Osteoradionecrosis of the Temporal Bone

Abstract

Objective To study osteoradionecrosis (ORN) of the temporal bone Study Design Retrospective case review Setting Academic medical center Patients Patients were included who had previously undergone radiation to the head and neck and then developed exposed necrotic bone within the ear canal that persisted at least three months Intervention(s) Patients were treated with a variety of modalities, including conservative therapy with antibiotic ear drops and in-office debridements, hyperbaric oxygen therapy and surgery. Main Outcome Measure(s) To describe the presentation and management of patients with temporal bone osteoradionecrosis. Results 33 patients with temporal bone osteoradionecrosis were included. The most common site of primary tumor was the parotid gland (n=11), followed by the nasopharynx (n=7). The time to development of ORN varied between 1 and 22 years, with mean 7.9 years. The mean radiation dose was 62.6 Gy to the primary tumor, 53.1 Gy to the affected temporal bone, and 65.2 Gy to the affected tympanic bone. The most common symptoms of ORN were otorrhea (n=15), hearing loss (n=13), and otalgia (n=12). 15 patients had bacterial superinfection, most commonly S. aureus (n=9). Conservative therapy was successful at managing symptoms but not in eradicating exposed bone in most patients. Surgery was used for recalcitrant pain, infection, cholesteatoma, cranial neuropathies, and intracranial complications. Conclusions Osteoradionecrosis is a rare complication of radiation to the temporal bone. Management should be aimed at relief of symptoms, eradication of superinfection, and treatment of other commonly present radiation effects like cholesteatoma and hearing loss.

Clinical Practice Guideline (Update): Earwax (Cerumen Impaction)

“…The onset of ORN of the temporal bone appears to be correlated with the radiation dose to the temporal bone itself, not the target, and may range from 1 year to decades posttreatment. 56 Radiation to the parotid gland, nasopharynx, and preauricular skin are noted in 2 contemporary case series as the most common radiation targets leading to ORN of the temporal bone. 56,57 The presence of dermatologic conditions such as eczema, seborrheic dermatosis, and ectodermal dysplasia can complicate management of cerumen.…”

“…56 Radiation to the parotid gland, nasopharynx, and preauricular skin are noted in 2 contemporary case series as the most common radiation targets leading to ORN of the temporal bone. 56,57 The presence of dermatologic conditions such as eczema, seborrheic dermatosis, and ectodermal dysplasia can complicate management of cerumen. While data are limited, these conditions can increase the frequency of cerumen impaction and the risk of otitis externa if present.…”

Pentoxifylline‐tocopherol‐clodronate combination: A novel treatment for osteoradionecrosis of the temporal bone

“…ORN is caused by tissue hypoxia from radiation‐induced vascular compromise . Patients with ORN of the temporal bone typically have local symptoms, such as pain, otorrhea, conductive hearing loss, trismus, infections (eg, osteomyelitis, cellulitis, systemic infection), and cranial neuropathies . Patients with ORN will have exposed bone and the presentation may mimic that of cancer recurrence, therefore, biopsy may be indicated …”

“…These patients, in particular, may have delayed healing, cosmetic defects, and require free tissue transfer depending on the extent of their disease. A stepwise management paradigm has been proposed by Sharon et al in which patients who fail conservative measures may go on to more invasive procedures; however, PENTOCLO therapy may afford patients another conservative treatment option before these procedures are required.…”

Mucoepidermoid Carcinoma of the Parotid: Very Close Margins and Adjuvant Radiotherapy

“…In addition, although occurring in less than 10% of cases, late radiation-related toxicity can be severe and debilitating. The most common of these late complications appears to be ototoxicity, due to either sensorineural hearing loss or temporal bone osteoradionecrosis [5, 15]. Severe xerostomia may occur but can be lessened by reducing radiation dose to the contralateral parotid and submandibular glands [16-18].…”