Andrea Costantino, Bianca Maria Festa, Filippo Marchi, Chung‐Kan Tsao, Raul Pellini, Luca Gazzini, Peter T. Dziegielewski, M Ciniglio, Francesco Mazzola, Luca Calabrese, Antonio Sarno, Giampiero Parrinello, Linda Chow, Jyh‐Kwei Chen, Giorgio Peretti, Armando De Virgilio
BACKGROUND: Osteoradionecrosis (ORN) is a severe complication following radiotherapy (RT), particularly after mandibular reconstruction with a fibula free flap. Risk prediction remains challenging due to limited data. METHODS: We conducted a multicenter retrospective study including 294 patients who underwent fibula free flap reconstruction and adjuvant RT. A predictive nomogram for ORN was developed using logistic regression with stepwise backward selection, validated via 10-fold cross-validation. RESULTS: ORN occurred in 9.9% of patients. Eight variables were retained in the final model, which demonstrated excellent discrimination (AUC = 0.94) and good calibration (mean absolute error = 0.017). The optimal threshold for classification was 0.30, with the model achieving a sensitivity of 1.0, specificity of 0.80, and an overall accuracy of 0.82. CONCLUSION: This is the first nomogram developed to predict ORN following fibula free flap mandibular reconstruction. It provides a personalized risk estimate, supporting individualized clinical decision-making and improved pre- and postoperative planning. Prospective validation is warranted.