Osteoradionecrosis of the mandible: A case series at a single institution

Abstract

BackgroundOsteoradionecrosis (ORN) defines exposed irradiated bone, which fails to heal over a period of 3–6 months without evidence of residual or recurrent tumor. In the previous decades, a staging and treatment protocol suggested by Marx, has dominated the approach to ORN. However, recently this paradigm is shifting. The purpose of this study was to evaluate our institutional experience in managing ORN through a retrospective review of case series from a large urban academic cancer centre.MethodsA retrospective chart review was conducted to include all ORN cases from 2003 to 2009 diagnosed at the Department of Otolaryngology – Head and Neck Surgery and the Department of Dentistry. The staging of ORN was assessed as affected by tumor site, tumor stage, radiotherapy modality and dose, chemotherapy, dental work, and time to diagnosis. The effectiveness of hyperbaric oxygen therapy (HBO) and surgery in the management of ORN was evaluated.ResultsFourteen cases of ORN were documented (incidence 0.84%). Primary subsites included tonsils, tongue, retromolar trigone, parotid gland, soft palate and buccal mucosa. There were 5 (35.7%) stage 1, 3 (21.4%) stage 2, and 6 (42.9%) stage 3 cases. ORN severity was not significantly associated with gender, smoking, alcohol use, tumor site, T stage, N stage, AJCC stage, or treatment modality (radiation alone, surgery with adjuvant radiation or adjuvant chemoradiation). Patients treated with intensity-modulated radiotherapy developed less severe ORN compared to those treated with conventional radiotherapy (p < 0.015). ORN stage did not correlate with radiation dose. In one patient only dental procedures were performed following radiation and could be implicated as the cause of ORN. HBO therapy failed to prevent ORN progression. Surgical treatment was required for most stage 2 (partial resections and free tissue transfers) and stage 3 patients (mandibulectomies and free tissue transfers, including two flaps in one patient). At an average follow up of 26 months, all patients were cancer-free, and there was no evidence of ORN in 84% of patients.ConclusionsIn early ORN, we advocate a conservative approach with local care, while reserving radical resections with robust reconstruction with vascularized free tissue for advanced stages.

Osteoradionecrosis of the mandible: A ten year single-center retrospective study

“…The majority of studies dealing with ORN have focused on risk factors associated with the causation of ORN (Morrish et al, 1981, Kluth et al, 1988, Jereczek-Fossa and Orecchia, 2002, Reuther et al, 2003, Gomez et al, 2011, Niewald et al, 2013, Tsai et al, 2013. To our knowledge, only four studies were found dealing with the severity of ORN (Store and Boysen, 2000, Notani , Chopra et al, 2011, Gevorgyan et al, 2013. They either consisted of a small sample size (Gevorgyan et al, 2013) or focused on the severity of ORN proposing new classification systems or modalities of therapy (Store andBoysen, 2000, Notani et al, 2003).…”

Manejo terapêutico e preventivo da osteorradionecrose: revisão integrativa da literatura

“…5,14,16 Em relação aos cuidados locais, nenhum dos artigos selecionados especificou como esses cuidados foram realizados. Na literatura essa abordagem é diversa, com utilização de digluconato de clorexidina e iodopovidona para limpeza das feridas.…”

Bilateral Osteoradionecrosis of Mandible: A Case Report

“…[6,7] Diseased tooth extractions (odontogenic and periodontal disease), denture trauma after irradiation, [8] abuse of alcohol and tobacco are also considered as risk factors for ORN. [6,9] Other factors associated with ORN are location of primary tumor in tongue, floor of mouth, alveolar ridge, reteromolar trigone, tonsil, stage III/IV cancer, doses above 60Gy of radiation, poor nutritional status which could affect wound healing. Prevention of ORN is an extremely important part of the comprehensive management of patients who undergo external beam radiation therapy to the head and neck.…”