Gallegos-Hernández JF, Reyes-Vivanco A, Arias-Ceballos H, Minauro-Muñoz GG, Ortiz-Maldonado AL, García-Ruiz DI, Hernández-Sanjuán M

Language: Spanish
References: 10
Page: 730-733
PDF size: 102.73 Kb.

ABSTRACT

Introduction: Osteoradionecrosis of the mandible is a relatively common complication in patients with head and neck cancer undergoing radiotherapy or concomitant chemoradiotherapy, characterized by exposure of the mandibular bone either in the mouth or in the facial skin, with no improvement with conservative treatment for six months. The risk factors are radiotherapy in head and neck region, lack of dental prophylaxis before treatment and dental extraction. Material and methods: Retrospective observational study analyzing incidence and etiologic factors of osteoradionecrosis in 250 patients undergoing radiotherapy or combined treatment of cervicofacial area between 2002 and 2010. Results: 25 patients were included; the horizontal branch was the most affected area, followed by the anterior arch. Associated factors were: stage (T4a and T4b), tumor location (oral cavity), dental extraction pre or post-radiotherapy, and radiotherapy time (pre-or postoperative); 72% had association with tooth extraction. Only five patients had control with conservative measures, and 20 required some type of mandibulectomy, only three of them were candidates for reconstruction with fibular free flap; none received treatment in a hyperbaric chamber. Conclusions: The data suggest that osteoradionecrosis has a multifactorial origin, and prevention is the best alternative and includes pretreatment dental prophylaxis to avoid tooth extractions and close monitoring and surveillance in order to identify early osteoradionecrosis. Most patients require mandible resection as definitive treatment.

REFERENCES

1. Epstein JB, Thariat J, Bensadoun RJ, et al. Oral complications of cancer and cancer thedrapy; from cancer treatment to survivorship. CA Cancer J Clin. 2012;62:400-22.

2. Lyons A, Osher J, Warner E, Kumar R, Brennan PA. Osteoradionecrosis - a review of current concepts in refining the extent of the disease and a new classification proposal. Br J Oral Maxilofac Surg. 2014;52:392-5.

3. Perrier M, Moeller P. Osteoradionecrosis. A review of the literature. Schweiz Monatschr Zahnmed.1994;104:271-7.

4. Shah JP. Oncologic dentistry, maxillofacial prosthetics and implants En: Shah JP, Patel SG, Singh B, editores. Head and neck surgery and oncology. 4th ed. Philadelphia: Elsevier Mosby. p. 752-71.

5. Marx RE. A new concept in the treatment of osteoradionecrosis. J Oral Maxilofac Surg. 1983;41:351-7.

6. Moore, Burke MC, Fenlon MR, Banerjee A. The role of general dental practitioner in managing the oral care of head and neck oncology patients. Dent Update. 2012;39:694-6.

7. Márquez-Santana TG, Díaz-Aguirre CM, Echeverría y Pérez E, Malpica- Sánchez EB. Osteoradionecrosis: experiencia en el Hospital General de México. GAMO 2011;10:269-277.

8. Delanian S, Chatel C, Porcher R, Depondt J, Lefaix JL. Complete restoration of refractory mandibular osteoradionecrosis by prolonged treatment with pentoxifylline-tocopherol-clodronate combination (PENTOCLO): a phase II trial. Int J Radiat Oncol Biol Phys. 2011;80:832-9.

9. Chon JK, Jang JY, Lee GJ, Jeong HS, Son YI, Bek C-H. Comprehensive management of osteoradionecrosis after radiation therapy for nasopharyngeal carcinoma. 5th International Conference on Head and Neck Cancer. IFHNOS. New York; 2014. Poster 0845.

10. Nabil S, Samman N. Risk factors for osteoradionecrosis alter head and neck radiation: systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113:54-69.