The value of reconstructive surgery in the management of refractory jaw osteoradionecrosis: a single-center 10-year experience

Bettoni, Jérèmie; Olivetto, M.; Duisit, Jérôme; Caula, Alexandre; Testelin, Sylvie; Dakpe, Stéphanie; Lengelé, Benoît; Devauchelle, Bernard

doi:10.1016/j.ijom.2019.06.007

Cited by 19 publications

(14 citation statements)

References 28 publications

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“…Thus, surgical treatment combined with antibiotic therapy is crucial even for early ORNJ stages. As reported by other studies, advanced ORNJ stages have poorer curing rate after surgical treatment [3,26]. In the present study, a signi cant correlation has been observed between the ORNJ stage and healing (p = 0.004).…”

Section: Discussionsupporting

confidence: 86%

“…For example, osteoradionecrosis of the jaws (ORNJ) is one of the severe adverse effects of craniofacial RT. The RT revolution, better clinical implementation, and prevention strategies have signi cantly decreased the ORNJ incidence from 37.5% decades ago to less than 5% presently [1][2][3]. Most cases appear within three years after RT with a median of 13 months between RT and ORNJ (ranges 2-122 months) [2,4].…”

Section: Introductionmentioning

confidence: 99%

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Fluorescence-guided Surgery of Osteoradionecrosis of the Jaw: A Retrospective Study

Aljohani

T²,

Chronopoulos

et al. 2021

Preprint

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BackgroundOsteoradionecrosis of the jaw (ORNJ) is one of the most severe head and neck complications in patients treated with radiotherapy (RT), and it is one of the diseases difficult to manage. The goal of the treatment is to achieve mucosal healing or suppress ORNJ progression. Currently, surgical removal of the necrotic bone is an effective management approach for advanced stages of ORNJ. This study aimed to identify the outcomes of fluorescence-guided surgery for ORNJ. MethodsNineteen ORNJ lesions in 15 hospitalized patients received fluorescence-guided surgery. Demographics, comorbidities, local preceding event, location, ORNJ stage, and treatment outcomes were retrospectively reviewed with a median follow-up period of 12 months.ResultsThe first 12 lesions (63%) were operated under tetracycline fluorescence, and 7 lesions (37%) were operated under auto-fluorescence. Overall, 4 lesions (21%) achieved complete mucosal healing, 8 lesions (42%) showed partial mucosal healing with bone exposure and no signs or symptoms of inflammation, and 7 lesions (37%) were progressive. The results showed that either healing or ORNJ stabilization was achieved in 63% of the lesions (n = 12). No significant association was observed between healing and the fluorescence technique.ConclusionFluorescence-guided surgery can be beneficial in curing or stabilizing ORNJ. Within the study limitations, autofluorescence-guided surgery seems to be as effective as tetracycline fluorescence-guided surgery for management of ORNJ. Trial registration: not applicable

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

Fluorescence-guided Surgery of Osteoradionecrosis of the Jaw: A Retrospective Study

Aljohani

T²,

Chronopoulos

et al. 2021

Preprint

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“…We figure that the first priority during the debridement operation should be given to finding viable anastomosis vessels, releasing soft-tissue fibrosis for exposure, and always prepared for coronoidectomy due to trismus relief concern. Due to the possible correlation established in the present study between intraoperative defect size changes and postoperative functional recovery, we also advocated designs of oversized and well-vascularized soft-tissue skin paddles or components for sufficient wound coverage after STI debridement in advanced ORN cases ( 44 , 45 ). Sometimes, it is not wise to attain osseous mandibular reconstructions in the first attempt when STIs accompanying ORN are severe.…”

Section: Discussionmentioning

confidence: 97%

Radiation-Induced Soft Tissue Injuries in Patients With Advanced Mandibular Osteoradionecrosis: A Preliminary Evaluation and Management of Various Soft Tissue Problems Around Radiation-Induced Osteonecrosis Lesions

Gao

Liu

et al. 2021

Front. Oncol.

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ObjectivesRadiation-induced soft-tissue injuries (STIs) in mandibular osteoradionecrosis (ORN) are not well studied regarding their correlations with nearby bone lesions. The aim of this study is to investigate the severity of radiation-induced STIs in advanced mandibular ORN and its relationship with hard-tissue damage and postoperative outcomes.MethodsA retrospective study was performed in our institution from January 2017 to December 2019. Aside from demographic factors, the associations between the triad ORN variables (irradiation doses, ORN stages, ORN sizes) and radiation-related STI factors, vascular characteristics, and postoperative functional recovery were assessed. In addition, the severity of STI was also compared with treatment outcomes. Such correlations were established via both univariate and multivariable analyses.ResultsA total number of 47 patients were included. The median follow-up reached 27 months. Nasopharyngeal cancer was the histology type among most patients (n = 21, 44.7%). The median irradiation doses reached 62 Gy (range, 40–110 Gy). For STI, the symptom scoring equaled an average of 5.4 (range from 1 to 12), indicative of the severity of STI problems. During preoperative MRI examinations, signs of hypertrophy or edema (n = 41, 87.2%) were frequently discerned. Most patients (n = 23, 48.9%) also had extensive muscular fibrosis and infection, which required further debridement and scar release. Surprisingly, most STI factors, except cervical fibrosis (p = 0.02), were not in parallel with the ORN levels. Even the intraoperative soft-tissue defect changes could not be extrapolated by the extent of ORN damage (p = 0.096). Regarding the outcomes, a low recurrence rate (n = 3, 6.9%) was reported. In terms of soft tissue-related factors, we found a strong correlation (p = 0.004) between symptom scores and recurrence. In addition, when taking trismus into consideration, both improvements in mouth-opening distance (p < 0.001) and facial contour changes (p = 0.004) were adversely affected. Correlations were also observed between the intraoperative soft-tissue defect changes and complications (p = 0.024), indicative of the importance of STI evaluation and management.ConclusionsThe coexistence of hard- and soft-tissue damage in radiation-induced advanced mandibular ORN patients reminds surgeons of the significance in assessing both aspects. It is necessary to take the same active measures to evaluate and repair both severe STIs and ORN bone lesions.

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“…Furthermore, it is important to decide when surgical treatment should be performed. Bettoni et al [5] proposed that early surgical treatment is preferred because most mORNs are progressive and irreversible. Notani et al [7] suggested that radiation-induced bone damage is not expected to change over time and early surgery is preferable.…”

Section: Discussionmentioning

confidence: 99%

“…HBO is often used as nonoperative treatment for mORN because it can stimulate fibroblast proliferation and angiogenesis [3]. In recent years, however, reports have suggested that the effectiveness of nonoperative treatment for mORN should be reconsidered and surgical treatment provided [4,5]. Thus, additional studies are required to determine the optimal treatment for mORN.…”

Section: Introductionmentioning

confidence: 99%

Clinical study of treatment methods and associated factors in mandibular osteoradionecrosis

et al. 2021

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This study aimed to determine the appropriate treatment methods and evaluate associated factors by comparing nonoperative treatment alone with a combination of both nonoperative and surgical treatment in 34 patients with mandibular osteoradionecrosis (mORN). The associated cure factors were analyzed by Cox regression. Propensity scores were calculated from factors that were not significant in the univariate analysis and used as covariates in the multivariate analysis. The cure rate among patients who received nonoperative and surgical treatment was higher than that observed with nonoperative treatment alone. Only the treatment method was associated with cure in both univariate and multivariate analyses.

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The value of reconstructive surgery in the management of refractory jaw osteoradionecrosis: a single-center 10-year experience

Cited by 19 publications

References 28 publications

Fluorescence-guided Surgery of Osteoradionecrosis of the Jaw: A Retrospective Study

Fluorescence-guided Surgery of Osteoradionecrosis of the Jaw: A Retrospective Study

Radiation-Induced Soft Tissue Injuries in Patients With Advanced Mandibular Osteoradionecrosis: A Preliminary Evaluation and Management of Various Soft Tissue Problems Around Radiation-Induced Osteonecrosis Lesions

Clinical study of treatment methods and associated factors in mandibular osteoradionecrosis

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