In the wake of new drugs that have been introduced for ORN like pentoxifylline, tocopherol, clodronate etc, traditional ‘conservative’ management of osteoradionecrosis (ORN) including minimal surgical debridement and hyperbaric oxygen therapy (HBOT) is under review. This study is a retrospective review of treatment outcomes of ORN of the mandible with specific reference to the evolving role of medical management with pentoxifylline (400mg twice daily), tocopherol (1000IU/mg/day) and doxycycline (100mg daily). The authors reviewed the presentation and management of 71 patients treated for ORN of the mandible at the regional head and neck unit during a 15-year period, and categorised them into three grades using the Notani classification: grade I (n=28), grade II (n=16), and grade III (n=27). Twelve patients with grade I ORN, three with grade II, and 10 with grade III, were prescribed medical treatment. Of these, three with grade I, and two with grade II ORN were cured, and progression of the disease had halted and there was satisfactory control of symptoms in eight with grade I and four with grade III disease. Patients who failed to respond to conservative treatment were further analysed for the need for free flap reconstruction. Medical management was introduced as a standard treatment after January 2006. Of the 39 patients diagnosed before this, 20 (51%) required resection and free flap reconstruction compared with only 8/32 (25%) after it had been introduced.