Osteoradionecrosis beyond the jaws: a mini case series and review of the literature

Wali, Rana; King, Richard M.; Patel, Vinod

doi:10.1111/ors.12459

Cited by 10 publications

(11 citation statements)

References 36 publications

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“…Worryingly, maxillofacial bones beyond the jaw have also been found to develop ORN even with IMRT. 30 RT dose is a well-recognised risk factor 10,31 and replicated in the current study (p = 0.007) particularly highlighting the OPC group in the 55-65 Gy and to a lesser degree the OCC group of the same dose. These finding align with those of Owosho et al 31 who found that 96% of ORN sites in their patients had been exposed to an average of 57.5 Gy while a number of studies highlighted the involvement of the jaws during RT delivery 28,29,[32][33][34] in this tumour group.…”

Section: Discussionsupporting

confidence: 76%

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Risk factors associated with osteoradionecrosis

et al. 2021

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Osteoradionecrosis (ORN) of the jaws is a serious and complex late effect following the use of radiotherapy (RT) for the management of head and neck cancer (HNC). The condition is still regularly seen even with the recommended dental guidance 1,2 highlighting active measures for prevention. This approach has seen a reduction in ORN but not eliminated it with an overall estimated risk of 5% still evident. 3 Its continual occurrence and the inability to guarantee a cure reflect the limited understanding of the condition and subsequent provision of an effective management. Both have seen an evolution via hypothesis and treatment proposed. Meyer's infection theory 4 and antimicrobial treatment were replaced by Marx's 3H theory and the use of hyperbaric oxygen therapy 5 which has now been superseded by Delanian & Lefaix's radiation-induced fibrosis (RIF) model treated via a pharmacological approach (pentoxifylline-tocopherol-clodronate

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Section: Discussionsupporting

confidence: 76%

“…Interestingly, recent studies have shown that IMRT may in fact irradiate a larger area of the jaws 28,29 placing a wider span at risk of ORN. Worryingly, maxillofacial bones beyond the jaw have also been found to develop ORN even with IMRT 30 …”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with osteoradionecrosis

et al. 2021

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“…18,19 It is argued that with IMRT all areas of the mouth become a target for some degree of exposure which explains the late effects not often seen previously. 20,21 Traditionally ORN has been associated maximum RT doses >60 to 75 Gy 6,15 ; however, it is now conceded that doses exceeding in the range of 30-40 Gy place patients at "at risk" of ORN. 22,23 There remains no international agreement on how to incorporate the predicted dose of radiation a dental unit will receive into the pre-treatment plan largely based upon the lack of knowledge at this level.…”

Section: Discussionmentioning

confidence: 99%

Dentoalveolar radiation dose following IMRT in oropharyngeal cancer—An observational study

Patel

Humbert-Vidan

Thomas

et al. 2021

Special Care in Dentistry

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Objectives: This observational study aims to determine individual dental doses in oropharyngeal cancer (OPC) patients managed by intensity modulated radiation treatment (IMRT).Materials and methods: OPC patients treated with IMRT had each tooth individually contoured on post-IMRT CT scans. The mean, maximum and minimum doses were calculated per tooth-based upon patient and tumor demographics (tumor size and nodal status). Results: A total of 160 patients were included in this study. Escalating tumor size and nodal status led to an observed increase in Dmean doses to the dentition on the contralateral tumor side. A significant region in both jaws received >30 Gy in this tumor group. Conclusion: Tumor demographics were observed to influence RT doses to the dentition and need to be considered when providing a pre-RT dental assessment. The observed dose of >30 Gy in large spans of the dentition and jaws highlights future risk of dental deterioration and ORN with long term survival.

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“… 5 Signs and symptoms of ORN include an area of exposed necrotic bone, numbness, abnormal mouth opening, orocutaneous fistula, and pain in the jaw area, which might also extend beyond the jaws. 8 Therefore, dental assessment before starting the treatment with radiotherapy for HNC patients is crucial. 9 This includes patient education about possible side effects of cancer therapy, prescription of a high fluoride-containing toothpaste, and dental extraction of teeth with a poor prognosis, which helps to reduce the need for dental extraction in HNC survivors post-radiotherapy, thereby reducing the risk of ORN.…”

Section: Introductionmentioning

confidence: 99%

The role of exercise therapy in managing post-radiotherapy trismus in head and neck cancer

Ezzat

Sharka

Huzaimi

et al. 2021

Journal of Taibah University Medical Sciences

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Trismus is a post-radiotherapy complication that affects survivors of head and neck cancers. It is described as the reduction of mouth opening to less than 35 mm. The condition is a progressive process; hence early intervention is crucial to prevent further damage and weakness to the elevator muscles of the mandible. Here, we report a 40-year-old woman with known squamous cell carcinoma of the maxillary sinus in stage T3N0M0 who had undergone upper right partial maxillectomy with subsequent 33 fractions of radiotherapy (66 Gy; intensity-modulating radiotherapy). Five months post-radiotherapy, the patient showed interest in replacing her missing teeth to restore her oral functions and facial appearance. At her post-radiotherapy visit in the dental assessment clinic, she showed a mouth opening of 12 mm. The TheraBite® Jaw Motion Rehabilitation System™ and wooden tongue depressors were alternatively used for 6 weeks (4–5 stretches/day; each stretch held for 15 s). Mouth opening gradually increased to 20 mm. Consequently, a definitive obturator prosthesis was fabricated using computer-aided design and computer-aided manufacturing technologies with the 3Shape D900 model scanner. These were challenging and time-consuming steps, but acceptable facial appearance and mouth opening were restored for the patient. This case suggests that Therabite® Jaw Motion Rehabilitation System TM and wooden tongue depressors help to increase mouth opening significantly if used together and alternatively.

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Osteoradionecrosis beyond the jaws: a mini case series and review of the literature

Cited by 10 publications

References 36 publications

Risk factors associated with osteoradionecrosis

Risk factors associated with osteoradionecrosis

Dentoalveolar radiation dose following IMRT in oropharyngeal cancer—An observational study

The role of exercise therapy in managing post-radiotherapy trismus in head and neck cancer

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