Abstract
Patients undergoing radiotherapy alone or as part of the treatment of head and neck cancer are likely to develop osteoradionecrosis (ORN). Dental extractions have been inferred as the main triggering factor of ORN, particularly in mandibular molars. The osteoradionecrosis has been reported in up to 20% of irradiated patients undergoing dental extraction and is recognized as the most severe complication of radiotherapy in the mandible, causing great discomfort and loss of quality of life of patients. The risk of ORN development is related to the dose, technique, and volume of irradiated tissue, and other predisposing factors such as: extraction at peri-radiotherapy period, site of extraction, pre-existing periodontal disease, general trauma, poor oral hygiene, nutritional deficiency, alcohol and smoking, and systemic diseases. The cellular injury and hypoxia caused by decreased blood supply reduce the recoverability of soft tissue and bone, predisposing them to necrosis and osteonecrosis, even spontaneous. Clinical management of osteoradionecrosis is complex and depending on the degree of involvement, it may require analgesics and antibiotics in addition to the adoption of surgical procedures, aiming to eliminate pain, control infection, and prevent or reduce the progression of the lesion. This paper aimed to report a case of osteoradionecrosis treated in the multidisciplinary clinic of the Onco Project - ICT/UNESP (São José dos Campos/SP, Brazil). A female patient aged 65 years with osteoradionecrosis and fistula after radiotherapy of squamous cell carcinoma in gingiva was submitted to tooth extraction, antibiotic therapy and local care with good response and flow interruption through the fistula. During the treatment, the carcinoma relapsed and the patient was referred for oncologic treatment.
Highlights
The osteoradionecrosis (ORN) is defined as the exposure of bone tissue irradiated on one or more areas of the mandible or maxilla, which does not heal for more than three months without signs of residual disease or relapse
Several theories have been proposed to explain the pathophysiology of osteoradionecrosis, the latest one proposes ORN occurs due to a radiation-induced fibro-atrophic mechanism, which includes the formation of free radicals, endothelial dysfunction, inflammation, microvascular thrombosis, fibrosis, remodeling, and necrosis of bone and soft tissues [2]
In 1983, stated that 35% of patients have osteoradionecrosis without the prior occurrence of local trauma and this is related to high dose of radiation received [5]
Summary
Rosana Ferreira SILVA1, Zulene Eveline Abreu RIBEIRO2, Lucio Murilo Dos SANTOS1, Rodrigo Dias NASCIMENTO3, Michelle Bianchi De MORAES3, Fernando Vagner RALDI3 1 – Department of Bioscience and Oral Diagnosis – School of Dentistry – Institute of Science and Technology – UNESP – Univ Estadual Paulista – São José dos Campos – SP – Brazil. 2 – Private Clinic 3 – Department of Diagnosis and Surgery – School of Dentistry – Institute of Science and Technology – UNESP – Univ Estadual Paulista – São José dos Campos – SP – Brazil.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
