Paradigm shifts in the management of osteoradionecrosis of the mandible

Jacobson, Adam S.; Buchbinder, Daniel; Hu, Kenneth; Urken, Mark L.

doi:10.1016/j.oraloncology.2010.08.007

Cited by 172 publications

(191 citation statements)

References 38 publications

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“…If there was an orocutaneous fistula, or large soft tissue loss, primary closure or softtissue reconstruction is accomplished during this surgery. HBOT is continued for another 10 treatments [5][6][7].…”

Section: Discussionmentioning

confidence: 99%

“…Its muscle tissue is considered particularly resistant to infection and plate exerted pressure [17]. When a free tissue transfer is not feasible, a viable treatment option supported by many authors is the use of the PMMC flap wrapped around an AO reconstruction plate for mandibular reconstruction to precisely bridge the mandibular defects [7,[17][18][19][20]. Ease of its application allows a relatively rapid and simple reconstructive option, especially in advanced or palliative cases or where the general condition of the patient does not allow for an extensive microvascular free flap transfer procedure [21].…”

Section: Discussionmentioning

confidence: 99%

“…He hence fell into stage 3 of Marx's classification criteria. While HBOT remains a part of the treatment, aggressive surgical resection of all diseased hard and soft tissue and immediate reconstruction with free tissue transfer has been suggested for stage 3 disease [6,7].…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic Features and Management Strategy of a Refractory Case of Osteoradionecrosis of the Mandible: Case Report and Review of Literature

Jeyaraj¹,

Bandyopadhyay

2015

J. Maxillofac. Oral Surg.

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Introduction Osteoradionecrosis of the jaws produces a considerable amount of esthetic as well as functional deficits seriously affecting quality of life of the patient. Cases are often notoriously difficult to treat and manage owing to associated comorbidities of the patient, post irradiation fibrosis and decreased vascularity at the site, which complicates free tissue flap and graft transfer, that subsequently succumb to failure. Hyperbaric oxygen therapy (HBOT), in which 100 % oxygen is administered by mask under 2.4 atm pressure, in a hyperbaric oxygen chamber, helps by increasing local vascularity. Aim and Methods It was the aim of this study to show that a particularly refractory, compromised and challenging case of osteoradionecrosis can be managed successfully even without HBOT, by mandibular segmental resection followed by reconstruction using a titanium reconstruction plate enveloped within a pedicled Pectoralis Major Myocutaneous flap. Result Post operative recovery of the patient was excellent with good functional and esthetic rehabilitation of the patient with and practically nil donor site morbidity. Conclusion It is important to have a thorough knowledge of the clinical, radiographic, histopathologic, CT and MRI features of osteoradionecrosis of the jaws in order to make a quick and accurate confirmatory diagnosis and to overcome possible diagnostic dilemmas. The strategy of reconstruction of a large mandibular defect using a bridging titanium plate sandwiched by a healthy vascularized myocutaneous flap, following ablative surgery for ORN, has proved to be a safe and reliable option for composite mandibular defects, with gratifying long term functional and cosmetic results.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Diagnostic Features and Management Strategy of a Refractory Case of Osteoradionecrosis of the Mandible: Case Report and Review of Literature

Jeyaraj¹,

Bandyopadhyay

2015

J. Maxillofac. Oral Surg.

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“…[5].Intensity Modulated Radiotherapy (IMRT), brachytherapy, helical tomotherapy could be the next advance in reducing rate of ORN. [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.…”

Section: Discussionmentioning

confidence: 99%

“…The replacement of the dead bone with a vascularised bone-containing flap will allow for restoration of the mandibular continuity and provide non irradiated soft-tissue coverage with blood supply. [6,8] There are other novel innovations in management of ORN which are 1200 mg/d pentoxifylline (PTX) for 6 months, combination of PTX and tocopherol (vitamin E). PTX is an antioxidant methylxanthine derivative with an anti-tumor necrosis factor effect.…”

Section: Discussionmentioning

confidence: 99%

Bilateral Osteoradionecrosis of Mandible: A Case Report

Mantri¹,

Munde²,

Shoeb³

et al. 2014

IJIRSET

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Osteoradionecrosis (ORN) defines exposed irradiated bone, which fails to heal over a period of 3-6 months without evidence of residual or recurrent tumor. It is a long term and serious complication of therapeutic radiotherapy for head and neck cancer. The pathogenesis of ORN has been proposed relating it to a fibroatrophic mechanism including free radical formation, endothelial dysfunction, inflammation, microvascular thrombosis leading to bone and tissue necrosis. Risk factors mainly include radiation related risk factors, surgery, tobacco and alcohol abuse. Removing of diseased teeth after radiotherapy is generally considered the main risk factor in ORN. Prevention of ORN is based on the preventive extractions of decayed or periodontally compromised teeth before radiotherapy. Based on the clinical staging various therapeutic protocols have been suggested. We here report a case of Bilateral mandibular ORN with discussion of clinical features, pathogenesis, preventive measures, and management of ORN.

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Primary vs Secondary Endosseous Implantation After Fibular Free Tissue Reconstruction of the Mandible for Osteoradionecrosis

Menapace

Abel

Jackson

et al. 2018

JAMA Facial Plast Surg

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The clinical and financial implications of the timing of dental rehabilitation after a fibula free tissue transfer (FFTT) for osteoradionecrosis (ORN) and osteonecrosis (ON) of the mandible have yet to be established. OBJECTIVE To compare the outcomes of primary implantation vs secondary implantation after FFTT for ORN and ON of the mandible. DESIGN, SETTING, AND PARTICIPANTS A retrospective review was conducted of 23 patients at a single tertiary academic referral center undergoing primary implantation or secondary implantation after FFTT for ORN and ON from January 1, 2006, to November 10, 2015. INTERVENTIONS All patients underwent FFTT with primary implantation (n = 12) or secondary implantation (n = 11). MAIN OUTCOMES AND MEASURES Outcomes of FFTT, dental implantation, implant use, diet, speech, and disease-free survival were reviewed. Fixed unit costs were estimated based on the mean cost analysis. RESULTS Twenty-three patients (7 women and 16 men; mean [SD] age, 62.4 [8.2] years [range, 24-81 years]) met the inclusion criteria. Of these, 18 had ORN and 5 had ON. Dental implantation was performed at the time of FFTT for 12 patients and was performed secondarily for 11 patients. There were a mean of 5.2 implants per patient performed, for a total of 121 implants. There was 1 complete flap failure in the primary implantation group. Neither flap nor implant complications were affected by the timing of the implantation. Overall, the implant survival rate was 95% (55 of 58) in the primary implantation group and 98% (62 of 63) in the secondary implantation group. Time from FFTT to abutment placement (primary implantation, 19.6 weeks; secondary implantation, 61.0 weeks) was significantly shorter after primary implantation (P < .001). There was no clinical difference in postoperative complications and implant outcomes for ORN vs ON. Improvement in speech and oral competence in the primary implantation group vs the secondary implantation group was not statistically significant, given an experiment-adjusted P = .001 set as significant (normal speech, 9 vs 3; P = .02; and normal oral competence, 9 vs 3; P = .02). Disease-free survival was 91% (20 of 22 patients) overall. Fixed unit (U) costs were 1.0 U for primary implantation and 1.24 U for secondary implantation. CONCLUSIONS AND RELEVANCE Patients undergoing primary implantation after FFTT for ORN and ON had a similar rate of complications compared with those undergoing secondary implantation. However, primary implantation allowed a faster return than secondary implantation to oral nutrition and prosthesis use. The fixed unit cost was reduced for those undergoing primary implantation. Although dental implantation was safe and effective in both groups, the decreased time to use and the decreased overall cost should prompt surgeons to consider primary implantation after FFTT for ORN and ON. LEVEL OF EVIDENCE 3.

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Paradigm shifts in the management of osteoradionecrosis of the mandible

Cited by 172 publications

References 38 publications

Diagnostic Features and Management Strategy of a Refractory Case of Osteoradionecrosis of the Mandible: Case Report and Review of Literature

Diagnostic Features and Management Strategy of a Refractory Case of Osteoradionecrosis of the Mandible: Case Report and Review of Literature

Bilateral Osteoradionecrosis of Mandible: A Case Report

Primary vs Secondary Endosseous Implantation After Fibular Free Tissue Reconstruction of the Mandible for Osteoradionecrosis

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