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The Laryngoscope Nov 2021To report the largest single-institution review of temporal bone osteoradionecrosis (TBORN), and characterize the disease's natural history, prognostic factors,...
OBJECTIVES/HYPOTHESIS
To report the largest single-institution review of temporal bone osteoradionecrosis (TBORN), and characterize the disease's natural history, prognostic factors, management, and outcomes.
STUDY DESIGN
Retrospective chart review.
METHODS
Retrospective review was conducted to identify patients with TBORN. Pertinent data were extracted. Descriptive statistics were used to summarize patient, tumor, and treatment characteristics. Multivariable analyses were conducted to explore associations between these characteristics and time to TBORN diagnosis and risk of developing diffuse disease.
RESULTS
TBORN was identified in 145 temporal bones from 128 patients. Mean age at diagnosis was 62 years, and mean time to diagnosis after radiotherapy was 10 years. Age greater than 50 years was associated with earlier diagnosis. According to the Ramsden criteria, 76% of TBs had localized and 24% had diffuse disease at initial diagnosis; 37% had diffuse disease at last follow-up. On multivariable analysis, diabetes, three-dimensional conformal radiotherapy (3D-CRT), and periauricular skin malignancy were significant risk factors for developing diffuse disease. Localized disease was successfully managed with conservative measures, whereas surgery was often necessary for diffuse disease. When TBORN spread outside the mastoid or infratemporal fossa, conservative measures were always unsuccessful.
CONCLUSIONS
TBORN occurs earlier in older patients. While diffuse disease is less common than localized disease, it occurs more frequently in patients with diabetes, history of 3D-CRT, and periauricular skin malignancies. Conservative management is appropriate for localized disease, while surgery is often necessary for diffuse disease. The prognostic factors identified helped propose a TBORN staging system and treatment guidelines which may improve patient risk stratification and disease management.
LEVEL OF EVIDENCE
4 Laryngoscope, 131:2578-2585, 2021.
Topics: Adult; Age Factors; Aged; Aged, 80 and over; Female; Follow-Up Studies; Head and Neck Neoplasms; Humans; Incidence; Male; Middle Aged; Osteoradionecrosis; Prognosis; Radiotherapy, Conformal; Retrospective Studies; Risk Assessment; Risk Factors; Skin Neoplasms; Temporal Bone; Young Adult
PubMed: 34287898
DOI: 10.1002/lary.29758 -
Oral Surgery, Oral Medicine, Oral... Nov 2017A significant complication of radiotherapy to the head and neck for cancer treatment is osteoradionecrosis (ORN) of the jaws. The management of ORN can be complex and... (Review)
Review
A significant complication of radiotherapy to the head and neck for cancer treatment is osteoradionecrosis (ORN) of the jaws. The management of ORN can be complex and often requires a multimodality approach. Nonsurgical treatments with or without adjunct measures and surgical interventions have all been employed on the basis of staging of the disease process. New theories on the pathophysiology of ORN have led to the identification of novel treatment modalities, including pharmacologic management using pentoxifylline, tocopherol, and clodronate (together referred to as "Pentoclo"). In this review article, we discuss the definition and staging of ORN, its etiology and pathophysiology, and traditional treatment options and present the available information on pentoxifylline, tocopherol, and clodronate and their use in combined therapy for ORN. Limited studies to date have demonstrated the effective pharmacologic use of Pentoclo in treating ORN and radiation-induced injury at other body sites. Further research is necessary to elucidate any potential role for the use of Pentoclo in the management of this debilitating disease process.
Topics: Clodronic Acid; Drug Combinations; Head and Neck Neoplasms; Humans; Osteoradionecrosis; Pentoxifylline; Tocopherols
PubMed: 29103566
DOI: 10.1016/j.oooo.2017.08.004 -
Australian Dental Journal Sep 2023Osteoradionecrosis (ORN) is an uncommon and debilitating consequence of head and neck radiotherapy and hyperbaric oxygen therapy (HBOT) has been advocated for...
BACKGROUND
Osteoradionecrosis (ORN) is an uncommon and debilitating consequence of head and neck radiotherapy and hyperbaric oxygen therapy (HBOT) has been advocated for prophylaxis prior to performing dentoalveolar procedures. The aim of this study was to evaluate a prophylactic HBOT protocol and describe the outcomes of susceptible individuals.
METHODS
A retrospective audit of adults who attended the Oral and Maxillofacial Surgery department at the Royal Adelaide Hospital (South Australia) who received dental extractions with a history of radiotherapy to the jaws from 2008 to 2020. Data including demographic information and outcomes of osteoradionecrosis and delayed healing was recorded.
RESULTS
A total of 121 individuals were eligible for case note review; 68.6% of individuals were male and 55.4% were aged over 67 years. Osteoradionecrosis occurred in 9.1% of individuals and delayed healing for 3.3%; fifteen individuals (12.4%) were unable to complete the HBOT protocol. The individuals who were diagnosed with ORN had a significant association with age (P = 0.006) and binary analysis showed alcohol consumption to be a significant predictor.
CONCLUSIONS
Prophylactic HBOT protocol had a lower proportion of individuals diagnosed with ORN and those who were diagnosed were more likely to be younger males and have current alcohol consumption.
Topics: Adult; Humans; Male; Aged; Female; Osteoradionecrosis; Hyperbaric Oxygenation; Retrospective Studies; South Australia; Head and Neck Neoplasms
PubMed: 37345410
DOI: 10.1111/adj.12963 -
Acta Medica Okayama Aug 2017Osteoradionecrosis (ORN), a well-known complication of radiotherapy in the mandibular bone, is very rare in the cervical spine. The authors report the result of a 3-year...
Osteoradionecrosis (ORN), a well-known complication of radiotherapy in the mandibular bone, is very rare in the cervical spine. The authors report the result of a 3-year follow-up of a 63-year-old female patient with ORN of the cervical spine. The patient had a history of laryngeal carcinoma and was treated with chemotherapy and radiation therapy with a total of 120 Gy. Eight years later, she developed acute, severe neck pain due to cervical spine necrosis. The authors performed vascularized fibular bone graft and posterior pedicle screw fixation to reconstruct her cervical spine. The patient was successfully treated with surgery, and cervical alignment was preserved. She had neither neurological deficits nor severe neck pain at her final follow-up 3 years later. Delaying treatment of ORN may be life threatening, so the early diagnosis of this condition is important for patients who receive radiotherapy. Otolaryngologists and spine surgeons should understand this potential complication to speed diagnosis and treatment as early as possible.
Topics: Cervical Vertebrae; Female; Humans; Middle Aged; Osteoradionecrosis
PubMed: 28824191
DOI: 10.18926/AMO/55312 -
International Journal of Oral and... Jun 2022Midline and paramedian mandibulotomies both have distinct anatomical and surgical strengths. A retrospective study was performed at Chang Gung Memorial Hospital, Linkou...
Midline and paramedian mandibulotomies both have distinct anatomical and surgical strengths. A retrospective study was performed at Chang Gung Memorial Hospital, Linkou Branch between 2014 and 2019 to investigate how the osteotomy site (midline (n = 221) or paramedian (n = 44)) and type (straight, notched, or stair-stepped) affect postoperative and post-radiotherapy complications in patients undergoing wide excision of tongue cancer with flap reconstruction. Midline mandibulotomies were predominantly of the straight osteotomy type, while paramedian mandibulotomies were mostly notched type (P < 0.001). Comparably low elective tooth extraction rates were found in both approaches (P = 0.556). Paramedian mandibulotomy showed a higher osteoradionecrosis rate (P = 0.026), but there was no significance in the sub-analysis of individual types. Paramedian sites were associated with more early infection (P = 0.036) and plate exposure (P = 0.036) than midline sites with the straight osteotomy type, but complication rates did not differ significantly for the notched and stair-stepped types. Paramedian sites (P = 0.020) and notched types (P = 0.006) were associated with higher odds of osteoradionecrosis in the univariable logistic regression analysis, but only the notched type remained significant in the multivariable analysis (P = 0.048). In conclusion, paramedian sites increased the rate of osteoradionecrosis, and correlation with the osteotomy type resulted in more osteoradionecrosis in notched types and more complications in straight paramedian mandibulotomies.
Topics: Humans; Mandible; Mandibular Osteotomy; Osteoradionecrosis; Postoperative Complications; Retrospective Studies; Tongue Neoplasms
PubMed: 34535350
DOI: 10.1016/j.ijom.2021.08.023 -
Macrophage and osteoclast polarization in bisphosphonate associated necrosis and osteoradionecrosis.Journal of Cranio-maxillo-facial... Jun 2017Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a complication of antiresorptive therapy with nitrogen-containing bisphosphonates (BP). With various...
PURPOSE
Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is a complication of antiresorptive therapy with nitrogen-containing bisphosphonates (BP). With various suggestions as to pathogenesis, the etiology of BRONJ is not sufficiently understood. Osteoclasts and their precursors, that is, macrophages, are the main target cells of BP. BP can repolarize regeneration- and healing-associated M2 macrophages towards the tissue destructive M1-type. The current study aims to elucidate differences in macrophage and osteoclast polarization in BRONJ, osteoradionecrosis (ORN) and healthy control specimens.
MATERIALS AND METHODS
A total of 39 jaw bone samples (18 BRONJ, 8 ORN and 13 healthy controls) were processed for immunohistochemistry to detect CD68-, CD11c- and CD163-positive cells. Macrophages and osteoclasts were distinguished on the basis of morphological differences. Samples were digitized, and the macrophage and osteoclast cell counts were quantitatively analyzed.
RESULTS
In jaw bone affected by BRONJ, a significantly increased macrophage infiltration and M1 polarization of macrophages can be seen. The density of CD68-expressing osteoclasts is significantly increased in BRONJ specimens compared to ORN and to healthy controls.
CONCLUSIONS
A bisphosphonate-derived shift of macrophage polarization towards M1-polarized macrophages might impair bone tissue homeostasis and thus contribute to the pathogenesis of BRONJ. The observed increase in osteoclast density might be caused by BP-induced prolonged osteoclast survival.
Topics: Aged; Bisphosphonate-Associated Osteonecrosis of the Jaw; Cell Count; Female; Humans; Immunohistochemistry; Jaw; Macrophages; Male; Middle Aged; Osteoclasts; Osteoradionecrosis
PubMed: 28365078
DOI: 10.1016/j.jcms.2017.02.023 -
Journal of Clinical Oncology : Official... Jun 2024To provide evidence-based recommendations for prevention and management of osteoradionecrosis (ORN) of the jaw secondary to head and neck radiation therapy in patients...
PURPOSE
To provide evidence-based recommendations for prevention and management of osteoradionecrosis (ORN) of the jaw secondary to head and neck radiation therapy in patients with cancer.
METHODS
The International Society of Oral Oncology-Multinational Association for Supportive Care in Cancer (ISOO-MASCC) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials and observational studies, published between January 1, 2009, and December 1, 2023. The guideline also incorporated systematic reviews conducted by ISOO-MASCC, which included studies published from January 1, 1990, through December 31, 2008.
RESULTS
A total of 1,539 publications were initially identified. There were 487 duplicate publications, resulting in 1,052 studies screened by abstract, 104 screened by full text, and 80 included for systematic review evaluation.
RECOMMENDATIONS
Due to limitations of available evidence, the guideline relied on informal consensus for some recommendations. Recommendations that were deemed evidence-based with strong evidence by the Expert Panel were those pertaining to best practices in prevention of ORN and surgical management. No recommendation was possible for the utilization of leukocyte- and platelet-rich fibrin or photobiomodulation for prevention of ORN. The use of hyperbaric oxygen in prevention and management of ORN remains largely unjustified, with limited evidence to support its practice.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
Topics: Osteoradionecrosis; Humans; Head and Neck Neoplasms
PubMed: 38691821
DOI: 10.1200/JCO.23.02750 -
Medicina Oral, Patologia Oral Y Cirugia... Nov 2022Analyze the incidence of MORN after head and neck radiotherapy by two novel irradiation techniques, 3DCRT and IMRT and compare the success rates of distinct authors.
BACKGROUND
Analyze the incidence of MORN after head and neck radiotherapy by two novel irradiation techniques, 3DCRT and IMRT and compare the success rates of distinct authors.
MATERIAL AND METHODS
An electronic search in Pubmed (MEDLINE), Ovid, Google Scholar and Cochrane Library (Wiley), databases was conducted with the key words "Radiotherapy, Conformal"[Mesh] OR "Radiotherapy, Intensity-Modulated"[Mesh]) AND "Osteoradionecrosis"[Mesh] for all databases. The inclusion criteria randomized controlled trials (RCT), as well as prospective and retrospective cohort studies published in English; MORN patients treated with 3D-CRT y IMRT.
RESULTS
27 articles were selected from 194 initially found. 14 articles out of 27 were excluded and finally included 8 publications were included in the systematic review that were ranked according to their level of scientific evidence using the SORT criteria.
CONCLUSIONS
When both RT techniques were compared; IMRT revealed a lower risk incidence of MORN development and enhanced dose constraint than 3D-CRT (less than 10%), this improvement could translate into less complications post RT treatment.
Topics: Humans; Radiotherapy, Intensity-Modulated; Incidence; Radiotherapy, Conformal; Osteoradionecrosis; Mandible
PubMed: 36243999
DOI: 10.4317/medoral.25459 -
Special Care in Dentistry : Official... May 2020The cumulative effect of radiation and the extent of related morbidities on oral tissues are enormous and increase over time. The numerous radiation-related side effects... (Review)
Review
The cumulative effect of radiation and the extent of related morbidities on oral tissues are enormous and increase over time. The numerous radiation-related side effects have a strong, negative influence on the oral functions and are responsible for a drastic reduction in the oral-health-related quality of life of the cancer survivors. In a significant deviation to the earlier approach of advising extraction of all remaining teeth before RT, the concept of preserving a maximum number of teeth in a state of health and for better oral functions postcancer cure has been globally accepted and is adhered to. The effects of radiation and their impact on the general well-being of the patients underscore the relevance of understanding the sequelae of radiation therapy on healthy oral tissues, preexisting oral diseases and their progression, impact on oral treatment needs, limitations in performing the indicated treatment, and shortcoming in treatment outcomes. It is vital for the professionals involved in head and neck cancer care to follow a well-devised referral system for oral care before and after RT and educate patients for a life-long follow-up.
Topics: Head and Neck Neoplasms; Humans; Mouth Diseases; Osteoradionecrosis; Quality of Life; Radiation Injuries
PubMed: 32378765
DOI: 10.1111/scd.12469 -
Head & Neck Mar 2022Perioperative management of advanced osteoradionecrosis of the head and neck requiring free flap (FF) reconstruction varies. Our objectives included assessment of...
BACKGROUND
Perioperative management of advanced osteoradionecrosis of the head and neck requiring free flap (FF) reconstruction varies. Our objectives included assessment of practice patterns and outcomes.
METHODS
Multi-institutional, retrospective review of FF reconstruction for head and neck osteoradionecrosis (n = 260).
RESULTS
Administration of preoperative antibiotics did not correlate with reduction in postoperative complications. Preoperative alcohol use correlated with higher rates of hardware exposure (p = 0.03) and 30-day readmission (p = 0.04). Patients with FF compromise had higher TSH (p = 0.04) and lower albumin levels (p = 0.005). Prealbumin levels were lower in patients who required neck washouts (p = 0.02) or a second FF (p = 0.03). TSH levels were higher in patients undergoing postoperative debridement (p = 0.03) or local flap procedures (p = 0.04).
CONCLUSION
Malnutrition, hypothyroidism, and substance abuse correlated with a higher incidence of postoperative wound complications in patients undergoing FF reconstruction for advanced osteoradionecrosis. Preoperative antibiotics use did not correlate with a reduction in postoperative wound complications.
Topics: Free Tissue Flaps; Head and Neck Neoplasms; Humans; Osteoradionecrosis; Postoperative Complications; Plastic Surgery Procedures; Retrospective Studies
PubMed: 34918862
DOI: 10.1002/hed.26957