Osteoradionecrosis Of The Jaws Research Articles

Zahnärztliche Betreuung bei Tumortherapie der Kopf-Hals-Region[nl]– Teil 1: Radiatio

The dental care because of radiotherapy in case of head and neck cancer should be practiced by skilled dentists. First the residual teeth and the dental restorations have to be cleaned and controlled very well. Radiographs complete examinations. Necessary extractions should consider the later prosthodontic restoration with regard to the financial situation of the patient. Mucosal distractors also useful for fluoridation of the teeth and spreader preventing areas which have not necessarily to be irradiated can be manufactured by the dentist. During irradiation the dentist can help to keep up good oral hygiene. After irradiation a close monitoring may avoid dental destruction and osteoradionecrosis of the jaws. The dentist should recommend strategies to moderate xerostomia and he can subscribe lymphodrainage if necessary. He can survey the opening of the mouth and the fluoridation of the teeth to limit irradiation caries and osteoradionecrosis. In the end the dentist has to reestablish esthetics, phonetics and chewing function by manufacturing dental restorations.

Treatment Failure in Osteoradionecrosis Involving the Mandible Following Enblock Resection of the Affected Bone: A Case Report

Osteoradionecrosis (ORN) of the jaws is a relatively common side effect of radiotherapy of head and neck tumours. It is a chronic condition that progresses slowly and does not tend to heal spontaneously. Irradiation brings about histological changes in hard and soft tissues, such as loss of ostoecytes, absence of osteogenic precussor cells, replacement of bone marrow by loose connective tissues and reduced expression of collagens and bone morphogenic protein by fibroblasts. Secondary lesions of these hypoxic tissues may then lead to an infection of the previously weakened bone and soft tissue and to development of a chronic, non-healing wound. Resection of bone without viable cells that remain around the area of resection will not facilitate revitalization. A case is presented of 35-year-old female with ORN of the mandible who presented with failure of wound healing following enblock resection of the affected part of bone. The possible causes of treatment failure and their management are discussed. Tanzania Medical Journal Vol. 23 (1) 2008: pp. 34-37

Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment

During the past 80 years a number of theories about the pathogenesis of osteoradionecrosis (ORN) have been proposed, with consequent implications for its treatment. Until recently tissue hypoxia and its consequences were accepted as the primary cause, and this led to the use of hyperbaric oxygen (HBO) for both treatment and prevention of complications of radiotherapy in the head and neck. The benefit of HBO has not been validated. A new theory for the pathogenesis of ORN has proposed that damage to bone is caused by radiation-induced fibrosis. Cells in bone are damaged as a result of acute inflammation, free radicals, and the chronic activation of fibroblasts by a series of growth factors. New treatments have therefore been devised that include pentoxifylline, a vasodilator that also inhibits fibrosis, and tocopherol ( vitamin E ) to reduce damage caused by free radicals. Impressive results in terms of reversing the process of ONR have been reported using these agents. It has been suggested that this theory and these agents could be the basis of future treatment and prevention of ORN.

Actinomyces—Gathering evidence of human colonization and infection

The roles of the ‘classical’ Actinomyces spp. as colonizers of oral cavities of man and animals, in development of intra-oral infections and as agents of actinomycosis have been well documented. This mini-review focuses on perceptions of human colonization and infection that have emerged in the past decade, largely as a result of advances in classification, identification and direct detection from clinical material. Arguably, of the greatest importance is the recognition of actinomycosis as a major factor and indicator of poor prognosis in both infected osteoradionecrosis and bisphosphonate-associated osteonecrosis of the jaws. Among recently described species, Actinomyces graevenitzii has been isolated almost exclusively from oral and respiratory sites and may be a causative agent of actinomycosis. Conversely, several other Actinomyces spp. are isolated commonly from superficial soft tissue infections. Members of the genus Actinobaculum, which is closely related to Actinomyces, are strongly associated with urosepsis. Isolation and identification of Actinomyces and related genera by conventional methods remain difficult. Diagnosis is commonly belated and based solely upon histological findings. Development of direct detection methods may aid patient management and further elucidate clinical associations.

Risk Factor Assessment for the Development of Osteoradionecrosis

Osteoradionecrosis (ORN) of the jaws has been extensively studied. However, controversy still exists regarding its etiology, risk factors, and the underlying mechanism of disease. The purpose of this study was to identify and evaluate significant risk factors for the development of ORN. This was a retrospective cohort study of 82 Massachusetts General Hospital patients radiated for head and neck cancer between 1984 and 2005. Patient records were reviewed to collect demographic information, medical and dental history (including dental intervention or trauma), tumor specific data, treatment details, and follow-up. Biologic variables (ie, age and gender) of potential significance were also evaluated. The major outcome variable was the development of ORN or lack of development of ORN. The time from radiation to ORN, or for non-ORN patients, time to last follow-up visit, was computed. Univariate analyses identified candidate variables associated with ORN (P < .15). Cox proportional hazards regression was used to evaluate these candidate variables as well as biologically relevant variables. Significant prognostic factors for the development of ORN (P < .05) were identified. Multivariate regression identified the following variables as significantly associated with decreased ORN risk: higher body mass index (P = .02) and use of steroids (P = .02). Radiation dose greater than 66 Gray (P = .03) was associated with an increased ORN risk. Optimization of nutritional status, use of steroids, and limitation of total radiation dose may minimize the risk of ORN.

Ostéoradionécroses des maxillaires (maxillaire et mandibulaire)

Osteoradionecrosis of the jaws is a well known complication of radiation therapy used in head and neck cancer. Osteoradionecrosis has been first described by Regaud in 1922. Osteoradionecrosis of the jaws is most of the time developed on mandibula; maxillary localisation is rare. Osteoradionecrosis of the jaws is a priority considering that patients have recovered of their primary disease. Treating osteoradionecrosis is difficult because of the patient's health status and the poor healing capacities of the irradiated tissues. In addition, the quality and amount of vascular bed are reduced for microvascular reconstruction. Osteoradionecrosis physiopathology is not totally understood. Conservative treatment is possible at the very beginning of the disease, but as much as the osteoradionecrosis is growing and is ancient, the treatment must be radical. Concerning osteoradionecrosis, the main problem is to be able to perform radical treatment without lasting too much time with conservative treatment. Mandibular reconstruction using osteo-cutaneous free flaps is actually the best solution for concerned patients. Since osteoradionecrosis is a major complication of numerous anti-cancer treatments, the best management is odontostomatologic prevention and radiotherapy technique.

Influence of post-radiation dental extractions on the incidence of osteoradionecrosis of the jaws

Influence of post-radiation dental extractions on the incidence of osteoradionecrosis of the jaws

Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients—a report of a thirty year retrospective review

This retrospective study aimed to demonstrate the incidence and the aetiological factors involved in osteoradionecrosis (ORN) in a group of 830 head and neck tumour patients who received radiotherapy between 1969 and 1999.The data showed an over all incidence of 8.2% and a 3-fold higher incidence for men than for women. Osteoradionecrosis was most commonly located in the body of the mandible. Concerning the risk factors, a negative influence was shown for advanced tumours, segmental resections of the mandible and pre-/post-radiation tooth extractions. Tooth extractions were found to be responsible for 50% of all cases. The osteoradionecroses were observed significantly earlier in patients who received pre-surgical radiotherapy than those who received post-surgical radiotherapy. Combined pre-surgical radio- and chemotherapy significantly hastened the appearance of osteoradionecrosis compared to pre-surgical radiotherapy alone. Only 40% of patients with osteoradionecrosis could be healed completely by means of surgery and antibiotic medication. Hyperbaric oxygenation (HBO) therapy was performed only in individual cases.The data suggest that osteoradionecrosis has a multifactorial aetiology. Therefore, a very close follow-up of tumour patients and a strict prophylactic management are required.

Management of refractory osteoradionecrosis of the jaws with surgery and adjunctive hyperbaric oxygen therapy.

This retrospective study aimed to determine the effectiveness of surgery and hyperbaric oxygen (HBO) treatment in the management of refractory osteoradionecrosis (ORN) of the jaws. Of the 18 patients who had undergone this treatment, 14 patients had complete healing, 3 patients had improved and one patient did not show any improvement. Of the 14 patients who had complete healing, only 4 still had a discontinuity defect of the mandible but they declined additional reconstructive surgery. In conclusion, surgery/HBO therapy showed satisfactory results in the management of refractory ORN of the jaws.

Management of refractory osteoradionecrosis of the jaws with surgery and adjunctive hyperbaric oxygen therapy

This retrospective study aimed to determine the effectiveness of surgery and hyperbaric oxygen (HBO) treatment in the management of refractory osteoradionecrosis (ORN) of the jaws. Of the 18 patients who had undergone this treatment, 14 patients had complete healing, 3 patients had improved and one patient did not show any improvement. Of the 14 patients who had complete healing, only 4 still had a discontinuity defect of the mandible but they declined additional reconstructive surgery. In conclusion, surgery/HBO therapy showed satisfactory results in the management of refractory ORN of the jaws.

Osteoradionecrosis of the jaws: Clinical characteristics and relation to the field of irradiation

Purpose: This study focuses on the clinical characteristics of patients with osteoradionecrosis (ORN) of the jaws and on the relation between the extent of the ORN and the field of irradiation. Patients and Methods: The study group consisted of 80 patients referred for treatment of ORN. Charts of the extent of ORN, based on panoramic radiographs, were drawn by the clinical investigator and compared with charts of the field of irradiation drawn by the oncologists. Also recorded was diagnosis of the lesion, stage, location, treatment schedule, and period and dose of irradiation. Also documented were various potential initiating factors for ORN. Results: Smoking habits of ORN patients were similar to those of other patients with head and neck cancer. A new primary tumor or a recurrence was diagnosed in 10% of the patients at the time of ORN. Only 3 patients had received accumulated doses of less than 60 Gy. More than half of the cases were initiated by removal of teeth; however, one third occurred spontaneously. ORN developed within the first 3 years in 74%; but ORN can emerge on a traumatic basis for an infinite number of years after radiation therapy. Widespread ORN may be symptomless apart from a discrete dehiscense of the oral mucosa. The predilection site for ORN is the mandibular molar region. All cases of ORN but 1 were found in the field of radiation. Conclusion: Because many ORN case are symptomless, more focus on mucosal dehiscence in the follow-up after radiation therapy is advocated in an effort to detect ORN at an early stage. The consequence of practically all ORN cases being located in the field of irradiation, together with tooth removal frequently being the initiating factor, should lead to a more aggressive preirradiation approach to dental pathology located within the field of radiation. © 2000 American Association of Oral and Maxillofacial Surgeons

Opportunistic actinomycosis in osteoradionecrosis of the jaws in patients affected by head and neck cancer: incidence and clinical significance.

Actinomycosis is occasionally an opportunistic infection occurrence in patients with osteoradionecrosis (ORN). A retrospective study (1992-97) of 50 patients with ORN of the jaws was done to evaluate the incidence and its clinical significance in the management of ORN. Actinomycosis was diagnosed in 12% of ORN cases. In 36 of the 50 patients including five cases of actinomycosis, the ORN was considered to be resolved after treatment. The median treatment duration of ORN was significantly longer (P<0.007) in patients with actinomycosis (29.7 months) than those without the disease (13.4 months). In conclusion, bone biopsy should be considered in cases of ORN with unsatisfactory response to its specific therapies, aiming to identify possible opportunistic actinomycosis infection.

Osteoradionecrosis of the jaws: clinical characteristics and relation to field of irradiation

Osteoradionecrosis of the jaws: clinical characteristics and relation to field of irradiation

Hyperbaric oxygen in the prevention of osteoradionecrosis of the jaws.

Patients who have had their jaws irradiated as part of management of head and neck malignancy are at risk of osteoradionecrosis (ORN) following tooth extraction. Thirty-seven patients with a history of irradiation to the jaws were managed during a four year period. Twenty-nine patients received hyperbaric oxygen therapy (HBO) consisting of 20 treatments before surgery and ten treatments after. Only one (4 per cent) developed ORN. Seven patients who did not have HBO and one who did (15 per cent) developed ORN. The need for prophylactic treatment with HBO is discussed. It is recommended that prophylactic HBO is used prior to surgery for irradiated facial bones.

Osteoradionecrosis of the jaws as a risk factor in radiotherapy: a report of an eight-year retrospective review.

Osteoradionecrosis of the jaws is a severe complication of radiotherapy in the treatment of the head and neck neoplasms. The literature indicates a recent decline in the reported incidence of this complication. The purpose of this study was to further assess the incidence rate for osteoradionecrosis. Factors previously associated with an increased risk for osteoradionecrosis were evaluated to determine possible relationships. A retrospective chart review was conducted for 193 patients treated with radiotherapy for malignant head and neck tumors over an eight-year period. Recorded diagnoses of osteoradionecrosis were noted. Factors previously correlated with the development of osteoradionecrosis were assessed. Of the 193 charts reviewed, 9 diagnoses of osteoradionecrosis of the jaws were made representing an incidence rate of 4.7% for the period evaluated. No single factor was noted to be associated with the development of osteoradionecrosis. The results indicate a low incidence rate for osteoradionecrosis as a post-radiation treatment complication. No single causative factor could be identified suggesting a multifactorial interaction responsible for osteoradionecrosis.

Osteoradionecrosis of the jaws: A retrospective study of the background factors and treatment in 104 cases

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.

Osteoradionecrosis of the jaws: A retrospective study of the background factors and treatment in 104 cases

Osteoradionecrosis of the jaws: A retrospective study of the background factors and treatment in 104 cases

A study of factors contributing to the development of osteoradionecrosis of the jaws

The histories of 14 patients in whom osteoradionecrosis developed were compared with those of 28 patients who had similar tumors and/or treatment and were not afflicted with osteoradionecrosis. 1. Fourteen of 15 episodes of bone complications occurred in the mandible, and 70% occurred within 1 year after the completion of radiation therapy. 2. A high dose of radiation, with conventional fractionation, did not specifically predispose patients to osteoradionecrosis. Fifty percent of the ORN patients actually received a total dose of 6000 rad or less. Combined radiation therapy and surgery did not seem to significantly i:ncrease the risk inasmuch as both groups of patients had similar combinations. In two of four patients who received methotrexate, however, osteoradionecrosis developed during the time of administration. 3. One of the most prevalent negative factors associated with the ORN patients was the continued heavy use of alcohol and tobacco by 86% of them. These strong tissue irritants could have significantly contributed to the breakdown of mucosa and exposure of bone. Alcohol and tobacco could also have potentiated the combined effects of the other negative factors, such as contributing to poor oral hygiene. 4. The ORN patients had poorer oral hygiene than the control group. Seventy-five percent of the patients with teeth who had osteoradionecrosis continued to have poor oral hygiene. In contrast, none of the control patients had poor oral hygiene. 5. A combination of factors relating to stage of tumor and treatment was found in the ORN patients. These factors included more advanced stages of tumors with presence of bone involvement, osteoradionecrosis occurring at or near the site of the tumor, surgery, extraction sites, and/or denture irritations. These conditions were found even though the control patients had a similar pattern of extractions and denture usage.

Dental extractions in relation to radiation therapy of 224 patients

The case histories of 224 patients treated with radiation therapy for head and neck malignancies at the Radiotherapy Clinic of the University Central Hospital in Turku during the years 1974–77 are reviewed. Of the 92 patients surviving for 5 years, 90 were available for re-examination. The median radiation dosage was 61 Gy in 6 to 8 weeks in patients with squamous cell carcinoma and other solid tumours and 43 Gy in 5 weeks in patients with lymphoma. The oral status of the patients was examined clinically and radiographically. From these patients, 45 teeth had been extracted before irradiation and 94 after irradiation. In no case had this resulted in osteoradionecrosis of the jaws. It is evident that the repairing of patient's teeth before radiation treatment, coupled with continuous preventive care of caries, will prevent serious complications from arising.

The management of osteoradionecrosis of the jaws

Therapeutic measures used in the management of osteoradionecrosis (ORN) of the jaws are reviewed with reference to clinical case material. The development of rational treatment regimes designed to deal with the underlying pathological problem are discussed.