Osteoradionecrosis of the Mandible: A Case Report

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Summary

Osteoradionecrosis (ORN) of the jaws is a serious complication of radiotherapy of head and neck malignancies. Different assumptions about its occurring, risk factors and possible therapeutical modalities exist, but the clinical outcome of such patients is still not on the desired level. This article presents a clinical case of ORN of the mandible, occurring with exposed and infected bone, necrotic process that extended through all the mandible body, as well as cutaneous fistula. The first site of ORN was detected 2 years after radiotherapy for oral cancer, with the second one detected 3 and a half years after radiotherapy. In both, the reason for exposing the bone was local trauma due to tooth extraction. Due to the stage of the condition, a decision for surgical treatment accompanied with antibiotics was made.

It is very important and critical for irradiated patients and patients with osteoradionecrosis to perform appropriate oral hygiene and frequent dental checks. Establishing protocols for prevention and treatment, but involving some new strategies regarding to this condition, are strongly recommended.

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  • 1. Beumer J Harrison R Sanders B Kurrasch M. Osteoradionecrosis: predisposing factors and outcomes of therapy. Head Neck Surg 1984; 6:819-827.

  • 2. Chrcanovic BR Reher P Sousa AA Harris M. Osteoradionecrosis of the jaws - a current overview. Part 1: Physiopathology and risk and predisposing factors. Oral Maxillofac Surg 2010; 14(1):3-16.

  • 3. Marx RE. Osteoradionecrosis; a new concept of its pathophysiology. J Oral Maxillofac Surg 1983; 41:283-288.

  • 4. Marx RE. A new concept in the treatment of osteoradionecrosis. J Oral Maxillofac Surg 1983; 41:351-357.

  • 5. Teng MS Futran ND. Osteoradionecrosis of the mandible. Curr Opin Otolaryngol Head Neck Surg 2005; 13(4):217-221.

  • 6. Curi MM Dib LL. Osteoradionecrosis of the jaws: a retrospective study of the background factors and treatment in 104 cases. J Oral Maxillofac Surg 1997; 55(6):540-544.

  • 7. Tsai CJ Hofstede TM Sturgis EM Garden AS Lindberg ME Wei Q et al. Osteora-dionecrosis and radiation dose to the mandible in patients with oropharyngeal cancer. Int J Radiat Oncol Biol Phys 2013; 1:415-420.

  • 8. Guimarães EP Rafaelly de Oliveira Pedreira F Correia Jham B de Carli ML Pereira AAC Hanemann JAC. Clinical Management of Suppurative Osteomyelitis Bisphosphonate-Related Osteonecrosis and Osteoradionecrosis: Report of Three Cases and Review of the Literature. Case Rep Dent. ID 2013402096 2013.

  • 9. Goldwaser BR Chuang SK Kaban LB August M. Risk factor assessment for the development of osteoradionecrosis. J Oral Maxillofac Surg 2007; 65(11):2311-2316.

  • 10. Oh HK Chambers MS Martin JW Lim HJ Park HJ. Osteoradionecrosis of the mandible: treatment outcomes and factors influencing the progress of osteoradionecrosis. J Oral Maxillofac Surg 2009; 67(7):1378-1386.

  • 11. Vanderpuye V Goldson A. Osteoradionecrosis of the mandible. A case report. J Natl Med Assoc 2009; 92:579-584.

  • 12. Myers R Marx RE. Use of hyperbaric oxygen in postradiation head and neck surgery. Natl Cancer Inst Monogr 1990; pp 151-157.

  • 13. Rice N Polyzois I Ekanayake K et al. The management of osteoradionecrosis of the jaws - a review. Surgeon 2015; 13:101-109.

  • 14. Peterson DE Doerr W Hovan A et al. Osteoradionecrosis in cancer patients: the evidence base for treatmentdependent frequency current management strategies and future studies. Support Care Cancer 2010; 18:1089-1098.

  • 15. Shaw RJ Dhanda J. Hyperbaric oxygen in the management of late radiation injury to the head and neck. Part I: Treatment. Br J Oral Maxillofac Surg 2011; 49(1):2-8.

  • 16. Jereczek-Fossa BA Orecchia R. Radiotherapy-induced mandibular bone complications. Cancer Treat Rev 2002; 28:65-74.

  • 17. Reuther T Schuster T Mende U Kübler A. Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients. A report of a thirty year retrospective review. Int J Oral Maxillofac Surg 2003; 32:289-295.

  • 18. Studer G Gratz KW Glanzmann C. Osteoradionecrosis of the mandible in patients treated with different fractionations. Strahlenther Onkol 2004; 180:233-240.

  • 19. Niewald M Fleckenstein J Mang K Holtmann H Spitzer WJ Rübe C. Dental status dental rehabilitation procedures demographic and oncological data as potential risk factors for infected osteoradionecrosis of the lower jaw after radiotherapy for oral neoplasms: a retrospective evaluation. Radiat Oncol 2013; 8:227.

  • 20. Silverstein P. Smoking and wound healing. Am J Med 1992; 93:225-245.

  • 21. Guo S DiPietro LA. Factors affecting wound healing. J Dent Res 2010; 89:219-229.

  • 22. Gevorgyan A Wong K Poon I Blanas N Enepekides DJ Higgins KM. Osteoradionecrosis of the mandible: a case series at a single institution. J Otolaryngol Head Neck Surg 2013; 42:46-52.

  • 23. Delanian S Lefaix JL. The radiation-induced fibroatrophic process: therapeutic perspective via antioxidant pathway. Radiother Oncol 2004; 73:119-131.

  • 24. Robarda L Louisb M-Y Blanchardb D Babina E Delanianc S. European Annals of Otorhinolaryngology Head and Neck Diseases 2014; 131:333-338.

  • 25. Rice N Polyzios I Ekanayake K Osama O Stassen LFA. The management of osteoradionecrosis of the jaws. A review the surgeon. 2015; 13:101-109.

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