Challenges of an unusual Osteoradionecrosis of the jaws: case report (original) (raw)
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Osteoradionecrosis of the Jaws after Radiotherapy Treatment in Head and Neck Area
2015
Although it can be stated that the incidence of osteoradionecrosis of the jaws (ORNJ) in the last reported period decreases, the therapy of this diagnosis has a considerably more complicated continuance as with bisphosphonates osteonecrosis (BON). Oral findings are extensive, not only alveolar bones of jaws are affected by radiation, but also oral mucosa and salivary glands, resulting to a significant mucositis and xerostomia. Research in dental and oral surgery often involves materials and procedures which are capable of improving clinical outcomes in terms of percentages of success. The goal of this research was to find a treatment approach which could reduce bleeding, promote effective bone regeneration and rapid soft-tissue healing by employing resources which are easy to use at a modest cost. Patients in our study were divided into three categories: patients with newly diagnosed cancer waiting for treatment, patients after radiotherapy without signs of osteonecrosis and patient...
Journal of Oral and Maxillofacial Surgery, 1997
Purpose: This study analyzed potential risk factors in patients who received radiation therapy and then developed osteoradionecrosis (ORN). Patients and Methods: A group of 104 patients who developed osteoradionecrosis of the jaws were reviewed treated between 1972 and 1992. Results: The most common affected site was the mandible (99 cases, 95.2%), followed by the maxilla (5 cases, 4.8%). Among all cases, 93 (89.4%) were induced-trauma ORN, and 11 (10.6%) were spontaneous ORN. The following risk factors were considered as predisposing factors for the appearance of ORN: Anatomic location of the tumor, tumor surgery, total radiation dose, dose rate/day, mode of radiation delivery, time from radiation therapy until the onset of ORN, and dental status. ORN developed more frequently with oral cancer than other head and neck cancers, The size of the tumor seemed not to influence the incidence of ORN except when the tumor invade the adjacent bone. Type of radiation delivery total bone dose, and modes of radiation appeared to influence the risk of ORN occurrence. After conservative treatment, 44 (42.3%) cases had complete healing and resolution 34 (32.6%) cases had a stable, chronic ORN process, and 26 (25.1%) cases had acute and progressive ORN. Conclusion: An understanding of the risk factors is important in preventing ORN after radiation therapy. Radiation therapy in combination with surgery has been a very common oncologic treatment of head and neck cancers. This form of treatment has provided high cure rates, but has also called increasing attention to its side effects. Osteoradionecrosis (ORN) is one of the most severe and serious complications of head and neck cancer treatment. ~-7 The term osworadionecrosis has been used to describe the loss of the covering oral mucosa and exposure of necrotic bone for a period longer than 3 months, s This process is usually associated with such
Osteoradionecrosis of the Jaws: A Review of Conservative and Surgical Treatment Options
2016
Although surgery is still the most important treatment modality in the management of head and neck cancer, radiotherapy (XRT) is increasingly being used, either as (neo)adjuvant therapy or as primary treatment with or without concurrent chemotherapy.1,2 Despite significant im-provements in reconstructive (micro)surgery over the last years, which have made more extensive tumor resections feasible, about two thirds of patients still require adjuvant XRT or concurrent chemoradiotherapy to improve oncologic outcome.2 Consequently, the majority of patients with head and neck cancer are at risk of developing osteoradionecrosis (ORN) of the jaws as a complication of XRT. ORN is themost serious and important complicationofXRT. It was defined byMarx in 1983 as the presence of exposed bone in an irradiated field that fails to heal within a 3-month period.3 The reported incidence of ORN in literature ranges from 0.9 to 35%.However, a recent large retrospective reviewof 830patients with head an...
Review of Osteoradionecrosis of the Jaw: Radiotherapy Modality, Technique, and Dose as Risk Factors
Journal of Clinical Medicine
Radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) is the cornerstone of organ-sparing or adjuvant therapy for nearly all head and neck cancers. Unfortunately, aggressive RT or CCRT can result in severe late toxicities, such as osteoradionecrosis of the jaws (ORNJ). The incidence of ORNJ is currently less than 5–6% due to advances in dental preventive care programs, RT planning systems, and RT techniques. Although numerous patient-, tumor-, and treatment-related factors may influence the incidence rates of ORNJ, RT modality (equipment), technique, and dose-volume-related factors are three of the most influential factors. This is mainly because different RT equipment and techniques have different levels of success at delivering the prescribed dose to the focal volume of the treatment while keeping the “organ at risk” safe. ORNJ risk is ultimately determined by mandibular dose, despite the RT technique and method being known predictors. Regardless of the photon delivery method, ...
Osteoradionecrosis of the Mandible: A Case Report
Balkan Journal of Dental Medicine, 2016
SummaryOsteoradionecrosis (ORN) of the jaws is a serious complication of radiotherapy of head and neck malignancies. Different assumptions about its occurring, risk factors and possible therapeutical modalities exist, but the clinical outcome of such patients is still not on the desired level. This article presents a clinical case of ORN of the mandible, occurring with exposed and infected bone, necrotic process that extended through all the mandible body, as well as cutaneous fistula. The first site of ORN was detected 2 years after radiotherapy for oral cancer, with the second one detected 3 and a half years after radiotherapy. In both, the reason for exposing the bone was local trauma due to tooth extraction. Due to the stage of the condition, a decision for surgical treatment accompanied with antibiotics was made.It is very important and critical for irradiated patients and patients with osteoradionecrosis to perform appropriate oral hygiene and frequent dental checks. Establish...
Retrospective study of osteoradionecrosis in the jaws of patients with head and neck cancer
Journal of the Korean Association of Oral and Maxillofacial Surgeons, 2019
Objectives: Osteoradionecrosis (ORN) is one of the most severe complications resulting from radiotherapy (RT) in patients with head and neck cancer (HNC). It is characterized by persistent exposed and devitalized bone without proper healing for greater than 6 months after a high dose of radiation in the area. To describe the profile and dental management of ORN in HNC patients undergoing RT in an oncological clinical research center. Materials and Methods: A retrospective descriptive study was performed to analyze dental records from HNC patients with ORN treated at an oncological clinical research center from 2013 to 2017. A total of 158 dental records for HNC patients were selected from a total of 583 records. Afterwards, this number was distributed to three examiners for manual assessments. Each examiner was responsible for selecting dental records that contained an ORN description, resulting in 20 dental records. Results: Mean patient age was 60.3 years with males being the most affected sex (80.0%). The most affected area was the posterior region of the mandible (60.0%) followed by the anterior region of the mandible (20.0%) and the posterior region of the maxilla (10.0%). The factors most associated with ORN were dental conditions (70.0%) followed by isolated systemic factors (10.0%) and tumor resection (5.0%). There was total exposed bone closure in 50.0% of cases. The predominant treatment was curettage associated with chlorhexidine 0.12% irrigation (36.0%). Conclusion: Poor dental conditions were related to ORN occurrence. ORN management through less invasive therapies was effective for the closure of exposed bone areas and avoidance of infection.