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PubMedDate not supplied

Hyperbaric oxygen therapy and mandibular osteoradionecrosis: a retrospective study and analysis of treatment outcomes.

BACKGROUND: Hyperbaric oxygen (HBO) therapy is recognized as an adjunctive treatment for osteoradionecrosis (ORN). It may also be used prophylactically in patients who require dental extractions and are at high risk for developing ORN. This article reviews the treatment outcomes of patients treated with HBO therapy at the Toronto General Hospital from 1985 to 1997. MATERIALS AND METHODS: A total of 297 charts of patients treated with HBO were reviewed. Criteria assessed included age of patient, gender, original diagnosis, radiation dose, time between radiation treatment and onset of ORN, presence or absence of fracture, orocutaneous fistula, pain, history of a precipitating event triggering ORN, medical status, HBO therapy (total oxygen time, number of dives), method of treatment of ORN and follow-up period. Minimum patient follow-up time for inclusion in the study was 6 months. RESULTS: Adequate information to meet the inclusion criteria was obtained for 75 patients. Group A (51 patients) had been treated for overt ORN with HBO alone, HBO with sequestrectomy, or HBO with sequestrectomy and reconstruction. Group B (24 patients at risk for developing ORN) had been treated with HBO prophylactically for dental extractions. In group A, only 3 patients (5.9%) failed to show improvement. In group B, only one patient (4.2%) had complications during healing. CONCLUSIONS: Encouraging results were achieved when HBO was used in the 2 groups described above. This paper supports existing literature on the potential benefit of HBO as a prophylactic agent and adjunctive treatment of ORN.

Adult↗
PubMed2003

Hyperbaric oxygen treatment protocols for mandibular osteoradionecrosis.

To determine hyperbaric oxygen (HBO2) treatment practices for osteoradionecrosis (ORN) of the mandible in North America, we surveyed hyperbaric facilities listed in the 1998 UHMS Chamber Directory. A survey response rate of 99.7% was achieved. Among the 316 facilities listed, 280 treat or would treat mandibular ORN with HBO2. Twelve different hyperbaric treatment protocols for the condition were reported. Approximately three-quarters of facilities utilize a protocol administering 90 minutes of 100% oxygen breathing at a treatment pressure of 2.4-2.5 atmospheres absolute (atm abs). The remaining one-quarter of facilities apply alternate hyperbaric treatment protocols. In summary, mandibular ORN is commonly treated at North American hyperbaric facilities but there is a lack of uniformity with regard to the protocol utilized for hyperbaric oxygen administration. There are no clinical data to support that any one treatment protocol is superior in out come to any other.

Clinical Protocols↗
PubMedDate not supplied

Osteoradionecrosis, oral health and dental treatment.

Osteoradionecrosis (ORN) is a potentially debilitating complication of radiation therapy in the treatment of carcinoma in and around the oral cavity. Treatment of ORN is by surgical resection of all necrotic tissue and primary closure of the mucosa. This is supplemented with HBO given in 90-minute sessions at approximately 2.5 ATM of pure oxygen for 20 sessions prior to surgical intervention and followed by 10 additional postoperative dives. Antibiotics, such as penicillins or similar spectrum antibiotics, may be utilized preoperatively and for approximately one week postoperatively.

Dental Care↗
PubMed2004

[A review of 11 cases of immediate free flap transfer for treating the advanced osteoradionecrosis of mandible].

OBJECTIVE: To assess the effectiveness and reliability of free flap transfer for treating the advanced osteoradionecrosis (ORN) of mandible. METHODS: Eleven cases of free flap transfer for treating the advanced ORN of mandible from October 1999 to February 2003 were reviewed. Data concerning the operation included site, stage and histology of primary tumor, dosage of radiotherapy, defect description, design of free flap, recipient vessel, free flap survival and complications. RESULTS: There were 8 males and 3 females, with age ranged 29-65 years old. Fifteen free flaps were used for reconstructing the defects, 12 were fibula flap, 2 were rectus abdominis myocutaneous flap, and 1 was radial forearm flap. All the free flaps survived completely without partial or total necrosis. The complication rate was 36.4%. All patients had complete resolution of ORN symptoms. No evidence of ORN recurrence was observed in any patient. CONCLUSION: Free flap transfer provides a reliable and effective means for treating the advanced ORN of mandible. Free fibula flap is the workhorse flap for reconstruction of mandible.

Adult↗
PubMed2004

[Diagnosis and treatment on osteoradionecrosis of skull base after radiotherapy for nasopharyngeal carcinoma].

OBJECTIVE: To investigate the diagnosis and management on osteoradionecrosis (ORN) of skull base in the patients with nasopharyngeal carcinoma (NPC) after radiotherapy. METHODS: All patients (n = 15) diagnosed as NPC and ORN of skull base were studied on the clinical data, diagnosis and therapy. RESULTS: All the patients were found with foul odor, headache, bleeding and exposed necrotic bone. 9 patients were treated by surgery, among them 2 patients died of temporal lobe radionecrosis, and the survival time of remaining 7 patients was 2 to 7 years. 5 patients with extensive ORN and 1 patient with local ORN were treated by conservative methods, among them 3 died of nasopharyngeal bleeding and 1 died of respiratory and heart failure, survival time of the remaining 2 patients was 3 to 5 years. CONCLUSIONS: ORN can be diagnosed by clinical characteristics, CT or MR, and endoscopic findings. Surgery is the best choice for ORN. The patients with extensive ORN or radiation-induced cranial neuropathy had poor prognosis. The most common causes of death were nasopharyngeal bleeding and exhaustion.

Adult↗
PubMed1992

[Mandibular osteoradionecrosis caused by radiotherapy of lip cancer. Differential diagnosis with tumor recurrence].

The onset of the bone radionecrosis is a relatively unusual problem which should be considered in the differential diagnosis of recurrences of irradiated tumors showing a high degree of aggressiveness. The AA. present a case report of a re-operated lower lip carcinoma which underwent further radiation therapy. A bony mandibular lesion was then observed, which led to the diagnosis of tumoral invasion at the mandible, and a partial mandibulectomy was then performed. The histopathological examination revealed a bone necrosis, probably due to radiotherapy. The clinical features and therapeutic management of mandibular osteoradionecrosis are commented.

Aged↗
PubMed1990

[Incidence of mandibular osteoradionecrosis in a series of 13 cases of carcinoma of the mouth floor].

In a 13-case series of epithelioma of the floor of the mouth given cobalt-therapy irrespective of the selected therapeutic protocol, the authors recorded 5 cases of osteoradionecrosis. In this study, they review both risk and prevention factors linked with radionecrosis at the localization site of this particular type of tumor. They also stress the importance of adapting the treatments, when introducing so-called néo-adjuvant systemic chemotherapy, the high efficacy rate of which is likely to reduce the risks of radionecrosis. This can be achieved either by eliminating completely or limiting the surgical step, or by bringing modifications to the post-operative radiation regimen.

Aged↗
PubMed1990

Osteoradionecrosis, pathogenesis, treatment and prevention.

The present paper discuss the development of osteoradionecrosis (ORN) in the jaws. ORN is the end stage of tissue injury induced by irradiation. The most prominent etiologic factor of ORN seems to be the effect of radiation on endothelial cells lining the vessels. These cells are, as tumor cells, highly radiosensitive, and radiation leads to a vascular damage resulting in hypoxic, hypovascular and hypocellular tissues. Wound healing in such tissues is impaired since nutritional demands of the wound, including oxygen, cannot be supplied due to the degenerative changes in the blood vessels. The paper furthermore describes the scientific basis for the use of hyperbaric oxygen therapy (HBO) in ORN. HBO increase the vascularity in the tissues injured by radiation, and thus tissue viability and healing capacity is increased reducing the risk for spontaneous or traumainduced ORN. Protocols for the treatment of patients with ORN are presented and prophylactic guidelines are described.

Adult↗
PubMed1990

Osteoradionecrosis: causes and prevention.

Osteoradionecrosis (ORN) is one of the most serious complications arising from head and neck radiation therapy. Current research has shown that ORN represents nonhealing, dead bone and is not a state of infection. ORN is the result of functional and structural bony changes that may not be expressed for months or years. ORN may occur spontaneously or in response to wounding. Predisposing factors include absorbed radiation dose, fractionation, delivery modality, and dental status. Timing of dental extractions and other factors have also been shown to affect incidence. ORN may be reduced through early intraoral evaluation, treatment, and adequate healing time prior to beginning RT. Hyperbaric oxygen (HBO) therapy has been beneficial in the prevention and treatment of ORN. It is of paramount importance for the medical community to recognize the factors that may reduce ORN incidence, endorse oral care protocols, and acknowledge the value of HBO therapy in the prevention and treatment of this disease.

Head and Neck Neoplasms↗
PubMed1989

[Osteoradionecrosis, a side effect of radiotherapy of malignant neoplasms of the head and neck--a review].

This paper is a review of the current literature concerning osteoradionecrosis. The pathogenetic mechanism, etiology, predisposing factors and frequency of the disease are discussed, and the relation between extractions before or after irradiation and the onset of the disease are stated. Diagnosis of the disease is analysed, together with the various methods of treatment and prevention. Finally, emphasis is given to the role of the dentist in the management and prevention of the disease.

Head and Neck Neoplasms↗
PubMed1989

Osteoradionecrosis of the mandible: a review.

Osteoradionecrosis (ORN) is a complex metabolic and tissue homeostatic deficiency created by radiation-induced tissue injury. Although infection was initially felt to play an important role in its pathogenesis, the role of microorganisms has been relegated to that of a contaminant. Trauma in some cases may provide a possible initiating factor for the process, or in the case of spontaneous ORN, the use of radioactive implants and the higher doses of radiation therapy as practised in the megavoltage era, may have an influence. The role of prevention cannot be over-emphasized. Dental evaluation is an important part of the initial patient assessment. Preservation of good or average teeth is recommended with subsequent regular follow-up and dental care. Post-treatment dental extraction should be minimized and delayed if possible until at least nine-12 months after completion of radiation therapy. Management of ORN requires assessment of the extent, both clinically and radiologically. Conservative management is recommended unless the disease is advanced or progressive. Radiologic evidence of fracture requires surgery. Modern surgical techniques offer satisfactory reconstruction. The role of hyperbaric oxygen remains controversial and limited to centers where hyperbaric techniques exist. The treatment is complex and time-consuming and results are confounded by the concurrent use of local antiseptic/antibiotic measures and surgery.

Humans↗
PubMed1989

Osteoradionecrosis of the jaw bones at the University of Kentucky Medical Center.

There is disagreement over the management of teeth in irradiated head and neck cancer patients. Some oral surgeons support preirradiation extraction; others favor maintaining teeth. Before 1974, The University of Kentucky Department of Radiation Medicine found osteoradionecrosis (ORN) of the jaw in 10.9% of 220 irradiated cancer patients. After a program of oral care was instituted, the incidence declined to 2.7%. Of 109 patients who received radiotherapy between 1976 and 1985, only three (2.7%) developed ORN of the mandible. There was also a reduction in patients treated with interstitial therapy during this time. 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. Post-irradiation extractions were not identified as a significant risk for necrosis. Hyperbaric oxygen is used as a treatment for persistent ORN.

Head and Neck Neoplasms↗
PubMed1979

Treatment of osteoradionecrosis by transoral hemimandibulectomy: report of case.

A case of progressive osteoradionecrosis after cobalt-60 radiation has been presented. A rational, but aggressive, treatment has been described. The morbidity of the procedure is minimal when proper instrumentation is available. The postoperative results are esthetically pleasing because, with radiation, there is so much fibrosis that facial contour is satisfactory even after a hemimandibulectomy.

Humans↗
PubMed1979

[Twenty-five cases of bone resection for mandibular osteoradionecrosis (author's transl)].

Good morphological and functional results are obtained in lateral osteoradionecrosis after bone resection by the endobuccal route, and this operation should be performed at an earlier stage. Median resections give poor results and in these cases it is reasonable to temporize in the normal manner. Long-term prognosis is only moderate as tumoral recurrences are frequent in these patients.

Humans↗
PubMed1986

[Current treatment of osteoradionecrosis].

Conventional treatment of osteoradionecrosis of mandible is by antibiotics combined if necessary with a hemimandibulectomy. A method is proposed which reduces bone excision to infected and necrotic tissue while respecting mandibular continuity. The bone remaining is covered by a flap taken from a distant region. Five cases treated in this way are reported. When mandibular continuity has to be interrupted to suppress infected foci, immediate repair is performed using an osteo-musculo-cutaneous flap, and six cases treated by this method are reported. A part from their mechanical covering and reconstructing roles these well vascularized flaps improve vitality of tissues they enclose, including the mandibular bone.

Combined Modality Therapy↗
PubMed1979

[Twenty years follow-up of a case of extensive osteoradionecrosis (author's transl)].

A patient was found to have the first signs of a fibrous dysplasia of the left maxilla 50 years ago. At that time it was thought to be a maxillary sarcoma and was treated by irradiation on two occasions. The authors first saw the patient 20 years ago when he presented for treatment of an extensive degenerated osteoradionecrosis due to the previous irradiation therapy. Excision and reconstructive treatment caused many medical, psychological, and surgical problems. A part from the interest aroused by the numerous surgical repair procedures carried out, the essentially iatrogenic nature of the lesion and its effect on the life of this unfortunate patient convinced the authors of the need for publishing this rather sad history.

Adolescent↗
PubMed1983

Osteoradionecrosis of the chest wall. Management of postresection defects using Marlex mesh and a rotated latissimus dorsi myocutaneous flap.

Full thickness chest wall resection and single stage reconstruction for osteoradionecrosis of the chest wall was performed on five patients. All patients had undergone radical mastectomy and radiation therapy from 5 to 18 years prior to chest wall resection. Defects varied from 12 X 5 cm to 15 X 15 cm, and included from two to four ribs. Reconstruction was performed using Marlex mesh to reconstruct the bony thorax and a rotated latissimus dorsi myocutaneous flap. Coverage was successfully performed in all cases, and no patient experienced postoperative pulmonary dysfunction. There were no complications related to either the bony thorax reconstruction or the latissimus flap. The use of this technique has provided a safe, convenient, and reliable method of chest wall reconstruction.

Aged↗