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Osteoradionecrosis


Presentation

  • At present, the focus is on the prevention of ORN.[contempclindent.org]
  • […] front teeth present the lowest risk.[medium.com]
  • Results: A total of 89 patients (55 male and 34 female) underwent extractions of teeth which were present in the radiation field.[cancerjournal.net]
  • We present a rare case of osteoradionecrosis in the lumbar spine 25 years after radiotherapy to the pelvis for cervical cancer. Case report A 58-year-old woman presented with a two-month history of lower lumbar pain.[online.boneandjoint.org.uk]
  • Oxigenotherapy presented better cicatrisation of soft tissues in irradiated wounds. No recurrence of primary tumor was observed.[arquivosdeorl.org.br]
Plethora
  • […] the radiation, trauma and infection theory [3] by Meyer in 1970, hypoxia, hypovascularity and hypocellularity by Marx in 1983, [4] and recently, the radiation-induced fibroatrophic theory. [5] Complexity in diagnosing of ORN is attributed to a wide plethora[contempclindent.org]
Intermittent Claudication
  • Pentoxifiylline has been used for the management of vascular disorders, such as intermittent claudication, and has anti-inflammatory mediators, such as TNF- α.[decisionsindentistry.com]
Lesion of the Tongue
  • Our findings correlated with the report by Owosho et al. that malignancies of the oropharynx were more prone to the development of ORN and in particular those having lesions of the tongue. [13] In our sample, the mandible was the site of ORN in most of[contempclindent.org]
Flushing
  • Dissection was performed flush on the thoracoacromial vascular pedicle to preserve the nerve branches to the clavicular part of the muscle.[omicsonline.org]
Distractibility
  • In case of extensive jaw surgery, good reconstruction options in the form of free fibular flap, [15] cancellous bone grafting, and distraction osteogenesis [16] are available. At present, the focus is on the prevention of ORN.[contempclindent.org]
Neglect
  • At around 9 months post-radiotherapy, the patient had developed pain in his lower molar teeth on the left side, which were then extracted by a local dentist who neglected to go into the patient’s recent history of irradiation to the maxillofacial region[omicsonline.org]

Workup

  • Signs and symptoms These include the following: Pain Swelling Trismus Exposed bone Pathologic fracture Malocclusion Workup Plain radiography of the mandible, or Panorex, depicts areas of local decalcification, osteolysis or sclerosis.[emedicine.medscape.com]
  • So, after the routine workup, the patient was taken up for Segmental mandibular resection followed by reconstruction under General anesthesia, without HBOT.[omicsonline.org]

Treatment

  • Patients are treated with 30 hyperbaric treatments preoperatively followed by bony debridement. Postoperatively they are given an additional ten treatments.[statpearls.com]
  • OsteoradionecrosisGoal of treatment – Resolution with maintenance of mandibular continuityPredictors of treatment outcomes vDose and Treatment Volume vThe higher the dose and the larger the treatment volume the less predictable the outcome. 48.[ffofr.org]
  • Treatment outcomes are illustrated in Table 3.[cda-adc.ca]
  • […] bone exposure require more radical treatment.[arquivosdeorl.org.br]
  • Although it is not surprising that those treated with HBO did not benefit from the treatment, particularly given the small sample size, it is difficult to explain why they did not do as well. The treatment of ORN is unsatisfactory.[oralcancernews.org]

Prognosis

  • […] in a mixed sclerotic-lucent pattern sequestration, especially of the buccal bone an absence of soft tissue mass is an important feature to differentiate it from neoplastic recurrence but the presence of soft tissue does not exclude ORN Treatment and prognosis[radiopaedia.org]
  • However, it is crucial to distinguish between ORN, a benign condition that is managed conservatively, and recurrent SCC, which carries a poor prognosis even with treatment.[ascopubs.org]
  • Patients are explained to regarding the importance of good oral hygiene maintenance, the need for the removal of teeth with poor prognosis, the complications of RT, and post-RT oral care. RT is initiated only after dental clearance.[contempclindent.org]
  • Management Prior to beginning radiation therapy, all patients should undergo a thorough dental evaluation, including full mouth radiographs, dental and periodontal diagnosis, and prognosis for each tooth.[emedicine.medscape.com]
  • Management of ORN from a dental perspective aims at preventing the development of ORN with thorough pre radiation therapy assessment of the patient, wherein all teeth with deep carious lesions or a hopeless periodontal prognosis are extracted.[ccij-online.org]

Etiology

  • Osteoradionecrosis of mandible: Etiology, prevention, diagnosis and treatment. Indian J Plast Surg. 2007; 40 :s65–71. [ Google Scholar ] 4. Jacobson AS, Buchbinder D, Hu K, Urken ML.[ncbi.nlm.nih.gov]
  • The etiology of osteoradionecrosis is considered to be multifactorial. These factors may increase the risk of the patient for development of osteoradionecrosis.[jdrr.org]
  • Etiology ORN can be either spontaneous or the result of an insult. Spontaneous ORN occurs when, in the process of otherwise normal turnover of bone, the degradative function exceeds new bone production.[emedicine.medscape.com]
  • It is critical that all necrotic bone be debrided and removed in stage III patients. stage III osteoradionecrosis patients receive 30 treatments preoperatively followed by ten hyperbaric oxygen treatments, postoperatively. [3] Etiology Osteoradionecrosis[statpearls.com]
  • The need to study the etiology and the treatment of such kind of pathology and its standardization in terms of its treatment made several authors do research. Regaud, 3 in 1922, was one of the first authors to describe ORN.[arquivosdeorl.org.br]

Epidemiology

  • Osteoradionecrosis is rarely seen in patients who received less than 6000 centiGrays (cGy) of radiation and can occur years to decades after radiation is concluded. [4] [5] Epidemiology Osteoradionecrosis occurs in approximately 9% of patients who receive[statpearls.com]
  • […] and Etiology [ edit ] Epidemiology [ edit ] The epidemiology of osteoradionecrosis has proven difficult to estimate, with previous studies reporting incidence of disease between 4.74-37.5%. [6] More recent reports have estimated the incidence to 2%,[en.wikipedia.org]
  • Epidemiology Frequency ORN is rare in patients who receive less than 60 gray (Gy) radiation therapy. Patients with ORN who receive less than 60 Gy and more than 50 Gy have been reported, but these cases are extremely rare.[emedicine.medscape.com]
Sex distribution
Age distribution

Pathophysiology

  • The factors are classified into four groups as shown in [Table 4]. [15], [16], [17], [18] Pathophysiology The pathophysiology of osteoradionecrosis is not very clear till date.[jdrr.org]
  • During early post-treatment period, patient should visit the dentist every 4 months.[ 3, 4 ] Pathophysiology Since, the first description of ORN was published in 1922 several hypothetical pathologic models have been proposed.[ncbi.nlm.nih.gov]
  • Pathophysiology Osteoradionecrosis is a delayed injury to an irradiated bone, where the bone becomes devitalised and exposed through a wound in the overlying skin or mucosa, with this wound not healing for 3-6 months. r Incidence/prevalence Incidence[eviq.org.au]
  • PATHOPHYSIOLOGY Bones are resistant to ORN as long as there is healthy, intact soft tissue.[decisionsindentistry.com]
  • Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg 1983; 41 : 283–288. 9 Marx R E, Johnson R P, Kline S N.[nature.com]

Prevention

  • Part II: Prevention. Br J Oral Maxillofac Surg 2011;49:9-13. 21. Vudiniabola S, Pirone C, Williamson J, Goss AN. Hyperbaric oxygen in the prevention of osteoradionecrosis of the jaws. Aust Dent J 1999;44:243-7. 22. Chuang SK.[cancerjournal.net]
  • We will use stem cells and animal systems to understand mechanisms promoting jaw necrosis and how to prevent them. The goal is to improve quality of life of cancer survivors.[grantome.com]
  • Description of the intervention There are many dental interventions for the prevention of ORN.[cochranelibrary.com]
  • Reviews: 2006 PMID 16458773 — "Osteoradionecrosis prevention myths." Wahl MH et al. Int J Radiat Oncol Biol Phys. 2006 Mar 1;64(3):661-9.[en.wikibooks.org]
  • Osteoradionecrosis is difficult to prevent and treat.[en.wikipedia.org]

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