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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 -
Clinical Oral Investigations Jan 2024To review the available prospective literature on hyperbaric oxygen (HBO) therapy for periodontal conditions. (Review)
Review
OBJECTIVE
To review the available prospective literature on hyperbaric oxygen (HBO) therapy for periodontal conditions.
MATERIALS AND METHODS
A comprehensive electronic and manual search was performed to identify clinical studies on adult patients who underwent hyperbaric oxygen therapy for periodontal treatments. A systematic literature search was conducted in PubMed, Cochrane, and Dentistry Oral Sciences Source databases.
RESULTS
Fourteen articles were included in the final literature review, of which five were RCTs and 11 were prospective clinical studies. Four studies discussed HBO as an adjunct to nonsurgical treatment of periodontitis, eight reported on HBO and osteoradionecrosis, and one examined HBO in bisphosphonate-related necrosis of the jaws.
CONCLUSIONS
HBO has shown superior efficacy compared to antibiotics as a prophylactic measure in preventing osteoradionecrosis (ORN) in patients with a history of high mandibular irradiation. Clinicians should consider referring such patients for HBO therapy before and after tooth extractions. However, for the surgical excision of existing ORN lesions, HBO therapy does not yield significant benefits but does not negatively impact outcomes either. Regarding the treatment of periodontitis patients, the variability among studies prevents definitive conclusions. HBO therapy as an adjunct to SRP in periodontitis treatment produces mixed results.
CLINICAL RELEVANCE
This study's clinical relevance lies in its exploration of the potential benefits of HBO for periodontal conditions. Also, it provides clinicians with insights into when and how to integrate HBO therapy into their treatment approaches, particularly for patients with a history of irradiation and those undergoing complex dental procedures.
Topics: Adult; Humans; Hyperbaric Oxygenation; Osteoradionecrosis; Prospective Studies; Periodontitis; Periodontal Diseases; Gingival Diseases
PubMed: 38182685
DOI: 10.1007/s00784-023-05410-7 -
Oral Diseases Oct 2021The aim of this systematic review was to estimate the osteoradionecrosis rate in patients with head and neck cancer due to teeth extraction performed before radiotherapy... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The aim of this systematic review was to estimate the osteoradionecrosis rate in patients with head and neck cancer due to teeth extraction performed before radiotherapy and to identify possible risk factors.
MATERIAL AND METHODS
PRISMA protocol was used to evaluate and present the results. PubMed, Scopus and Web of Science were used as search engines: English full-length papers of clinical studies, in peer-reviewed journals, were investigated. Cumulative meta-analysis was performed with a random effects model (PROSPERO registration code: CRD42018079986).
RESULTS
Among 2,020 records screened, 8 were included in this review. Sixteen of 494 patients who underwent tooth extraction before radiotherapy developed osteoradionecrosis, with an osteoradionecrosis incidence of 2.2% (95% Confidence of Interval = 0.6-3.9, p < .185, I = 3,044%). All cases were reported in the mandible. No other clinical risk factor for osteoradionecrosis was detected.
CONCLUSIONS
Even if it is generally recommended to remove oral foci before radiotherapy, this systematic review confirmed that teeth extractions before radiotherapy represent a risk factor for osteoradionecrosis; the considerable amount of missing data prevented us from identifying other possible risk factors for osteoradionecrosis onset. Major efforts should be done to perform sounder methodological clinical investigations.
Topics: Humans; Jaw; Osteoradionecrosis; Retrospective Studies; Risk Factors; Tooth Extraction
PubMed: 32531873
DOI: 10.1111/odi.13485 -
Oral Oncology Oct 2022Virtual surgical planning (VSP) and computer aided design utilization in head and neck reconstruction has become increasingly popular within the discipline. Advocates of... (Review)
Review
Virtual surgical planning (VSP) and computer aided design utilization in head and neck reconstruction has become increasingly popular within the discipline. Advocates of the technology over traditional free hand surgery cite benefits including improved intraoperative efficiencies and postoperative outcomes that have been demonstrated during mandibular reconstruction. More recently, VSP for maxillary and mid facial reconstruction, generally considered more complex than their mandibular counterparts, have been applied with the hopes of similar benefits. However, our literature search revealed no large-scale randomized control trial substantiating these benefits. As such, the aim of this review was to synthesize the existing research on utilization of VSP in the context of maxillary reconstruction. Three databases were systematically searched for articles pertaining to maxillary reconstruction for oncologic, traumatic, or osteoradionecrosis indications. Four hundred and fourteen unique articles were reviewed by two independent reviewers ultimately revealing sixteen studies appropriate for qualitative synthesis including 142 patients. Results of our studies reveal the extreme heterogenicity of application of this technology under the label of virtual surgical planning. Outcome reporting methods were grossly inconsistent amongst all the articles resulting in inability to appropriately synthesize data quantitatively for a meta-analysis. Overall, there was no standard of reporting outcomes of maxillary reconstruction, and no randomized trials comparing virtual surgical planning versus freehand surgery and therefore there is insufficient data to objectively prove purported benefits. To facilitate future comparative studies, a minimal standard of reporting for maxillary VSP is presented and the need for a randomized control trial is highlighted.
Topics: Computer-Aided Design; Free Tissue Flaps; Humans; Mandibular Reconstruction; Maxilla; Randomized Controlled Trials as Topic; Plastic Surgery Procedures; Surgery, Computer-Assisted
PubMed: 35952582
DOI: 10.1016/j.oraloncology.2022.106058 -
Head & Neck Apr 2020There is no recommendation regarding the timing for implant surgery in patients with head and neck cancer (HNC) who require postoperative radiation therapy (RT). This... (Review)
Review
There is no recommendation regarding the timing for implant surgery in patients with head and neck cancer (HNC) who require postoperative radiation therapy (RT). This systematic review focused on the literature about the outcomes of implants placed during ablative surgery in patients with HNC who underwent postoperative RT. Implants placed after radiation therapy and implants placed in reconstructed jaws were excluded. Four comparative studies involving 755 native mandible primary implants were analyzed. The survival rate with postimplantation RT was 89.6% vs 98.6% in patients with no additional radiation. The overall success of implant-retained overdenture in patients with RT performed postimplantation was 67.4% vs 93.1% in patients with implant surgery that was carried out 1 year after the completion of radiation therapy. Only five cases of osteoradionecrosis (ORN) of the jaw were reported. The outcomes for implant survival rates appear to be positive for irradiated implants.
Topics: Carcinoma, Squamous Cell; Dental Implantation, Endosseous; Dental Implants; Head and Neck Neoplasms; Humans; Jaw; Mandible; Osteoradionecrosis
PubMed: 31898358
DOI: 10.1002/hed.26065 -
Scientific Reports May 2024Our study aimed to estimate the prevalence of total free flap failure following free flap reconstruction for mandibular osteoradionecrosis (mORN) and assess the impact... (Meta-Analysis)
Meta-Analysis
Our study aimed to estimate the prevalence of total free flap failure following free flap reconstruction for mandibular osteoradionecrosis (mORN) and assess the impact of potential moderators on this outcome. A comprehensive systematic literature search was independently conducted by two reviewers using the Medline, Scopus, Web of Science and Cochrane Library databases. Quality assessment of the selected studies was performed, and prevalence estimates with 95% confidence intervals (CI) were calculated. Outlier and influential analyses were conducted, and meta-regression analyses was employed to investigate the effects of continuous variables on the estimated prevalence. Ultimately, forty-six eligible studies (involving 1292 participants and 1344 free flaps) were included in our meta-analysis. The findings of our study revealed a prevalence of 3.1% (95% CI 1.3-5.4%) for total free flap failure after reconstruction for mORN. No study was identified as critically influential, and meta-regression analysis did not pinpoint any potential sources of heterogeneity. These findings provide valuable insights for researchers and serve as a foundation for future investigations into the management of mandibular osteoradionecrosis and the prevention of free flap failure in this context.
Topics: Humans; Osteoradionecrosis; Free Tissue Flaps; Prevalence; Plastic Surgery Procedures; Mandibular Diseases; Mandibular Reconstruction; Mandible
PubMed: 38750124
DOI: 10.1038/s41598-024-61862-1 -
Oral and Maxillofacial Surgery Dec 2022This systematic review aimed to assess whether the use of autologous platelet concentrates immediately after tooth extraction would prevent ORN in patients treated with... (Review)
Review
This systematic review aimed to assess whether the use of autologous platelet concentrates immediately after tooth extraction would prevent ORN in patients treated with radiotherapy (RT) for head and neck cancer (HNC). MEDLINE, Embase, Ovid, Scopus, Web of Science, CENTRAL Cochrane, and OpenGrey databases were searched (up to, and including, June 2021) by two independent reviewers to identify studies, followed by further manual search. As inclusion and exclusion criteria for the studies, only controlled clinical trials (randomized or not) were considered. The risk of bias of each included study was assessed using the Cochrane Risk of Bias Tool. Of the 129 potentially eligible studies, only 2 were included, both randomized controlled clinical trials; however, one used platelet-rich plasma and another leukocyte- and platelet-rich fibrin. Overall, both autologous platelet concentrates had no effect on the outcome assessed. The use of autologous platelet concentrates seems not to be beneficial for ORN prevention following tooth extractions in HNC patients treated with RT; however, according to the available evidence, a reliable statement cannot be made.
Topics: Humans; Osteoradionecrosis; Platelet-Rich Fibrin; Platelet-Rich Plasma; Tooth Extraction
PubMed: 35048208
DOI: 10.1007/s10006-021-01030-1 -
Cureus Jun 2020Scalp defects with exposed calvaria that have previously been irradiated present a unique reconstructive challenge. Patients with previously radiated scalp defects often...
Scalp defects with exposed calvaria that have previously been irradiated present a unique reconstructive challenge. Patients with previously radiated scalp defects often have few reconstructive options due to poor health or personal choice. The aim of this study was to evaluate the results of non-operative management for patients with prior radiotherapy to the scalp who developed exposed calvaria. The outcomes of interest were major and minor complications related to exposed calvaria with a time frame of follow-up of greater than one year or death from any cause. A retrospective chart review was performed to identify patients with prior radiotherapy and surgery for skin cancer to the scalp who subsequently developed exposed calvaria. Data from four surgeons from 2008 to 2019 was collected. Next, a systematic review of PubMed, EMBASE, Cochrane Library, and CINAHL was conducted to identify articles in which non-operative management was utilized for exposed calvaria post-radiotherapy. Nineteen patients were identified who received radiotherapy either before developing recurrent malignancy requiring operation or requiring radiation postoperatively because of close or involved margins and who subsequently developed exposed calvaria. Six of these patients had an additional attempt at local flap or skin grafting that failed. All patients had an American Society of Anesthesiologists score of three or four. All were managed with local wound care. Ten patients had near-complete healing with wound care alone. Eight patients are still alive from one to six years after the presentation. One patient, who remains alive, developed an intracranial abscess requiring long-term antibiotics but was medically compromised by concomitant myelodysplastic syndrome, mantle cell lymphoma on chemotherapy, atrial fibrillation on anticoagulation, and heart failure. Three patients developed new malignancies requiring re-operation with watchful waiting. Two of the three cases resulted in failure to control disease, but control of malignancy occurred in one case with resection of recurrent cancer and exposed bone. The systematic review of the literature yielded three studies that met the inclusion criteria. None of the studies encountered cases of meningitis, encephalitis, or death due to the non-operative treatment of exposed calvaria post radiation. Coverage of the calvaria with well-vascularized tissue is the reconstructive goal in the majority of circumstances. This case series and systematic review found that non-operative management of exposed calvaria post-radiotherapy can be an option for patients who are either not candidates for aggressive surgical treatment or who refuse surgery.
PubMed: 32714689
DOI: 10.7759/cureus.8751 -
Stem Cell Reviews and Reports Dec 2020Osteoradionecrosis (ORN) of the mandible is a severe complication of radiotherapy for head and neck cancer and is arduously difficult to manage. Current treatment...
BACKGROUND
Osteoradionecrosis (ORN) of the mandible is a severe complication of radiotherapy for head and neck cancer and is arduously difficult to manage. Current treatment options carry risks with some patients remaining incurable. Mesenchymal stromal/stem cell (MSC) therapy has shown promising results supporting osteogenesis and regeneration of radiotherapy-damaged tissues. The aim of this study was to systematically review the literature on the safety and efficacy of MSCs in treating ORN.
METHODS
A systematic search was performed on MEDLINE, Embase, Cochranes Library online databases, and clinicaltrials.gov to identify preclinical and clinical studies examining the effect of MSCs on osseous healing of ORN. The preclinical studies were assessed according to the SYRCLEs guidelines and risk of bias tool.
RESULTS
Six studies (n = 142) from 5 countries were eligible for analysis. Of these four were preclinical studies and two clinical case studies. Preclinical studies found MSC treatment to be safe, demonstrating bone restorative effects and improved soft tissue regeneration. In the clinical cases, healing of bone and soft tissue was reported with no serious adverse events.
CONCLUSION
The evidence from the included studies suggests that MSCs may have beneficial regenerative effects on the healing of ORN. None of the studies reported adverse events with the use of MSCs. More carefully controlled studies with well-identified cells are however needed to demonstrate the efficacy of MSCs in a clinical setting. Graphical abstract.
Topics: Animals; Disease Models, Animal; Humans; Male; Mandible; Mesenchymal Stem Cell Transplantation; Middle Aged; Osteoradionecrosis; Publication Bias; Risk; Time Factors; Wound Healing
PubMed: 32869179
DOI: 10.1007/s12015-020-10034-5 -
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