Osteoradionecrosis—A review of current concepts in defining the extent of the disease and a new classification proposal

Lyons, Andrew; Osher, Jona; Warner, Elinor; Kumar, Ravi; Brennan, Peter A.

doi:10.1016/j.bjoms.2014.02.017

Cited by 86 publications

(74 citation statements)

References 15 publications

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“…Bone that is closest to the tumour being irradiated is the most susceptible to ORN 1. Surgeries such as osteotomy and mandibular resection can be used to debulk the tumour; these procedures, as well as procedures that occur after RT, including dental extraction due to poor oral hygiene, increase the risk of ORN 1 2…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, recent treatment protocols have begun implementing these agents and have shown promising results. Multiple studies have shown that with conservative medical treatment (eg, pentoxifylline, vitamin E and antibiotics), progression past early stage ORN is rare 2 20 21. Furthermore, treatment initiated within a few days of bone exposure provides the greatest results 2…”

Section: Discussionmentioning

confidence: 99%

“…Recently, Lyons2 proposed a four-stage system in which treatment with pentoxifylline, vitamin E and antibiotics cured stage 1 ORN (disease involving <2.5 cm of bone in asymptomatic patients) and halted progression of stage 2 ORN (disease involving >2.5 cm bone in asymptomatic patients). Individuals in stage 3 ORN (disease involving >2.5 cm of bone in symptomatic patients) required debridement, while stage 4 ORN (presence of fracture or fistula, or evidence of inferior dental nerve injury) warranted reconstruction with free flap 2…”

Section: Discussionmentioning

confidence: 99%

“…Significant risks exist with traditional open resection, which can potentially worsen the patient's condition; inflamed, irradiated tissue and bone are unpredictable and slow to heal 2. Our patient was successfully treated with a transoral endoscopic ultrasonic resection of the hyoid bone, which minimises collateral damage to surrounding structures 4–7…”

Section: Introductionmentioning

confidence: 94%

“…The overlying skin or mucosa may or may not be intact 2. It is an important and serious complication of radiation therapy (RT) performed for the treatment for head and neck cancers.…”

Section: Introductionmentioning

confidence: 99%

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Osteoradionecrosis of the hyoid bone – a novel application of the Sonopet ultrasonic aspirator

Gill

Joshi

2014

BMJ Case Reports

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A 66-year-old man with a history of squamous cell carcinoma of the right tonsil presented to the emergency department with two life-threatening episodes of haemoptysis 9 months after completion of chemoradiation. He was evaluated to rule out recurrent malignancy, and was determined to have osteoradionecrosis of his hyoid bone that had led to an oropharyngeal fistula. Given the proximity to branches of the external carotid, he was offered tracheostomy and resection of the protruding necrotic bone with ultrasonic bone aspirator, which was placed down the shaft of the laryngoscope to minimise damage to adjacent structures. He tolerated the procedure well with complete resolution of exposed bone on follow-up laryngoscopy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 94%

“…The overlying skin or mucosa may or may not be intact 2. It is an important and serious complication of radiation therapy (RT) performed for the treatment for head and neck cancers.…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Osteoradionecrosis of the hyoid bone – a novel application of the Sonopet ultrasonic aspirator

Gill

Joshi

2014

BMJ Case Reports

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Rates of osteoradionecrosis in resected oral cavity cancer reconstructed with free tissue transfer in the intensity‐modulated radiotherapy era

Hong

Fritz

et al. 2023

Head & Neck

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Background: Resected oral cavity carcinoma defects are often reconstructed with osteocutaneous or soft-tissue free flaps, but risk of osteoradionecrosis (ORN) is unknown. Methods: This retrospective study included oral cavity carcinoma treated with free-tissue reconstruction and postoperative IMRT between 2000 and 2019.Risk-regression assessed risk factors for grade ≥2 ORN. Results: One hundred fifty-five patients (51% male, 28% current smokers, mean age 62 ± 11 years) were included. Median follow-up was 32.6 months (range, 1.0-190.6). Thirty-eight (25%) patients had fibular free flap for mandibular reconstruction, whereas 117 (76%) had soft-tissue reconstruction.Grade ≥2 ORN occurred in 14 (9.0%) patients, at a median 9.8 months (range, 2.4-61.5) after IMRT. Post-radiation teeth extraction was significantly associated with ORN. One-year and 10-year ORN rates were 5.2% and 10%, respectively.

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Comparison of surgical outcomes between primary plate and fibular flap transfer for reconstruction of segmental mandibular defects

2021

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Purpose Although two ways of reconstruction have been reviewed for a long period, comparison of large sample size with nearly randomized patient selection is rare. Here, we compare the surgical outcomes of these two methods from two large medical institutes. Methods Totally 176 patients were included from two medical centers with different protocols, 62 patients from MacKay Hospital repair defects with fibula flaps using reconstruction plates. Also 114 patients from Kaohsiung ChangGung Hospital treat with reconstruction plates combine anterior lateral thigh flaps, in which 12 cases had secondary fibula flap after plate exposure. Electronic medical records were reviewed retrospectively. Short (3–12 months) and long‐term (>12 months) outcomes were evaluated. Results Short‐term evaluation revealed that the secondary fibula had a higher rate of vascular complications (33 vs. 6%, p = .02). Primary fibula had a higher risk of post reconstructive surgical debridement (60 vs. 40%, p = .018). Long‐term follow‐up revealed radiation therapy significantly worsened bone healing (p = .03). Primary fibula had a lower rate of screw loosening (14.0 vs. 40.3%, p = .002). Radiation therapy did not increase the plate exposure rate among the groups (33 vs. 27%, p = .389). Disease free survival showed no significant difference between two groups (53.1 ± 3.5 vs. 47.8 ± 2.8 months, p = .317). Conclusion Primary fibula reconstruction should be considered whenever possible to reduce the risk of late complications and simplifies the management after a potential plate exposure. Notably, radiation therapy apparently has no significant effect on plate exposure rate both in ALT or fibula groups.

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Osteoradionecrosis—A review of current concepts in defining the extent of the disease and a new classification proposal

Cited by 86 publications

References 15 publications

Osteoradionecrosis of the hyoid bone – a novel application of the Sonopet ultrasonic aspirator

Osteoradionecrosis of the hyoid bone – a novel application of the Sonopet ultrasonic aspirator

Rates of osteoradionecrosis in resected oral cavity cancer reconstructed with free tissue transfer in the intensity‐modulated radiotherapy era

Comparison of surgical outcomes between primary plate and fibular flap transfer for reconstruction of segmental mandibular defects

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