Osteoradionecrosis of the mandible is one of the severe complications of radiation therapy for head and neck cancer. Generally, osteoradiomyelitis or osteoradionecrosis presenting pathological fracture is categorized into advanced stage that requires mandibular resection followed by bone reconstruction. We report a case of pathological mandibular fracture caused by osteoradionecrosis and osteoradiomyelitis, which was treated with open reduction internal fixation in combination with adjuvant

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... apies, closed irrigation-suction system, hyperbaric oxygen treatment and free composite iliac bone grafts. The patient was a 65-year-old male who had undergone superselective intra-arterial chemotherapy concurrent with radiotherapy for oropharynx cancer 5 years before. He had suffered from alveolar bone exposure and pain in the left mandible, accompanied by swollen cheek and skin fistula. Panoramic radiography and CT images revealed diffuse bone resorption and fracture in the left mandible. Histopathological examination showed no metastasis of the oropharynx cancer or other malignancy. We adopted closed irrigation-suction therapy in the period between the debridement of necrotic bone and the open reduction internal fixation, in order to control the infection and inflammation. The postoperative course was favorable and no trouble has been observed.