New classification system for osteoradionecrosis of the jaws – An integrative review

The aim of this paper was to present an overview of the previous published classification and staging systems for osteoradionecrosis (ORN) of the jaws and propose a new classification system for ORN. An electronic search was conducted using Medical Subject Headings (MeSH) terms, 'osteoradionecrosis' and 'classification', and free text words, 'stage', 'staging', 'ORN', classification'. A total of 2053 manuscripts were identified, of which 21 were included, reviewed, and analysed by all authors. A total of 21 different classification and staging systems were identified. Objective findings, included exposed bone and/or fistula, as well as radiological evidence of pathological fracture, were the three most used factors in the existing classification and staging systems (57.1%, 38%, 52.4%). Nine classification and staging systems (42.9%) were treatment-dependent. Fourteen out of the 21 (66.7%) classification and staging systems only described changes in the mandible. Notably, only one article described changes in the maxilla. No standardised classification or staging system has to our knowledge addressed the complexity of ORN. There is a clear need for a new classification and staging system that enables the monitoring of disease progression, evaluation of treatment outcomes, restaging, and comparison of different treatment approaches. We propose a new classification system to address these unmet needs.