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Journal of Neuro-oncology Dec 2020Radiation therapy (RT) is often necessary for the treatment of head and neck cancers. Osteoradionecrosis (ORN) is a rare, but potentially serious complication of RT. RT... (Review)
Review
Radiation therapy (RT) is often necessary for the treatment of head and neck cancers. Osteoradionecrosis (ORN) is a rare, but potentially serious complication of RT. RT leads to the destruction of vasculature in radiated tissue causing hypoxia and tissue necrosis. ORN can occur in any bone, but bones with naturally poor blood supply appear to be more susceptible. Bones of the skull base are susceptible, with ORN occurring in the anterior, central, and lateral skull base. Risk factors include cancer type and location, radiation dose, and a variety of patient factors. Patients often present with pain, bleeding, and foul odor and are typically found to have exposed and necrotic bone. Treatment options vary depending on the severity, but typically include pentoxifylline and vitamin E as well as surgical debridement, with less evidence supporting hyperbaric oxygen therapy. Recognition and prompt treatment of ORN will allow for improved patient outcomes.
Topics: Animals; Head and Neck Neoplasms; Humans; Osteoradionecrosis; Radiotherapy; Skull Base Neoplasms
PubMed: 32394326
DOI: 10.1007/s11060-020-03462-3 -
Dentistry Journal Jan 2023Osteonecrosis of the jaw is a condition in which bone cells die due to various causes. It is classified as drug-induced jaw osteonecrosis, osteoradionecrosis, traumatic,... (Review)
Review
Osteonecrosis of the jaw is a condition in which bone cells die due to various causes. It is classified as drug-induced jaw osteonecrosis, osteoradionecrosis, traumatic, non-traumatic, and spontaneous osteonecrosis. Antiresorptive or antiangiogenic drugs cause drug-induced osteonecrosis. The combination of medications, microbial contamination, and local trauma induces this condition. Osteoradionecrosis is a severe radiation therapy side effect that can affect people with head and neck cancer. It is described as an exposed bone area that does not heal for longer than three months after the end of radiation treatment with the absence of any indications of an original tumor, recurrence, or metastasis. Trauma (tooth extraction), tumor site, radiation dose that the patient receives, the area of the bone which is irradiated, oral hygiene, and other factors are risk factors for the development of osteonecrosis. Less frequently, osteonecrosis can also be induced by non-traumatic and traumatic causes. Non-traumatic osteonecrosis is brought on by infections, acquired and congenital disorders, as well as the impact of chemicals. Traumatic osteonecrosis is brought on by thermal, mechanical, or chemical damage. The treatment of osteonecrosis can be conservative, which aims to be beneficial for the patient's quality of life, and surgical, which involves debridement of the necrotic bone.
PubMed: 36661560
DOI: 10.3390/dj11010023 -
Current Opinion in Otolaryngology &... Oct 2019To describe current standard of care for osteoradionecrosis (ORN) of the mandible and report possible future trends. (Review)
Review
PURPOSE OF REVIEW
To describe current standard of care for osteoradionecrosis (ORN) of the mandible and report possible future trends.
RECENT FINDINGS
Cutting guides may be used to reduce surgical time and possibly improve outcomes. There has also been recent investigation into the use of pentoxifylline and tocopherol or pentoxifylline, tocopherol and clodronate (a well known conservative medial regime) as a prevention for development of ORN after dental extractions and the first randomized controlled study is upcoming. Augmented reality has shown promise as a comparable and inexpensive possible alternative to cutting guides.
SUMMARY
Current standard of care involves conservative/supportive therapy with antioxidants, antibiotics, steroids, and pain control for low-grade ORN with surgery reserved for high-grade/progressive ORN with refractory to conservative therapy and with significant oral dysfunction.
Topics: Antioxidants; Humans; Mandible; Osteoradionecrosis; Plastic Surgery Procedures; Surgical Flaps
PubMed: 31389851
DOI: 10.1097/MOO.0000000000000571 -
JAMA Otolaryngology-- Head & Neck... Aug 2023
Topics: Humans; Proton Therapy; Osteoradionecrosis; Radiotherapy Dosage; Mandibular Diseases
PubMed: 37318819
DOI: 10.1001/jamaoto.2023.1302 -
JAMA Otolaryngology-- Head & Neck... Aug 2023
Topics: Humans; Proton Therapy; Osteoradionecrosis; Radiotherapy Dosage; Mandibular Diseases
PubMed: 37318798
DOI: 10.1001/jamaoto.2023.1301 -
Cancers Sep 2023Post-oropharyngeal cancer treatment complications include a multitude of oral side effects that impact overall survival and quality of life. These include acute and... (Review)
Review
Post-oropharyngeal cancer treatment complications include a multitude of oral side effects that impact overall survival and quality of life. These include acute and chronic conditions affecting the oral cavity and head and neck, such as mucositis, infection, xerostomia, dysgeusia, radiation caries, osteonecrosis, and trismus. This review will summarize the most common oral complications from oropharyngeal cancer therapy. The authors would like to point out that the literature cited frequently combines oropharyngeal and head and neck cancer results. If recommendations are made strictly related to oropharyngeal cancers, this will be highlighted.
PubMed: 37760517
DOI: 10.3390/cancers15184548 -
Journal of Dental Sciences Jul 2022
PubMed: 35784171
DOI: 10.1016/j.jds.2022.04.025