Incidence of osteoradionecrosis following oral and maxillofacial surgery in irradiated head and neck cancer patients

Abstract

Aim The aim of this study was to investigate the incidence of osteoradionecrosis following various surgical procedures, including tooth extraction, periodontal surgery, pre‐prosthetic surgery, removal of bone spicules and removal of bone reconstruction/osteosynthesis plates. Material and methods The charts of 68 patients who had undergone post‐radiotherapy surgical procedures were reviewed. The following information was obtained: gender, age, radiotherapy dose and field, type of surgical procedure and time between the end of radiotherapy and the surgical procedure. Results Osteoradionecrosis developed in 14 patients and did not statistically correlate with gender, radiotherapy dose and field or time between the end of radiotherapy and the surgical procedure. Removal of bone spicules was significantly associated with osteoradionecrosis (P = 0.033), compared with tooth extraction, pre‐prosthetic surgery, removal of reconstruction/osteosynthesis plates and periodontal surgery. Conclusions Our findings show removal of bone spicules is a significant risk factor for the development of osteoradionecrosis, suggesting that careful evaluation and management of spicules in previously irradiated patients is particularly important in the prevention of osteoradionecrosis.

Manejo multimodal para reabilitação oral de paciente irradiado em cabeça e pescoço: relato de caso

“…No presente caso clínico, o tratamento de escolha para o dente 27 foi a exodontia, já que a perda óssea avançada inviabilizava qualquer outro tratamento menos invasivo. Como possíveis medidas para a prevenção de osteorradionecrose baseadas em uma outra teoria que propõe infecção subsequente à trauma local em osso previamente exposto à radiação (Dhanda et al, 2016), prescreveu-se antibioticoterapia pós-operatória (Al-Bazie et al, 2016;de Menezes et al, 2014;Maxymiw et al, 1991) associada à terapia fotodinâmica antibacteriana (Campos et al, 2015). Esta terapia foi aplicada já que possui relatos bastante promissores na prevenção e tratamento da osteorradionecrose, além de não-invasiva.…”

Osteonecrosis of the jaws: a 14‐year retrospective survey of hospital admissions

“…It is defined as an area of exposed bone in the maxillofacial region that does not heal within 8 weeks after identification by a health care provider, in a patient who has received antiresorptive or antiangiogenic agents with no history of radiation or metastatic disease to the jaws . The exact pathogenesis of both diseases remains controversial despite extensive research, although a number of treatment‐related and patient‐specific risk factors have been implicated as possible contributors …”