J Korean Assoc Oral Maxillofac Surg.  2019 Feb;45(1):21-28. 10.5125/jkaoms.2019.45.1.21.

Retrospective study of osteoradionecrosis in the jaws of patients with head and neck cancer

• Manzano BR
• Santaella
• Oliveira M
• Rubira CM
• Santos PS

• KMID: 2461488
• DOI: http://doi.org/10.5125/jkaoms.2019.45.1.21

Abstract

OBJECTIVES
Osteoradionecrosis (ORN) is one of the most severe complications resulting from radiotherapy (RT) in patients with head and neck cancer (HNC). It is characterized by persistent exposed and devitalized bone without proper healing for greater than 6 months after a high dose of radiation in the area. To describe the profile and dental management of ORN in HNC patients undergoing RT in an oncological clinical research center.
MATERIALS AND METHODS
A retrospective descriptive study was performed to analyze dental records from HNC patients with ORN treated at an oncological clinical research center from 2013 to 2017. A total of 158 dental records for HNC patients were selected from a total of 583 records. Afterwards, this number was distributed to three examiners for manual assessments. Each examiner was responsible for selecting dental records that contained an ORN description, resulting in 20 dental records.
RESULTS
Mean patient age was 60.3 years with males being the most affected sex (80.0%). The most affected area was the posterior region of the mandible (60.0%) followed by the anterior region of the mandible (20.0%) and the posterior region of the maxilla (10.0%). The factors most associated with ORN were dental conditions (70.0%) followed by isolated systemic factors (10.0%) and tumor resection (5.0%). There was total exposed bone closure in 50.0% of cases. The predominant treatment was curettage associated with chlorhexidine 0.12% irrigation (36.0%).
CONCLUSION
Poor dental conditions were related to ORN occurrence. ORN management through less invasive therapies was effective for the closure of exposed bone areas and avoidance of infection.

Keyword

Osteoradionecrosis; Head and neck neoplasms; Mandible; Conservative treatment; Maxilla

Figure

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  Fig. 1 Flow chart of study design. (HNC: head and neck cancer, RT: radiotherapy, ORN: osteoradionecrosis)

Reference

1. Nadella KR, Kodali RM, Guttikonda LK, Jonnalagadda A. Osteoradionecrosis of the jaws: clinico-therapeutic management: a literature review and update. J Maxillofac Oral Surg. 2015; 14:891–901.

2. Wong JK, Wood RE, McLean M. Conservative management of osteoradionecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997; 84:16–21.

3. Sathasivam HP, Davies GR, Boyd NM. Predictive factors for osteoradionecrosis of the jaws: a retrospective study. Head Neck. 2018; 40:46–54.

4. Ramli R, Ngeow WC, Rahman RA, Chai WL. Managing complications of radiation therapy in head and neck cancer patients: part IV. Management of osteoradionecrosis. Singapore Dent J. 2006; 28:11–15.

5. Regaud C. [Sur la necrose des os attente par un processus cancereux et traits par les radiations]. Compt Rend Soc Biol. 1922; 87:629. French.

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

7. Watson WL, Scarborough JE. Osteoradionecrosis in intraoral cancer. Am J Roentgenol. 1938; 40:524–534.

8. Epstein JB, Rea G, Wong FL, Spinelli J, Stevenson-Moore P. Osteonecrosis: study of the relationship of dental extractions in patients receiving radiotherapy. Head Neck Surg. 1987; 10:48–54.

9. Thorn JJ, Hansen HS, Specht L, Bastholt L. Osteoradionecrosis of the jaws: clinical characteristics and relation to the field of irradiation. J Oral Maxillofac Surg. 2000; 58:1088–1093. discussion 1093-5.

10. Jereczek-Fossa BA, Garibaldi C, Catalano G, d'Onofrio A, De Pas T, Bocci C, et al. Analysis of mandibular dose distribution in radiotherapy for oropharyngeal cancer: dosimetric and clinical results in 18 patients. Radiother Oncol. 2003; 66:49–56.

11. Maxymiw WG, Wood RE, Liu FF. Postradiation dental extractions without hyperbaric oxygen. Oral Surg Oral Med Oral Pathol. 1991; 72:270–274.

12. Katsura K, Sasai K, Sato K, Saito M, Hoshina H, Hayashi T. Relationship between oral health status and development of osteoradionecrosis of the mandible: a retrospective longitudinal study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 105:731–738.

13. Piret P, Deneufbourg JM. [Mandibular osteoradionecrosis: sword of Damocles of radiotherapy for head and neck cancers?]. Rev Med Liege. 2002; 57:393–399. French.

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

15. Epstein JB, Hatcher DC, Graham M. Bone scintigraphy of fibroosseous lesions of the jaw. Oral Surg Oral Med Oral Pathol. 1981; 51:346–350.

16. Mainous EG, Hart GB. Osteoradionecrosis of the mandible. Treatment with hyperbaric oxygen. Arch Otolaryngol. 1975; 101:173–177.

17. Scannapieco FA, Yu J, Raghavendran K, Vacanti A, Owens SI, Wood K, et al. A randomized trial of chlorhexidine gluconate on oral bacterial pathogens in mechanically ventilated patients. Crit Care. 2009; 13:R117.

18. Støre G, Boysen M. Mandibular osteoradionecrosis: clinical behaviour and diagnostic aspects. Clin Otolaryngol Allied Sci. 2000; 25:378–384.

19. 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.

20. Kuhnt T, Stang A, Wienke A, Vordermark D, Schweyen R, Hey J. Potential risk factors for jaw osteoradionecrosis after radiotherapy for head and neck cancer. Radiat Oncol. 2016; 11:101.

21. Kuo TJ, Leung CM, Chang HS, Wu CN, Chen WL, Chen GJ, et al. Jaw osteoradionecrosis and dental extraction after head and neck radiotherapy: a nationwide population-based retrospective study in Taiwan. Oral Oncol. 2016; 56:71–77.

22. Chronopoulos A, Zarra T, Tröltzsch M, Mahaini S, Ehrenfeld M, Otto S. Osteoradionecrosis of the mandible: a ten year single-center retrospective study. J Craniomaxillofac Surg. 2015; 43:837–846.

23. Koga DH, Salvajoli JV, Kowalski LP, Nishimoto IN, Alves FA. Dental extractions related to head and neck radiotherapy: ten-year experience of a single institution. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2008; 105:e1–e6.

24. Moon DH, Moon SH, Wang K, Weissler MC, Hackman TG, Zanation AM, et al. Incidence of, and risk factors for, mandibular osteoradionecrosis in patients with oral cavity and oropharynx cancers. Oral Oncol. 2017; 72:98–103.

25. Ben-David MA, Diamante M, Radawski JD, Vineberg KA, Stroup C, Murdoch-Kinch CA, et al. Lack of osteoradionecrosis of the mandible after intensity-modulated radiotherapy for head and neck cancer: likely contributions of both dental care and improved dose distributions. Int J Radiat Oncol Biol Phys. 2007; 68:396–402.

26. Nooh N. Dental implant survival in irradiated oral cancer patients: a systematic review of the literature. Int J Oral Maxillofac Implants. 2013; 28:1233–1242.

27. Tsai CJ, Hofstede TM, Sturgis EM, Garden AS, Lindberg ME, Wei Q, et al. Osteoradionecrosis and radiation dose to the mandible in patients with oropharyngeal cancer. Int J Radiat Oncol Biol Phys. 2013; 85:415–420.

28. Wahl MJ. Osteoradionecrosis prevention myths. Int J Radiat Oncol Biol Phys. 2006; 64:661–669.

29. Lyons A, Ghazali N. Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg. 2008; 46:653–660.

30. Walter C, Grötz KA, Kunkel M, Al-Nawas B. Prevalence of bisphosphonate associated osteonecrosis of the jaw within the field of osteonecrosis. Support Care Cancer. 2007; 15:197–202.

31. Jawad H, Hodson NA, Nixon PJ. A review of dental treatment of head and neck cancer patients, before, during and after radiotherapy: part 1. Br Dent J. 2015; 218:65–68.

32. Kluth EV, Jain PR, Stuchell RN, Frich JC Jr. A study of factors contributing to the development of osteoradionecrosis of the jaws. J Prosthet Dent. 1988; 59:194–201.

33. Owosho AA, Tsai CJ, Lee RS, Freymiller H, Kadempour A, Varthis S, et al. The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): the Memorial Sloan Kettering Cancer Center experience. Oral Oncol. 2017; 64:44–51.

34. 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; 55:540–544. discussion 545-6.

35. Malska-Waniewska I. Microdensitometric analysis of the influence of x-irradiation on mature bone in humans. Acta Med Pol. 1971; 12:357–380.

36. Marx RE, Johnson RP, Kline SN. Prevention of osteoradionecrosis: a randomized prospective clinical trial of hyperbaric oxygen versus penicillin. J Am Dent Assoc. 1985; 111:49–54.