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Osteoradionecrosis of the Jaw


Presentation

  • CONCLUSIONS: The present study is the first report comparing the incidence of osteoradionecrosis between superselective intra-arterial chemoradiotherapy and intravenous chemoradiotherapy.[ncbi.nlm.nih.gov]
  • A review of the most recent experiences shows that, with present management methods at the University of Kentucky, ORN is not a significant problem. Of 30 patients treated in 1986, only one had ORN, and this was of the maxilla.[ncbi.nlm.nih.gov]
  • We present a rare case of massive tongue necrosis occurring simultaneously with bilateral osteoradionecrosis (ORN) of the jaw in a patient with a history of treatment, including surgery and postoperative radiotherapy, for a retromolar trigone carcinoma[ncbi.nlm.nih.gov]
  • […] front teeth present the lowest risk.[medium.com]
  • This gives the body the opportunity to heal and significantly improve, if not totally relieve patients of their presenting symptoms.[longbeachhyperbaricmedicine.com]
Pain
  • One month after the surgical procedure, the patient responded satisfactorily to the treatment, showing significant improvement in speech and oral food intake, as well as significant decrease in lingual pain.[ncbi.nlm.nih.gov]
  • You may experience pain, swelling and malocclusion (misalignment of the teeth). For diagnosis and treatment of this condition, seek the oral and maxillofacial surgeons at Jefferson.[hospitals.jefferson.edu]
  • Back and neck pain are among the most common conditions people suffer from. For some, back and neck pain is an annoyance or inconvenience; for others, it can be debilitating.[northwell.edu]
  • In addition, patients may complain of fetor oris (also known as halitosis), numbness, or chronic pain. The area may also present swollen or as a fistula. Severe cases include cortical bone fracture and/or an oro-antral communications.[medium.com]
  • In most cases osteoradionecrosis gradually progresses, becoming more extensive and painful that leads to infection and pathological fracture.[link.springer.com]
Malocclusion
  • You may experience pain, swelling and malocclusion (misalignment of the teeth). For diagnosis and treatment of this condition, seek the oral and maxillofacial surgeons at Jefferson.[hospitals.jefferson.edu]
  • ICD-10-CM Codes › M00-M99 Diseases of the musculoskeletal system and connective tissue › M26-M27 Dentofacial anomalies [including malocclusion] and other disorders of jaw › M27- Other diseases of jaws › Inflammatory conditions of jaws 2016 2017 2018 2019[icd10data.com]
  • It is believed that the reparative capacity of radiation-injured bone is exceeded Clinical presentation: pain, swelling, trismus, exposed bone, pathologic fracture, malocclusion, oral cutaneous fistula formation Grading Grade I: exposed alveolar bone[en.wikibooks.org]
Dental Caries
  • […] osteoradionecrosis, only progressive dental caries resulted in a significant difference for osteoradionecrosis.[ncbi.nlm.nih.gov]
Delayed Wound Healing
  • Bisphosphonates also have antiangiogenic properties which can delay wound healing [Ruggiero et al 2004, Migliorati et al 2006]. Bisphosphonate-associated osteonecrosis can develop spontaneously [Migliorati et al 2006].[ispub.com]
Distractibility
  • Monson et al (2012) The effects of high dose and highly fractionated radiation on distraction osteogenesis in the murine mandible. Radiation Oncology 7:15 CrossRef Google Scholar 28.[link.springer.com]
  • Assessment of Stress in Patients Visiting a Dental Hospital YOSHINORI TORIYAMA, et al. 163 A Case of Evaluation of Oral Implantation Using SPECT Bone Scintigraphy (Bone SPECT) TSUYOSHI NISHIMURA, et al. 176 A Patient Treated for Alveolar Deficiency with Distraction[jsodom.org]
Fear
  • Full Title: Hyperbaric Oxygen to Prevent Osteoradionecrosis of the Irradiated Mandible (HOPON) Medical condition: Osteoradionecrosis (ORN) of the irradiated mandible; the most feared complication of radiotherapy for head and neck cancer.[clinicaltrialsregister.eu]
Seizure
  • The side effects of HBO are transient myopia, middle ear barotrauma and seizures. [15] Nowadays, treatment of ORN is based on the clinical, radiological and CT findings, which help to determine the stage of the disease as early, intermediate, or advanced[ccij-online.org]

Workup

Periostal Elevation
  • If an extraction is performed, avoid using periosteal elevators, irrigate the site with saline, eliminate bony spicules, and try to create primary closure. Fluoridated Toothpaste.[medium.com]

Treatment

  • Ozone therapy is given as an option in the therapeutic protocol for the prevention and treatment of ORN.[ncbi.nlm.nih.gov]
  • One month after the surgical procedure, the patient responded satisfactorily to the treatment, showing significant improvement in speech and oral food intake, as well as significant decrease in lingual pain.[ncbi.nlm.nih.gov]
  • It has been used successfully in the treatment of delayed radiation injury for over 30 for years. Hyperbaric oxygen treatment allows more oxygen to reach these radiation damaged areas.[longbeachhyperbaricmedicine.com]
  • The present paper provides a literature review and update on the risk factors underlying osteoradionecrosis, its clinical and diagnostic particulars, prevention and most widely accepted treatment options including the latest treatment modalities.[link.springer.com]
  • Hyperbaric oxygen is used as a treatment for persistent ORN.[ncbi.nlm.nih.gov]

Prognosis

  • Teeth in the RT field were usually extracted if thought to have poor long-term prognosis from dental disease.[scinapse.io]
  • 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]
  • The current school of thought - grossly carious, periodontally "hopeless," or those teeth deemed to have poor prognosis for retention beyond twelve months should be removed prior to the initiation of radiation therapy - this avoids dental manipulations[slideshare.net]

Etiology

  • Keywords Osteoradionecrosis Etiology Pathophysiology Risk factors Treatment options Bisphosphonate osteonecrosis This is a preview of subscription content, log in to check access. References 1.[link.springer.com]
  • […] due to the underlying etiology.[icd10data.com]
  • […] en Osteonecrosis : although the etiology is considered to be multifactorial (including corticosteroid use, alcohol consumption, severe immunosuppression, higher body mass index), cases of osteonecrosis have been reported particularly in patients with[it.glosbe.com]
  • Osteomyelitis: Etiology, diagnosis, treatment and outcome in a public versus a private institution. Infection 29(6):333-6. 16. Mader JT, Shirtliff ME, Bergquist SC, Calhoun J (1999). Antimicrobial treatment of chronic osteomyelitis.[ispub.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

  • In an effort to clarify the current frequency of and risk factors for ORNJ, Beadle and colleagues reviewed data from the NCI Surveillance, Epidemiology, and End Results database, linked to Medicare claims records.[medpagetoday.com]
  • EPIDEMIOLOGY Maxillofacial osteonecrosis has been microscopically confirmed in patients as young as 12 years of age and as old as 94, and has been reported in both genders.Typically, however, more than 80% of patients are 35-55 years of age and an equal[flipper.diff.org]
  • Methods The Surveillance, Epidemiology, and End Results (SEER)–Medicare database was used to identify patients treated with RT for oral cancers from 1999 to 2007.[scinapse.io]
  • An epidemiological study of alendronate-re-lated osteonecrosis of the jaws. A case series from the south-east of Scotland with attention given to case definition and prevalence . J Bone Miner Metab 2012; 30 : 171. 29. FGDP.[nature.com]
Sex distribution
Age distribution

Pathophysiology

  • Lyons A, Ghazali N (2008) Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg 46:653–660 CrossRef PubMed Google Scholar 2.[link.springer.com]
  • The pathophysiology is still not well understood, yet there are several postulated theories. Probably, the most popular and well-known hypothesis was proposed by Marx in 1983.[medium.com]
  • Hardcover: 900 pages Publisher: Quintessence Publishing (IL); Slipcase edition (November 1, 2002) ***2) Osteoradionecrosis: A new concept of its pathophysiology Marx RE, Journal of Oral and Maxillofacial Surgery, May 1983 (Vol. 41, Issue 5, Pages 283-[osseonews.com]
  • Early theories on ORN held that three factors—radiation, trauma, and infection—contributed to the pathophysiology of this disease process.[e-ceo.org]
  • The pathophysiological basis for the development of ORN initially as stated by Marx was considered to be a theory of hypoxia, hypocellularity and hypovascularity (HHH).[ccij-online.org]

Prevention

  • KEYWORDS: Hyperbaric oxygen; Management; Osteoradionecrosis; Prevention[ncbi.nlm.nih.gov]
  • Ozone therapy is given as an option in the therapeutic protocol for the prevention and treatment of ORN.[ncbi.nlm.nih.gov]
  • From our study, dental caries is the most important risk factor for osteoradionecrosis; therefore, a radiation caries prevention program is crucial to control osteoradionecrosis.[ncbi.nlm.nih.gov]
  • The most widely applied and most extensively documented indication for hyperbaric oxygen in chronic radiation injury is in its use in the treatment and prevention of radiation necrosis of the jaw(s).[longbeachhyperbaricmedicine.com]
  • Full Title: Hyperbaric Oxygen to Prevent Osteoradionecrosis of the Irradiated Mandible (HOPON) Medical condition: Osteoradionecrosis (ORN) of the irradiated mandible; the most feared complication of radiotherapy for head and neck cancer.[clinicaltrialsregister.eu]

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