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At least 127 records · Page 7Linked to original sources
PubMed1996

Does hyperbaric oxygen have a role in the management of osteoradionecrosis?

A retrospective study of 12 episodes of osteoradionecrosis treated with hyperbaric oxygen (HBO) in 11 patients was carried out. The cases had been previously treated by more conventional methods including surgery, unsuccessfully. All the cases treated by HBO had a successful outcome, although 83% of the patients required concomitant surgery to remove necrotic bone. The costs and contra-indications for hyperbaric oxygen therapy are discussed.

Contraindications↗
PubMed2000

Opportunistic actinomycosis in osteoradionecrosis of the jaws in patients affected by head and neck cancer: incidence and clinical significance.

Actinomycosis is occasionally an opportunistic infection occurrence in patients with osteoradionecrosis (ORN). A retrospective study (1992-97) of 50 patients with ORN of the jaws was done to evaluate the incidence and its clinical significance in the management of ORN. Actinomycosis was diagnosed in 12% of ORN cases. In 36 of the 50 patients including five cases of actinomycosis, the ORN was considered to be resolved after treatment. The median treatment duration of ORN was significantly longer (P<0.007) in patients with actinomycosis (29.7 months) than those without the disease (13.4 months). In conclusion, bone biopsy should be considered in cases of ORN with unsatisfactory response to its specific therapies, aiming to identify possible opportunistic actinomycosis infection.

Actinomycosis↗
PubMed1975

Osteoradionecrosis of the temporal bone.

A series of twenty-nine cases of osteoradionecrosis of the temporal bone is described. Two patterns occur: a localized involvement of the tympanic plate which resolves after the spontaneous separation of a sequestrum of bone, and a more diffuse necrosis of the temporal bone with a high risk of involvement of adjacent structures, in particular the brain, labyrinth and facial nerve and to a lesser extent the temporomandibular joint and the parotid gland. Localized osteonecrosis occurs more commonly when the temporal bone is in the periphery of an irradiated field whereas irradiation aimed primarily at the temporal bone is more likely to be followed by diffuse disease. The use of megavoltage irradiation has not led to the disappearance of the complication which may occur as much as twenty years after the completion of the course of radiotherapy.

Adult↗
PubMed1990

Osteoradionecrosis of the mandible: study of 104 cases treated by hemimandibulectomy.

One hundred and four cases of osteoradionecrosis (ORN) of the mandible following irradiation of head and neck cancer are reported. Conservative management for ORN failed in all cases. Indications of hemimandibulectomy included intractable pain, severe trismus, pathological fracture, oro-cutaneous fistula and persistent exposure of bone. Surgical approach was intra-oral in 100 cases and extra-oral in four. Immediate soft tissue reconstructions were carried out in 20 per cent cases. Post-operative complications included minor sepsis (8.6 per cent), major sepsis (2.9 per cent), haemorrhage (2.9 per cent) and fistula (3.8 per cent). Major complications occurred only in patients treated exclusively by external irradiation at doses equal to or higher than 65 Gy. Relief from pain and trismus was obtained and normal swallowing was established following radical surgery.

Adult↗
PubMed2000

Management of refractory osteoradionecrosis of the jaws with surgery and adjunctive hyperbaric oxygen therapy.

This retrospective study aimed to determine the effectiveness of surgery and hyperbaric oxygen (HBO) treatment in the management of refractory osteoradionecrosis (ORN) of the jaws. Of the 18 patients who had undergone this treatment, 14 patients had complete healing, 3 patients had improved and one patient did not show any improvement. Of the 14 patients who had complete healing, only 4 still had a discontinuity defect of the mandible but they declined additional reconstructive surgery. In conclusion, surgery/HBO therapy showed satisfactory results in the management of refractory ORN of the jaws.

Adult↗
PubMed1999

Mandibular osteoradionecrosis: a comparison of computed tomography with panoramic radiography.

OBJECTIVES: To compare the value of computed tomography (CT) with panoramic radiography in the diagnosis and presurgical evaluation of mandibular osteoradionecrosis (ORN). METHODS: Retrospective study comparing the diagnostic information from CT and panoramic radiography of 33 patients with clinical symptoms of ORN. In six patients the imaging was compared macroscopically with the resected mandible. RESULTS: Both panoramic radiography and CT revealed ORN in 31 cases. In 22 the anterior-posterior extent of the lesions could be estimated with equal reliability. In six patients the lesion appeared larger on CT and in three on panoramic radiography. Mono- or bicortical destruction, central necrosis and sequestration were better visualized by CT. Comparison between the imaging findings and the surgical resection showed that CT depicted the topography of the specimen more accurately. CONCLUSIONS: CT is superior to panoramic radiography in visualizing the features of mandibular ORN and the anterior-posterior extent of the lesion.

Adult↗
PubMed2001

Osteoradionecrosis of the mandible. Comparison of the effects of external beam irradiation and brachytherapy.

OBJECTIVE: To compare the difference in location and severity of osteoradionecrosis (ORN) of the mandible following either external beam irradiation alone or combined with brachytherapy in the management of orofacial cancer. METHODS: CT was used to evaluate ORN in relation to the radiation source and field and the site of malignancy in 31 patients with orofacial carcinomas. Twenty-three patients received combined radiotherapy and brachytherapy and eight patients only external radiotherapy. The radiation dose distribution to the mandible was calculated retrospectively. RESULTS: In the combined radiotherapy group all patients had ORN of the lingual cortex, mostly adjacent to the position of previous iridium implants. Lingual defects were also found in the contralateral mandible in 35% of patients. Defects in the buccal cortex were seen in 30%. In the external radiotherapy group, ORN was found in both buccal and lingual cortices and 50% also in the contralateral mandible. When brachytherapy with iridium implants was used the dose to the buccal cortex was about one-third of that to the lingual cortex. There was no dose gradient between the cortices using external beam irradiation alone. CONCLUSIONS: Evidence of ORN was found in both groups of irradiation regimens. Thus, the entire irradiated mandible should be considered as a compromised tissue at risk of ORN.

Adult↗
PubMed2000

Mandibular osteoradionecrosis: clinical behaviour and diagnostic aspects.

We have retrospectively studied 73 patients with mandibular osteoradionecrosis (ORN) following radiotherapy (high voltage external beam radiation alone, or combined with brachytherapy) ranging from 50 to 130 Gy (mean 76) with fields including the mandible. Based on this analysis we defined four distinctive stages: Stage 0: mucosal defects only; Stage I: radiological evidence of necrotic bone with intact mucosa; Stage II: positive radiographic findings with denuded bone intra-orally; Stage III: clinically exposed radionecrotic bone, verified by imaging techniques, along with skin fistulas and infection. The clinical features and characteristics of these stages are described, along with their clinical courses and outcome. The incompleteness of current ORN definitions, mainly emphasizing mucosal defects and bone exposure, and the need for a revised ORN classification is pointed out. Based on these observations and the insufficiency of previous definitions, we arrived at the following ORN definition: Radiological evidence of bone necrosis within the radiation field, where tumour recurrence has been excluded.

Adult↗
PubMed1999

Hyperbaric oxygen corrects sacral plexopathy due to osteoradionecrosis appearing 15 years after pelvic irradiation.

In 1982, a 55-year-old woman was treated by total cystectomy and adjuvant radiotherapy/chemotherapy for a leiomyosarcoma of the bladder. Fifteen years later she presented with symptoms and signs of sacral plexopathy. Investigations revealed osteoradionecrosis of the sacrum. Hyperbaric oxygen therapy (HBO2) was instituted and progressive resolution of the neurological complaints followed. HBO2 should be considered when managing late-onset sequelae in previously irradiated patients.

Bone Diseases↗
PubMed2000

Osteoradionecrosis of the jaws: clinical characteristics and relation to the field of irradiation.

PURPOSE: This study focuses on the clinical characteristics of patients with osteoradionecrosis (ORN) of the jaws and on the relation between the extent of the ORN and the field of irradiation. PATIENTS AND METHODS: The study group consisted of 80 patients referred for treatment of ORN. Charts of the extent of ORN, based on panoramic radiographs, were drawn by the clinical investigator and compared with charts of the field of irradiation drawn by the oncologists. Also recorded was diagnosis of the lesion, stage, location, treatment schedule, and period and dose of irradiation. Also documented were various potential initiating factors for ORN. RESULTS: Smoking habits of ORN patients were similar to those of other patients with head and neck cancer. A new primary tumor or a recurrence was diagnosed in 10% of the patients at the time of ORN. Only 3 patients had received accumulated doses of less than 60 Gy. More than half of the cases were initiated by removal of teeth; however, one third occurred spontaneously. ORN developed within the first 3 years in 74%; but ORN can emerge on a traumatic basis for an infinite number of years after radiation therapy. Widespread ORN may be symptomless apart from a discrete dehiscense of the oral mucosa. The predilection site for ORN is the mandibular molar region. All cases of ORN but 1 were found in the field of radiation. CONCLUSION: Because many ORN case are symptomless, more focus on mucosal dehiscence in the follow-up after radiation therapy is advocated in an effort to detect ORN at an early stage. The consequence of practically all ORN cases being located in the field of irradiation, together with tooth removal frequently being the initiating factor, should lead to a more aggressive preirradiation approach to dental pathology located within the field of radiation.

Adult↗
PubMed2002

MR imaging characteristics of osteoradionecrosis of the pelvis after radiation therapy on gynecological tumors.

PURPOSE: To describe MR imaging characteristics of osteoradionecrosis (ORN) of the pelvis as a result of radiation therapy (RT) on gynecological tumors. MATERIAL AND METHODS: Radiography, computed tomography (CT) and magnetic resonance imaging (MRI) were performed on 9 women (mean age 67.5 years) with gynecological tumors to identify ORN. T1- and T2-weighted sequences and contrast-enhanced t1-weighted sequences with and without fat saturation were used. The patients began developing pain after the completion of RT indicating a possible ORN a which time MRI was performed. MR images were correlated with the results of clinical examinations. RESULTS: Depending on the time elapsed after RT, ORN presented with different signal intensities. The acquired images suggested that signal changes in T2-weighted images as well as the different enhancement behaviour of ORN could be dependent on the time elapsed after RT. Visualisation of the affected regions was best achieved with fat-saturated T1-weighted sequences. CT showed increased density in the affected regions corresponding to osteosclerosis. In all cases the sacroiliac joint was affected, some times bilaterally. CONCLUSION: MRI is helpful in detecting and characterizing ORN. Changes in signal intensity, based on histopathological tissue changes could make a chronological classification possible.

Aged↗
PubMed1991

[Hyperbaric oxygen in the treatment of osteoradionecrosis of the mandible].

Osteoradionecrosis (ORN) of the mandible is one of the most dreaded complications in the treatment of cancer of the head and neck. If conservative and surgical treatment have not been successful, very often the only remaining solution is surgical intervention into the bone continuity of the mandible. In a group of eight patients suffering from ORN of the horizontal ramus of the lower jaw we gathered first experiences with hyperbaric oxygen therapy in combination with an operation to preserve the bone continuity (debridement of the bone and closing of the soft tissues). Hyperbaric oxygen was given during a time span of 13 to 52 hours (average: 36 hours). It was only with those two patients who received more than 50 hours of hyperbaric oxygen therapy that we achieved our aim of "total recovery from ORN of the mandible while saving its bone continuity". In one case where there was no clinically manifest recidivation of the tumour, the tumour showed rapid growth under hyperbaric oxygen therapy. In three cases partial resection of the mandible had to be performed without reconstruction for cure of ORN. Despite the loss of bone continuity these patients are only slightly cosmetically impaired and nutrition causes no problems. In two patients ORN still exists. On the basis of our first experiences with a small group of patients and in accordance with various publications, we conclude that hyperbaric oxygen therapy is a significant adjunct in the treatment of the mandible if a well-founded diagnosis is established and if it is followed by a well-adjusted therapy.

Adult↗
PubMed2002

Osteoradionecrosis of the mandible: scientific basis for clinical staging.

Osteoradionecrosis of the mandible can be a serious complication of radiotherapy for head and neck cancer. The disorder generally presents in one of several distinct clinical variations. This is probably because of a complex interaction of etiologic factors. A clinical staging system for the disorder is described. Such a system is necessary for the conduct of clinical research, and for the development and assessment of treatment regimens.

Head and Neck Neoplasms↗
PubMed2001

Differentiation of recurrent nasopharyngeal carcinoma and skull base osteoradionecrosis by Epstein-Barr virus-derived latent membrane protein-1 gene.

OBJECTIVES: In patients with nasopharyngeal carcinoma (NPC), the differentiation between recurrent primary cancer and osteoradionecrosis (ORN) is clinically difficult. Epstein-Barr virus (EBV)-derived latent membrane protein-1 (LMP-1) has been demonstrated to be highly associated with NPC. The objective of this study is to define the role of the LMP-1 gene in the differential diagnosis of recurrent NPC and ORN. STUDY DESIGN: Prospective. METHODS: From July 1998 to June 2000, 15 postirradiated patients with NPC who were initially diagnosed to have skull base ORN underwent endoscopic sequestrectomy. The sequestra were examined for the presence of the LMP-1 gene and cancer. RESULTS: Two of 15 patients had recurrent cancer and only these two patients demonstrated a positive LMP-1 gene in their surgically removed sequestra. The presence of the LMP-1 gene in the sequestrum coincided with biopsy-proven local recurrence. CONCLUSIONS: The LMP-1 gene is a potential marker to differentiate between recurrent NPC and ORN. The presence of the LMP-1 gene in patients with ORN may indicate local recurrence.

Diagnosis, Differential↗
PubMed1987

Osteoradionecrosis of the olecranon: treatment by radial forearm flap.

Osteoradionecrosis of the olecranon is an unusual pathologic entity, treated best by debridement and wound closure using vascularized tissue. Local skin is often unavailable for flap design and transposition. The radial forearm flap can be isolated on a proximal vascular pedicle and transposed to cover the wound. In the case presented, healing was brisk and complete, allowing early elbow mobilization. Although the donor site is not easily concealed, no functional impairment results from flap elevation and all full-thickness wounds are confined to the involved extremity.

Adult↗
PubMed2005

Osteoradionecrosis with combined mandibulotomy and marginal mandibulectomy.

INTRODUCTION: To evaluate the outcome of simultaneous anterior mandibulotomy and marginal mandibulectomy for patients with oral cavity cancer. MATERIAL AND METHODS: The medical charts of seven patients who underwent simultaneous anterior mandibulotomy and marginal mandibulectomy for oral cavity cancer between July 1994 and June 2004 in Chang Gung Memorial Hospital, Taiwan were retrospectively reviewed. These seven patients had no prior radiation therapy nor clinical or radiographic evidence of mandible bone invasion. RESULTS: Seven patients, between 34 to 62 years of age, were followed up in the clinics from 4.5 to 39 months with an average of 19.4 months. Five (71%) patients developed mandible osteoradionecrosis. Among them, two patients underwent radical sequestrectomy followed by reconstruction with a free fibular osteoseptocutaneous flap or soft tissue flap, and the other three patients either received removal of the mandible fixation miniplate, limited sequestrectomy of the mandible, or conservative antibiotic treatment individually. CONCLUSIONS: Simultaneous anterior mandibulotomy and marginal mandibulectomy results in a high morbidity rate of avascular necrosis of the mandible and therefore should be avoided. To avoid a disastrous complication, segmental mandibulectomy and a composite free fibular osteoseptocutaneous flap reconstruction would be a preferred surgical alternative.

Adult↗
PubMed2006

Diagnosis and management of skull base osteoradionecrosis after radiotherapy for nasopharyngeal carcinoma.

OBJECTIVE: The objective of this study was to investigate the diagnosis and management of skull base osteoradionecrosis (ORN) after radiotherapy for nasopharyngeal carcinoma (NPC). METHODS: The general information, clinical manifestations, and treatment outcomes were retrospectively evaluated in 15 patients with skull base ORN after radiotherapy for NPC. RESULTS: The common symptoms of skull base ORN included foul odor, headache, and epistaxis. Endoscopic examination showed exposed bone or sequestration in the nasopharynx. The characteristic findings according to computed tomography included the following: bone was destroyed extensively and symmetrically or regionally; bone was exposed to the air cavity; sequestration can be observed; and small air bladder was present in the parenchyma. There were nine patients regional skull base ORN receiving surgery, two of whom died of postradiation temporal lobe necrosis and seven of whom survived for 2 to 7 years. Conservative treatments were provided to six patients, including five patients with extensive skull base ORN and one patient with regional ORN, among which three patients died of nasopharyngeal bleeding, one patient died of exhaustion, and two patients survived for 3 to 5 years. CONCLUSIONS: Clinical diagnosis of skull base ORN was based on symptoms, computed tomography, or magnetic resonance imaging and endoscopy. The final confirmation was according to pathologic examination. Surgery had the best effect. Extensive ORN accompanied by radiation brain damage or cranial nerves damage had poor prognosis. Nasopharyngeal bleeding and exhaustion were the main causes of death.

Endoscopy↗