Marx Classification for Mandibular Osteoradionecrosis

The Marx Classification is used to grade the severity of mandibular oseteoradionecrosis.¹
Marx (1983) divided patients with osteoradionecrosis into 3 stages depending on their response to treatment:
- Stage I: Exposed alveolar bone without a pathologic fracture, which responds to hyperbaric oxygen.
- Stage II: Does not respond to hyperbaric oxygen, and requires sequestrectomy and saucerization.
- Stage III: Full thickness bone damage, pathologic fracture, or orocutaneous fistula. Usually requires segmental resection and reconstruction with free tissue.²

Stage	Features
Stage I	Exposed alveolar bone without a pathologic fracture, which responds to hyperbaric oxygen.
Stage II	Does not respond to hyperbaric oxygen, and requires sequestrectomy and saucerization.
Stage III	Full thickness bone damage, pathologic fracture, or orocutaneous fistula. Usually requires segmental resection and reconstruction with free tissue.

Marx, Robert E. “A new concept in the treatment of osteoradionecrosis.” Journal of Oral and Maxillofacial Surgery 41.6 (1983): 351-357. ↩
Chang, David W., et al. “Management of advanced mandibular osteoradionecrosis with free flap reconstruction.” Head & Neck: Journal for the Sciences and Specialties of the Head and Neck 23.10 (2001): 830-835. ↩

Last updated October 24, 2022