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Oral Oncology Jan 2017Mandibular osteoradionecrosis (ORN) is a common and serious complication of head and neck radiotherapy for which there is little reliable evidence for prevention or... (Review)
Review
Refining the definition of mandibular osteoradionecrosis in clinical trials: The cancer research UK HOPON trial (Hyperbaric Oxygen for the Prevention of Osteoradionecrosis).
INTRODUCTION
Mandibular osteoradionecrosis (ORN) is a common and serious complication of head and neck radiotherapy for which there is little reliable evidence for prevention or treatment. The diagnosis and classification of ORN have been inconsistently and imprecisely defined, even in clinical trials.
METHODS
A systematic review of diagnosis and classifications of ORN with specific focus on clinical trials is presented. The most suitable classification was evaluated for consistency using blinded independent review of outcome data (clinical photographs and radiographs) in the HOPON trial.
RESULTS
Of 16 ORN classifications found, only one (Notani) appeared suitable as an endpoint in clinical trials. Clinical records of 217 timepoints were analysed amongst 94 randomised patients in the HOPON trial. The only inconsistency in classification arose where minor bone spicules (MBS) were apparent, which occurred in 19% of patients. Some trial investigators judged MBS as clinically unimportant and not reflecting ORN, others classified as ORN based on rigid definitions in common clinical use. When MBS was added as a distinct category to the Notani classification this ambiguity was resolved and agreement between observers was achieved.
DISCUSSION
Most definitions and clinical classifications are based on retrospective case series and may be unsuitable for prospective interventional trials of ORN prevention or treatment. When ORN is used as a primary or secondary outcome in prospective clinical trials, the use of Notani classification with the additional category of MBS is recommended as it avoids subjectivity and enhances reliability and consistency of reporting.
Topics: Clinical Trials as Topic; Head and Neck Neoplasms; Humans; Mandible; Osteoradionecrosis; United Kingdom
PubMed: 28024727
DOI: 10.1016/j.oraloncology.2016.12.002 -
Lasers in Medical Science Dec 2022This systematic review aimed to answer the research focused question: What are the effects of photobiomodulation (PBM) therapy on bone healing after ionizing irradiation... (Review)
Review
This systematic review aimed to answer the research focused question: What are the effects of photobiomodulation (PBM) therapy on bone healing after ionizing irradiation in animal models? The EMBASE, LILACS, LIVIVO, PubMed, Scopus, and Web of Science databases, including gray literature, were searched using the following keywords: "Head and Neck Neoplasms"; "Ionizing Radiation"; "Low-Level Light Therapy"; and "Bone regeneration", focusing on the primary studies that assessed the effects of PBM therapy on animal models of irradiated bone. Six studies have met the eligibility criteria and presented an overall regular quality according to the risk of bias assessment tools. All the studies utilized rat animal model and near-infrared laser PBM at low power output setting. Most of the studies showed increased new bone formation, osteocytes, osteoblasts, and vascularization networking, as a result of PBM therapy. However, only one out of the six studies has not shown any differences in bone healing in both lased and non-lased animal groups. Nevertheless, PBM therapy is a potential tool to improve bone healing induced by ionizing radiation. However, due to the scarce number of studies and the great variability of laser parameters and treatment protocols, a clear conclusion cannot be drawn. Hence, extensive preclinical in vivo studies are warranted to ensure these beneficial effects have been addressed prior to translational clinical trials.
Topics: Rats; Animals; Low-Level Light Therapy; Bone Regeneration; Head and Neck Neoplasms; Wound Healing; Lasers
PubMed: 36194304
DOI: 10.1007/s10103-022-03649-2 -
Microsurgery May 2024Successive osteoseptocutaneous fibula transfers for jaws reconstruction are rare but important options. This study contributes patient-reported and clinical outcomes, as...
BACKGROUND
Successive osteoseptocutaneous fibula transfers for jaws reconstruction are rare but important options. This study contributes patient-reported and clinical outcomes, as well as systematically reviews all existing reports.
METHODS
All sequential fibula transfers performed by the senior author were reviewed from a prospectively managed database, including University of Washington quality of life (UWQoL). Systematic review was conducted in PubMed and Cochrane databases for similar publications.
RESULTS
Eighteen patients (average age 51.5 years) received sequential fibulas (mean 4.7 years between reconstructions). Secondary fibulas more often had benign indications (72.2% vs. 33.3%, p = .04), most commonly osteoradionecrosis (38.9%). At a mean follow-up of 30.5 months, the average interincisal distance increased from 21.8 to 27.6 mm, and 92.3% tolerated an oral diet following the second fibula. Eight patients completed the UW-QoL before and after the second fibula, and three prior to the first fibula. Composite physical function was significantly decreased from 96.7 prefibula reconstruction to 63.3 following the first (p < .001) and 64.2 after the second fibula (p < .001). There were no differences in other domains. The systematic review yielded six articles reporting 56 patients (mean 39 months between fibulas). Secondary fibulas were performed for repeat malignancy (45%) and osteoreadionecrosis (39%), resulting in elevated tube feeding from 20% following the first to 39% following the second, but overall high quality of life in two studies.
CONCLUSIONS
Sequential osteoseptocutaneous fibula reconstructions of jaws are often performed for benign indications such as osteoradionecrosis. Overall function and QoL are comparable with those following the first fibula transfer.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Bone Transplantation; Fibula; Free Tissue Flaps; Mandibular Reconstruction; Quality of Life
PubMed: 38747121
DOI: 10.1002/micr.31184 -
Oral Surgery, Oral Medicine, Oral... Jul 2024A systematic review with meta-analysis was conducted to define the incidence of osteoradionecrosis (ORN) in patients with oral cavity cancer (OCC) treated with... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
A systematic review with meta-analysis was conducted to define the incidence of osteoradionecrosis (ORN) in patients with oral cavity cancer (OCC) treated with intensity-modulated radiotherapy (IMRT), and to identify the risk factors influencing its development.
STUDY DESIGN
Six databases were searched systematically. A meta-analysis was performed to determine overall, spontaneous, and dental extraction-attributed incidences of ORN. The Grading of Recommendations Assessment, Development, and Evaluation tool evaluated evidence certainty.
RESULTS
Out of 11 eligible studies, 6 underwent meta-analysis for the overall aggregated ORN incidence in OCC patients receiving IMRT, resulting in an incidence rate of 8% (95% CI: 6%-11%). Regarding development reasons, 2 studies were assessed, revealing an incidence of 36% (95% CI: 1%-98%) for spontaneous ORN, and 17% (95% CI: 5%-44%) ensued from dental extraction exclusively pre-RT. All rates had very low certainty of evidence. Factors significantly correlated with ORN development included postoperative RT use (78%), employment of therapeutic doses above 50 Gy, and mandibular involvement (80.5%).
CONCLUSION
The findings suggest that IMRT alone is not sufficient to decrease ORN rates in OCC patients, underscoring the importance of precisely identifying the involved risk factors. However, further detailed primary studies will be necessary.
Topics: Humans; Osteoradionecrosis; Radiotherapy, Intensity-Modulated; Incidence; Mouth Neoplasms; Risk Factors; Jaw Diseases
PubMed: 38772792
DOI: 10.1016/j.oooo.2024.04.008 -
Medicina Oral, Patologia Oral Y Cirugia... Mar 2021to systematically review the literature, comparing the healing of osteoradionecrosis (ORN) among the therapeutic alternatives: surgical, pharmacological and combined.
BACKGROUND
to systematically review the literature, comparing the healing of osteoradionecrosis (ORN) among the therapeutic alternatives: surgical, pharmacological and combined.
MATERIAL AND METHODS
The review was organized according to the PRISMA protocol with regards to the following PICO question: patients with ORN of the jaws (P=Patient); all interventions reported (I = intervention); between all therapies (C=Comparison); healing of lesions (O=outcome).
RESULTS
Surgical treatment was the most common choice (46.3%) followed by pharmacological treatment, exclusively (25.9%) or combined (26.9%). Treatment exclusively by surgical intervention seems to be most effective option, with 51.2% of the lesions healed, OR for healing of 5.7 (CI95% 1.9-16.9, p=0.002). Only 1 case (0.9%) corresponded to low level laser therapy.
CONCLUSIONS
It seems clear that early intervention with conservative surgical combined with pharmacological methods improves the prognosis of ORN.
Topics: Head and Neck Neoplasms; Humans; Jaw; Jaw Diseases; Osteoradionecrosis; Prognosis
PubMed: 33037800
DOI: 10.4317/medoral.24132 -
Oral Surgery, Oral Medicine, Oral... Nov 2019Medication-related osteonecrosis of the jaw (MRONJ) is a pathologic process resulting in progressive destruction of the jaws. There are no established guidelines for the...
OBJECTIVE
Medication-related osteonecrosis of the jaw (MRONJ) is a pathologic process resulting in progressive destruction of the jaws. There are no established guidelines for the medical management of MRONJ. Interest in pentoxifylline and tocopherol is growing because these agents have been shown to be effective in treating osteoradionecrosis of the jaw. This review evaluates the clinical usefulness of pentoxifylline and tocopherol in treating MRONJ.
STUDY DESIGN
Literature databases were searched for relevant reports of pentoxifylline and tocopherol in treating MRONJ. Only English-language reports and human studies were considered.
RESULTS
There were 3 published observational studies and 2 abstracts relevant to this topic. The combination of pentoxifylline and tocopherol is associated with subjective and objective improvements and no major adverse outcomes.
CONCLUSIONS
Pentoxifylline and tocopherol has been demonstrated to be effective for managing MRONJ nonsurgically, and, thus, this treatment modality holds promise. However, larger clinical studies are needed to optimize dose and duration.
Topics: Bisphosphonate-Associated Osteonecrosis of the Jaw; Bone Density Conservation Agents; Humans; Osteoradionecrosis; Pentoxifylline; Phosphodiesterase Inhibitors; Tocopherols
PubMed: 31488389
DOI: 10.1016/j.oooo.2019.08.004 -
Imaging Science in Dentistry Sep 2021This study aimed to summarize the impact of neck and head radiation treatment on maxillofacial structures detected on panoramic radiographs.
PURPOSE
This study aimed to summarize the impact of neck and head radiation treatment on maxillofacial structures detected on panoramic radiographs.
MATERIALS AND METHODS
In this systematic review, the authors searched PubMed Central, Embase, Scopus, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar for original research studies up to February 2020 that included the following Medical Subject Headings keywords: words related to "radiotherapy" and synonyms combined with keywords related to "panoramic radiography" and "oral diagnosis" and synonyms. Only original studies in English that investigated the maxillofacial effects of radiotherapy via panoramic radiographs were included. The quality of the selected manuscripts was evaluated by assessing the risk of bias using Cochrane's ROBINS-I tool for non-randomized studies.
RESULTS
Thirty-three studies were eligible and included in this review. The main objectives pertained to the assessment of the effects of radiation on maxillofacial structures, including bone architecture alterations, periodontal space widening, teeth development abnormalities, osteoradionecrosis, and implant bone loss. The number of participants evaluated ranged from 8 to 176.
CONCLUSION
The interaction between ionizing radiation and maxillofacial structures results in hazard to the tissues involved, particularly the bone tissue, periosteum, connective tissue of the mucosa, and endothelium. Hard tissue changes due to radiation therapy can be detected on panoramic radiographs.
PubMed: 34621649
DOI: 10.5624/isd.20210011 -
Oral Oncology Mar 2015Pre-radiation dental screening of head-neck cancer patients aims to identify and eliminate oral foci of infection to prevent post-radiation oral problems. The evidence... (Review)
Review
Pre-radiation dental screening of head-neck cancer patients aims to identify and eliminate oral foci of infection to prevent post-radiation oral problems. The evidence for the efficacy of dental screening is unclear. In this systematic review, we analyzed available evidence on the efficacy of pre-radiation elimination of oral foci of infection in preventing oral sequelae. A search was conducted (MEDLINE/EMBASE) for papers published up to May 2014. Papers on head-neck cancer patients subjected to pre-radiation dental screening, (chemo)radiation and oral follow-up were included. Of the 1770 identified papers, 20 studies fulfilled the inclusion criteria of which 17 were retrospective. A great heterogeneity in patient groups, dental screening techniques, definitions of oral foci of infection and techniques for eliminating foci was found. Most papers lacked essential details on how dental screening was performed and a clear definition of an oral focus of infection. The evidence for efficacy of elimination of oral foci of infection to prevent post-radiotherapy oral sequelae was inconclusive. Consequently, the efficacy of pre-radiation elimination of oral foci of infection remains unclear. No conclusions can be drawn about a definition of an oral focus of infection and whether pre-radiation elimination of these foci should be mandatory. We therefore suggest prospective studies with well-defined criteria for oral foci of infection, a clear description of which foci were eliminated and how, a detailed description of pre-radiation dental screening, clearly described patient and tumor characteristics, and a detailed dental history and dental status. Subsequently, oral problems that occur post-radiation should be systematically recorded.
Topics: Dental Care; Head and Neck Neoplasms; Humans; Infection Control; Jaw Diseases; Mouth Diseases; Osteoradionecrosis; Treatment Outcome
PubMed: 25524386
DOI: 10.1016/j.oraloncology.2014.11.017 -
Journal of Plastic, Reconstructive &... Jan 2023Due to the rarity of the need for claviculectomy and the subsequent clavicle reconstruction, currently there is no consensus on the reconstructive approach for the... (Review)
Review
BACKGROUND/OBJECTIVES
Due to the rarity of the need for claviculectomy and the subsequent clavicle reconstruction, currently there is no consensus on the reconstructive approach for the clavicle. The clavicle is an essential bony structure that is necessary for optimal upper limb anatomical and physiological functionalities.
OBJECTIVE
This study analyzes the reconstructive approach, vascular anastomosis, complications, and long-term outcome of clavicle reconstruction using a free vascularized fibular flap through a systematic review of the literature and a case report from our institution.
METHODS
A comprehensive literature search was executed in the Ovid MEDLINE, Embase, and Google Scholar databases. The search strategy was designed to capture the concept of cases that underwent clavicle reconstruction after necessary claviculectomy with sufficient clinical information for detailed analysis. Using the final included articles, we analyzed and summarized the outcomes associated with clavicle reconstruction using free fibular osteocutaneous flap.
RESULTS
A review of 179 articles yielded 11 publications with 26 cases that had detailed clinical information. We presented an additional case from our institution database. The systematic review of 27 cases revealed that clavicle nonunion due to various causes accounted for 73.08% of the cases for claviculectomy and the eventual reconstruction with a free fibular flap. The mean follow-up period in this study is 29.54 months with the range of 3 to 120 months. A total of 92.31% of the cases showed evidence of complete osseous consolidation.
CONCLUSION
When claviculectomy is necessary, a free fibular flap can be utilized for the subsequent clavicle reconstruction to provide optimal anatomical and physiological functionality of the clavicle.
Topics: Humans; Clavicle; Free Tissue Flaps; Plastic Surgery Procedures; Bone Transplantation; Fibula
PubMed: 36538867
DOI: 10.1016/j.bjps.2022.08.078 -
British Dental Journal Dec 2022Introduction/objectives Radiotherapy (RT) has a detrimental effect on the histomorphology of oral tissues. Patients undergoing RT are at risk of developing macrovascular...
Introduction/objectives Radiotherapy (RT) has a detrimental effect on the histomorphology of oral tissues. Patients undergoing RT are at risk of developing macrovascular and microvascular changes, which can lead to significant clinical consequences. Despite advances in RT delivery systems, radiation injury remains a modern-day clinical problem. The aim of this systematic review is to investigate the available evidence regarding the impact of RT to the dental pulp and the clinical manifestations of these effects.Data and sources A multi-database search (PubMed, Medline, Embase and CINAHL) was performed to identify related papers published from inception until November 2021. An additional manual search was performed to identify further articles. The data extracted from relevant papers were analysed according to the outcomes selected in this review.Study selection The search generated seven articles eligible for analysis with a total of 2,709 teeth included. RT dose exposure ranged from 30-71.2 Gray with a common finding that RT decreases the number of teeth responding to pulp sensibility testing.Conclusions Knowledge related to the impact of RT on dental pulp is limited and based on weak evidence and a low-level quality of studies. Future studies should incorporate exact RT doses to the teeth and use replicable pulpal testing methods. Understanding the pulpal status post-RT remains an important consideration as dental extractions should be avoided in this cohort due to the risk of osteoradionecrosis.
PubMed: 36473977
DOI: 10.1038/s41415-022-5301-8