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One of the most common and severe side effects of radiotherapy or concurrent chemo-radiotherapy for head and neck cancers is osteoradionecrosis of the jaws, which affects 2-22% patients. Correct diagnosis is crucial for the effective and timely management of osteoradionecrosis of the jaws. However, various stages of osteoradionecrosis of the jaws resemble osteomyelitis, medication-related osteonecrosis of the jaw, or tumor recurrences, challenging the diagnostic certainty. The clinical and radiological resemblance of osteoradionecrosis of the jaws to these non-radiotherapy-related conditions are the main contributors to this challenging situation. Nevertheless, it may be possible to avoid diagnostic roadblocks by using image analysis methods such as orthopantomography, computed tomography (CT), magnetic resonance imaging, bone scintigraphy, positron emission tomography, and single-photon emission CT (SPECT). There is no widely accepted consensus on the precise diagnosis of osteoradionecrosis of the jaws, although its general characteristics have been reported in the literature. The current chapter covers osteoradionecrosis of the jaws and its clinical and radiological features and provides information on relevant strategies to be used for an accurate diagnosis, with a specific emphasis on radiological and nuclear medicine techniques.
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