 Hello everyone, welcome back to another session on dandestrian mode. So today's topic is osteo-radio necrosis Which is coming in oral pathology So osteo-radio necrosis the name name itself gives a clue that is it is a necrosis bone Due to radiation the osteo means bone Radiation and a necrosis to bone so formation of a necrosis to bone for a dead bone Due to radiation. So let's get into the detail of osteo-radio necrosis So osteo-radio necrosis, it is an inflammatory condition of bone that is osteomyelitis That occurs after the bone has been exposed to therapeutic doses of radiation Which result in or followed by formation of a sequestrum or dead bone or a necrosis to bone So ultimately the irradiated areas becoming a dead bone after a particular etiology So that is what osteo-radio necrosis is So etiology the 50-grade osis causes irreversible damage that causes the bone Hypo-cellular and hypo-vascular changes and the dental trauma or the dental extraction after radiation therapy will result in a Dead bone formation. So after radiation there will be hypo-cellularity and hypo-vascularity in the bone So over that if there is dental trauma or dental extraction So that will be a problem and ultimately it leads to a formation of a dead bone or a sequestrum So what are the clinical features? It is most commonly seen in mandible rather than maxilla because of the microanatomy and less vasculature in mandible and loss of mucosal covering and they will be exposed to bone. So this is most Striking features of osteo-radio necrosis that is loss of mucosal covering and presence of exposed bone Pain may or may not be present and there might be swelling and extra oral drainage And posterior part of mandible is more affected than the anterior part of mandible Because in the posterior part of mandible the radiation is more commonly happening because of the tumors of Neck region or tumors of Theroids tumors of salivary glands so various tumors are Coming in that area. So that is why posterior mandible is more commonly affected in Than the anterior mandibular region So anterior mandibular region is not divided of any tumors, but most commonly the head and neck region radiation is Coming closer to the posterior mandible. So it is most commonly seen in posterior part of mandible rather than the anterior part of mandible. So the exposed bone becomes necrotic as a result of loss of vascularity from periosteum Which result in sequestrum formation that is dead bone So what are the radiographic features? So there are early changes and later changes Early changes there will be well-defined area of bone resorption within the outer cortical plate of mandible. In later changes the bone will be of Leitich sclerotic or mixed nature and there will be ill-defined borders and there will be Irregular widening of periodontal membrane space So the differential diagnosis the bone resorption Stimulated by high levels of radiation. So but in that high level of radiation there will not be any exposed bone like Osteo-radio necrosis. So the exposed bone and loss of mucosal covering is a Critical features of osteo-radio necrosis and chronic osteomyelitis is another differential diagnosis So how do we manage osteo-radio necrosis? So osteo-radio necrosis is To an extent it is not a preventable condition because anyway in head and neck regions people has to They have to undergo Radiation for the treatment of malignancy. So sometimes this is inevitable Still management is based on conservative approach or radical approach. In conservative approach it is done to maintain the integrity of inferior border of mandible we Administrative antibiotics to control the infection and there will be sequestratomy. That is the dead bone will be removed That is a necrosis dead bone will be removed and also local debridement will be done and To control the pain we use we can use Narcotic analgesics and proper hydration and nutrition should be supplemented and ultrasound therapy should be done and In radical approach that is based on the hyperbaric oxygen therapy and local debridement and also the mouth rinsing So hyperbaric oxygen is a most critical treatment option of osteo-radio necrosis as a playing Oxygen so it is supplying hundred percentage oxygen at a two to four atmospheric pressure for 90 minutes Sessions five days per week. So that is a therapy regimen That is hundred percent oxygen two to four atmospheric pressure 40 minutes. Sorry 90 minutes five days per week So on a preventive side, we need to look for a pre-irradiation care Mouth rinsing salivary substitutes are also some other options. So osteo-radio necrosis. It's a small topic which is the formation of a dead bone Due to radiation therapy. So just because of radiation the dead bone is not actually formed It is because on the irradiated area or irradiated bone There will be trauma or extraction. So that causes a formation of sequestrum So radiation is resulting in hypovascularity and hypocellularity So in this area if trauma happens or if extraction is happening, so there will be chance of Dead bone formation. So that's all about osteo-radio necrosis I will come up with the new session on dentistry and more. Thank you