Although Marx’s treatment protocol provides a framework for
managing ORN, the concept of determining a patient’s disease
stage based on their response to treatment is very different from
how surgeons are conditioned to treat diseases of the head and
neck. In the treatment of head and neck cancer we utilize physical
examination findings and a variety of different imaging techniques
to stage the disease prior to formulating a treatment plan. It is the
stage of disease that dictates the treatment options for each patient.
In the contemporary management of ORN, we now utilize
imaging and physical exam findings to stage the disease and then
formulate the best possible treatment plan for each individual patient.
Hence, Marx’s treatment protocol remains an important contribution
to the treatment of ORN, but the current approach has
shifted to staging the disease first and then developing a treatment
plan.