Osteoradionecrosis of the mandible and its treatment

MacDougall, John A.; Evans, Alida M.; Lindsay, R.K.

doi:10.1016/0002-9610(63)90407-0

Cited by 27 publications

(4 citation statements)

References 7 publications

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“…Since higher radiation dosage is associated with was associated with significantly higher incidence of osteoradionecrosis, [26][27][28] we examined the dosage used in the patients, and we found that the radiation dosage did not differ between groups in our study (muscle vs. nonmuscle ¼ 61.6 AE 6.7 vs. 60.7 AE 7.0, p ¼ 0.661, Independent t-test), which was the definitive dosage for oropharyngeal cancer. Trauma or mandibulectomy is a risk for ORN, 10,29 but the defect size was even larger and bone length was even longer in muscle group. Treatment of ORN or osteomyelitis needs multiple treatment modalities, including the combination of administration of antibiotics, surgical debridement of infected bone, and a perforator flap coverage for a better outcome.…”

Section: Discussionmentioning

confidence: 93%

Osteomyocutaneous Free Fibula Flap Prevents Osteoradionecrosis and Osteomyelitis in Head and Neck Cancer Reconstruction

Wang

Liu

Chen

et al. 2021

J Reconstr Microsurg

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Background Osteoradionecrosis (ORN) is one of the most severe complications of free fibula reconstruction after radiotherapy. The gold standard treatment of osteomyelitis involves extensive debridement, antibiotics, and sufficiently vascularized muscle flap coverage for better circulation. Therefore, we hypothesized that free fibula flap with muscle could decrease the risk of ORN. Methods This study consisted of 85 patients who underwent reconstruction with free fibula flap in head and neck cancer by a single reconstructive surgeon at Kaohsiung Veterans General Hospital over a period of 19 years (1998–2016). Patients with postoperative adjuvant radiotherapy were included in the study and were grouped by either free fibula osteocutaneous flap or free fibula osteomyocutaneous flap (with flexor hallucis longus muscle), and the incidence of ORN was compared. Results Of the 85 patients, 15 were reconstructed with osteocutaneous fibula flap and 70 were with osteomyocutaneous fibula flap. The rate of ORN or osteomyelitis was significantly lower in the muscle group (18.6%, n = 13/70 vs. 46.7%, n = 7/15, p = 0.020, Chi-square test). Conclusion Vascularized muscle transfer increases perfusion of surrounding tissues and the bone flap, thereby decreasing the incidence of osteomyelitis or osteonecrosis.

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Section: Discussionmentioning

confidence: 93%

Osteomyocutaneous Free Fibula Flap Prevents Osteoradionecrosis and Osteomyelitis in Head and Neck Cancer Reconstruction

Wang

Liu

Chen

et al. 2021

J Reconstr Microsurg

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“…These imaging features were not associated with the severity of ORN [ 40 , 41 ]. However, in the present study, multivariate analysis indicated that non-sequestration was a risk factor for a poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Treatment Outcomes and Pathological Features in Patients with Osteoradionecrosis: A Retrospective Study

Tadokoro¹,

Hasegawa²,

Takeda³

et al. 2022

IJERPH

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A standard treatment for osteoradionecrosis (ORN) has not yet been established because of the diversity. Therefore, identifying the risk factors for a poor prognosis is essential. This study retrospectively investigated the factors associated with the prognosis of ORN in 68 patients. Relevant clinical data of all patients were obtained. Of the patients, 16 who underwent extensive surgery underwent histopathological analysis. The necrotic changes of the anterior and posterior margins in the cortical and cancellous bones were investigated. Multivariate analyses showed statistically significant associations between poor prognosis in patients with ORN and high radiation dose (hazard ratio [HR] 1.15), orocutaneous fistula (HR 2.93), and absence of sequestration (HR 2.49). Histopathological analysis showed a viable anterior margin of the middle portion of the cortical bone for all recovered cases; in contrast, most cases (75%) with a poor prognosis showed necrotic changes. The anterior margin of the cancellous bone was viable and resilient to high irradiation, regardless of the prognosis. These results suggest that patients with orocutaneous fistula should receive early surgical intervention, even if the affected area is limited or asymptomatic. In extensive surgery, a sufficient safety margin of necrotic bone, particularly in the anterior region, is required to improve the prognosis.

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“…Mandibular osteoradionecrosis (ORN) is a serious complication of radiation therapy for neoplasms of the oral cavity, oropharynx, nasopharynx, and parotid gland, with a varying reported incidence of 5% to 22% [9, 11, 18, 19]. The higher incidence of mandibular involvement has been attributed to its lower blood supply compared with the maxilla and the compact bone structure [11, 20].…”

Section: Osteoradionecrosismentioning

confidence: 99%

Imaging of the Head and Neck following Radiation Treatment

Debnam

2011

Pathology Research International

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Squamous cell carcinoma of the head and neck occurs in approximately 40,000 patients annually in the United States and is often treated with radiation therapy. Radiological studies are obtained following treatment for head and neck malignancies to assess for recurrent tumor, posttreatment changes, and associated complications. Radiation treatment creates a difficult clinical picture for oncologists, head and neck surgeons, neuroradiologists, and neuropathologists. As post-treatment imaging studies are often discussed at radiology/pathology working conferences, knowledge of the imaging appearance of radiation-associated changes in the head and neck and the terminology used by neuroradiologists may not only aid in interpretation of the pathologic specimen, but also assist in communications with neuroradiologists and referring clinicians.

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Osteoradionecrosis of the mandible and its treatment

Cited by 27 publications

References 7 publications

Osteomyocutaneous Free Fibula Flap Prevents Osteoradionecrosis and Osteomyelitis in Head and Neck Cancer Reconstruction

Osteomyocutaneous Free Fibula Flap Prevents Osteoradionecrosis and Osteomyelitis in Head and Neck Cancer Reconstruction

Factors Associated with Treatment Outcomes and Pathological Features in Patients with Osteoradionecrosis: A Retrospective Study

Imaging of the Head and Neck following Radiation Treatment

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