Temporal Bone Osteoradionecrosis: An 18‐year, Single‐Institution Experience

Abstract

Objectives/Hypothesis: To report the largest single-institution review of temporal bone osteoradionecrosis (TBORN), and characterize the disease's natural history, prognostic factors, management, and outcomes.Study Design: Retrospective chart review. Methods: Retrospective review was conducted to identify patients with TBORN. Pertinent data were extracted. Descriptive statistics were used to summarize patient, tumor, and treatment characteristics. Multivariable analyses were conducted to explore associations between these characteristics and time to TBORN diagnosis and risk of developing diffuse disease.Results: TBORN was identified in 145 temporal bones from 128 patients. Mean age at diagnosis was 62 years, and mean time to diagnosis after radiotherapy was 10 years. Age greater than 50 years was associated with earlier diagnosis. According to the Ramsden criteria, 76% of TBs had localized and 24% had diffuse disease at initial diagnosis; 37% had diffuse disease at last follow-up. On multivariable analysis, diabetes, three-dimensional conformal radiotherapy (3D-CRT), and periauricular skin malignancy were significant risk factors for developing diffuse disease. Localized disease was successfully managed with conservative measures, whereas surgery was often necessary for diffuse disease. When TBORN spread outside the mastoid or infratemporal fossa, conservative measures were always unsuccessful.Conclusions: TBORN occurs earlier in older patients. While diffuse disease is less common than localized disease, it occurs more frequently in patients with diabetes, history of 3D-CRT, and periauricular skin malignancies. Conservative management is appropriate for localized disease, while surgery is often necessary for diffuse disease. The prognostic factors identified helped propose a TBORN staging system and treatment guidelines which may improve patient risk stratification and disease management.

Bilateral diffuse temporal bone osteoradionecrosis: a diagnostic and therapeutic challenge

“…whereas for diffuse disease, conservative treatment was successful in only 19% but surgery was successful in 87% (89% for lateral temporal bone resection with mastoid obliteration and 100% for mastoidectomy without mastoid obliteration) and produced disease resolution in 91% of the cases. 11 In our patient, the surgical treatment was considered successful with adequate symptoms control bilaterally (100%) and produced disease resolution on the left side with complete skin coverage over all previously exposed bone, at last follow-up (even considering the right facial palsy sequel).…”

Anterior Skull Base Osteoradionecrosis in the Age of Intensity-Modulated Radiation Therapy: A Case Series

“…ORN most likely develops because XRT causes hypocellularity, hypovascularity, and abnormal osteoblast and osteoclast activity, leading to ischemic necrosis [8][9][10] . In Otolaryngology, the most common ORN site is the mandible;however, ORN has also occurred in the anterior, central, and lateral skull base 1,[5][6][7][11][12][13][14] .…”

“…[8][9][10] In otolaryngology, the most common ORN site is the mandible; however, ORN has also occurred in the anterior, central, and lateral skull base. 1,[5][6][7][11][12][13][14] Timely diagnosis and treatment of skull base ORN can prevent complications such as internal carotid artery bleeding, meningitis, cerebrospinal fluid leaks, pathologic fractures, and more. 2,6,15,16 Treatment strategies include antibiotics, hyperbaric oxygen (HBO), pentoxifylline and tocopherol, and surgical intervention.…”