxifylline, and amifostine are used nowadays in trying increase the success rates and improve quality of the reconstruction. This review summarizes the main research progress in osteoradionecrosis and reconstruction treatment of osteoradionecrosis with mandibular defect.