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Manzano BR, Santaella NG, Oliveira MA, Rubira CMF, Santos PSDS. Retrospective study of osteoradionecrosis in the jaws of patients with head and neck cancer. J Korean Assoc Oral Maxillofac Surg 2019; 45:21-28. [PMID: 30847293 PMCID: PMC6400702 DOI: 10.5125/jkaoms.2019.45.1.21] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/05/2018] [Accepted: 06/08/2018] [Indexed: 01/20/2023] Open
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.
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Affiliation(s)
- Brena Rodrigues Manzano
- Departament of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Natália Garcia Santaella
- Departament of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Marco Aurélio Oliveira
- Departament of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Cássia Maria Fischer Rubira
- Departament of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
| | - Paulo Sérgio da Silva Santos
- Departament of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil
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Evaluation of a community-based dental screening program prior to radiotherapy for head and neck cancer: a single-center experience. Support Care Cancer 2019; 27:3331-3336. [DOI: 10.1007/s00520-018-4626-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 12/27/2018] [Indexed: 11/26/2022]
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Pereira IF, Firmino RT, Meira HC, Vasconcelos BCE, Noronha VRAS, Santos VR. Osteoradionecrosis prevalence and associated factors: A ten years retrospective study. Med Oral Patol Oral Cir Bucal 2018; 23:e633-e638. [PMID: 30341256 PMCID: PMC6260996 DOI: 10.4317/medoral.22310] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Accepted: 08/06/2018] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Osteoradionecrosis (ORN) is one of the most serious complications of head and neck radiotherapy and is considered a public health problem worldwide. This study aims to determine the prevalence and associated factors of ORN in patients undergoing radiotherapy for head and neck malignancy. MATERIAL AND METHODS A cross-sectional retrospective study was conducted, in which all medical records of patients undergoing head and neck radiation in the period between 2006 to 2015 (10 years) were examined. Clinical and demographic data were extracted. Multivariate Poisson regression analysis with robust variance was employed to access the relationship between ORN and independent variables (p < 0.05; 95% CI). RESULTS The sample comprised 413 medical records of patients undergoing radiotherapy. The prevalence of ORN was 9.7 %. Most participants were males (78.2%). The mean age of subjects was 55 years (± 14 years). The mandible was the main site of occurrence of ORN (85.0%). The following variables were associated with ORN : presence of oral mucositis (PR = 3.03; 95% CI: 1.30-7.03), history of smoking (PR = 0.23; 95% CI: 0.07-0.74), number of teeth removed before radiotherapy (PR = 1.06; 95% CI: 1.01-1.11) and visit to the dentist before radiation (PR = 0.08; 95% CI: 1.02-1.11). CONCLUSIONS The prevalence of ORN was low and was associated with the presence of oral mucositis and the number of removed teeth before radiation. Visiting the dentist before radiotherapy and stop-ping smoking were protective factors for ORN.
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Affiliation(s)
- I-F Pereira
- School of Dentistry, Federal University of Minas Gerais, Department of Clinical, Pathology and Surgery, Presidente Antônio Carlos, 6627 - 31270-901- Pampulha Belo Horizonte - MG, Brazil,
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Abstract
PURPOSE OF REVIEW Osteonecrosis of the jaw (ONJ) is a rare and severe necrotic bone disease reflecting a compromise in the body's osseous healing mechanisms and unique to the craniofacial region. Antiresorptive and antiangiogenic medications have been suggested to be associated with the occurrence of ONJ; yet, the pathophysiology of this disease has not been fully elucidated. This article raises the current theories underlying the pathophysiology of ONJ. RECENT FINDINGS The proposed mechanisms highlight the unique localization of ONJ. The evidence-based mechanisms of ONJ pathogenesis include disturbed bone remodeling, inflammation or infection, altered immunity, soft tissue toxicity, and angiogenesis inhibition. The role of dental infections and the oral microbiome is central to ONJ, and systemic conditions such as rheumatoid arthritis and diabetes mellitus contribute through their impact on immune resiliency. Current experimental studies on mechanisms of ONJ are summarized. The definitive pathophysiology is as yet unclear. Recent studies are beginning to clarify the relative importance of the proposed mechanisms. A better understanding of osteoimmunology and the relationship of angiogenesis to the development of ONJ is needed along with detailed studies of the impact of drug holidays on the clinical condition of ONJ.
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Affiliation(s)
- J Chang
- Department of Periodontology, University of Florida College of Dentistry, Gainesville, FL, 32610, USA
| | - A E Hakam
- Department of Periodontology, University of Florida College of Dentistry, Gainesville, FL, 32610, USA
| | - L K McCauley
- Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, 1011 North University Ave, Ann Arbor, MI, 48109, USA.
- Department of Pathology, Medical School, University of Michigan, Ann Arbor, MI, USA.
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Liu Y, Cao W, Kong X, Li J, Chen X, Ge Y, Zhong W, Fang S. Protective effects of α‑2‑macroglobulin on human bone marrow mesenchymal stem cells in radiation injury. Mol Med Rep 2018; 18:4219-4228. [PMID: 30221711 PMCID: PMC6172405 DOI: 10.3892/mmr.2018.9449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 07/20/2018] [Indexed: 12/18/2022] Open
Abstract
Osteoradionecrosis of the jaws (ORNJ) is a complication of oral and maxillofacial malignancy that arises following radiotherapy; progressive jaw necrosis severely decreases the quality of life of patients. Human bone marrow mesenchymal stem cells (hBMMSCs) are a cell type with self‑renewal and pluripotent differentiation potential in the bone marrow stroma. These cells are associated with bone tissue regeneration and are one of the primary cell types affected by bone tissue radiation injury. α‑2‑macroglobulin (α2M) is a glycoprotein‑rich macromolecule that interacts with cytokines, growth factors and hormones to serve a variety of biological roles. In addition, α2M possesses radio‑protective effects. The aim of the present study was to investigate whether α2M has protective effects against radiation injury of hBMMSCs. Cell counting kit‑8 and colony formation assays were used to monitor cell proliferation. Western blot analysis and reverse transcription‑quantitative polymerase chain reaction were used to detect Beclin1, microtubule‑associated protein 1A/1B, sex determining region Y, Nanog, runt‑related transcription factor 2, osteoglycin and manganese superoxide dismutase expression. The formation of calcium nodules was evaluated by Alizarin red staining after osteogenic induction. Flow cytometric analysis of Annexin‑V and propidium iodide double staining was used to detect changes in apoptosis rate. Alkaline phosphatase and superoxide dismutase activity were determined using colorimetric assays. Reactive oxygen species levels were detected using 2',7'‑dichlorodihydrofluorescein diacetate. The results of the present study revealed that α2M increased the rate of proliferation, reduced autophagy, alleviated pluripotent differentiation injury, increased the osteogenic differentiation ability and decreased the rate of apoptosis in hBMMSCs following irradiation via an antioxidative pathway. In conclusion, α2M exhibited protective effects against radiation injury in hBMMSCs and may be considered a potential therapeutic agent for the prevention and treatment of ORNJ.
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Affiliation(s)
- Yang Liu
- Department of Oral and Maxillofacial Surgery, The Sixth Affiliated Hospital of Sun Yat‑Sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Wanting Cao
- Department of Oral and Maxillofacial Surgery, The Sixth Affiliated Hospital of Sun Yat‑Sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Xiangbo Kong
- Department of Stomatology, Sun Yat‑Sen Memorial Hospital of Sun Yat‑Sen University, Guangzhou, Guangdong 510120, P.R. China
| | - Jie Li
- Department of Oral and Maxillofacial Surgery, The Sixth Affiliated Hospital of Sun Yat‑Sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Xueying Chen
- Department of Oral and Maxillofacial Surgery, The Sixth Affiliated Hospital of Sun Yat‑Sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Yaping Ge
- Department of Oral and Maxillofacial Surgery, The Sixth Affiliated Hospital of Sun Yat‑Sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Wanzhen Zhong
- Department of Oral and Maxillofacial Surgery, The Sixth Affiliated Hospital of Sun Yat‑Sen University, Guangzhou, Guangdong 510655, P.R. China
| | - Silian Fang
- Department of Oral and Maxillofacial Surgery, The Sixth Affiliated Hospital of Sun Yat‑Sen University, Guangzhou, Guangdong 510655, P.R. China
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Bastos P, Patel V, Festy F, Hosny N, Cook RJ. In-vivo imaging of the microvasculature of the soft tissue margins of osteonecrotic jaw lesions. Br Dent J 2018; 223:699-705. [PMID: 29123273 DOI: 10.1038/sj.bdj.2017.888] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/13/2017] [Indexed: 01/20/2023]
Abstract
Introduction Given the increasing incidence of medication-related jaw osteonecrosis, and recognition of the mucosal blood supply's importance, we have developed a non-invasive Real Time Optical Vascular Imaging (RTOVI) instrument. Imaging the red blood cells within the sub-mucosal capillary networks demonstrates the microcirculatory anatomy. We report a small trial, demonstrating the technique's viability, examining mucosal microcirculatory changes adjacent to osteonecrotic lesions.Aims Imaging the microvasculature of soft tissue margins of patients' exposed necrotic bone lesions in situ was intended to provide unique observational as well as quantitative data, using an image analysis routine, based on ImageJ software. Our interest was to evaluate whether this could offer valuable information for complex wound margin management.Methods Four osteoradionecrosis and four medication-related osteonecrosis patients (M:F 1:1 mean 68.25 years) were enrolled under the NRES Ethics 11/LON/0354 and KCL Research Ethics Committee (REC) BDM/14/15-14 approvals. Microvascular images from mucosal margins of exposed mandibular osteonecrosis lesions were compared with equivalent images from both uninvolved contralateral mucosa and similar mucosal sites in four healthy subjects.Results We demonstrated narrow hypo-vascularised oedematous lesion margins surrounded by a concentric inflammatory band and normal mucosa beyond. Parameters reporting individual capillary shape, via mean percentage of occupancy per capillary per field of view and capillary loop aspect ratio, differed significantly between groups (ANOVA, p = 0.0002 and p = 0.04 respectively). Values reporting capillary number and area showed expected changes but did not reach statistical significance.Conclusion This pilot study demonstrated the feasibility of mucosal microvascular imaging in assessing the microvascular changes found in the soft tissues at the margins of osteonecrotic lesions, with potential to inform therapeutic interventions and clinical decisions to continue or modify regime strategies at the earliest opportunity. Given the increasing incidence of medication-related jaw osteonecrosis, and the recognition of the importance of mucosal blood supply, we developed a non-invasive instrument demonstrating microcirculation anatomy by imaging transiting red blood cells.
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Affiliation(s)
- P Bastos
- Dept. Tissue Engineering & Biophotonics KCL Dental Institute, Guy's Campus, London, SE1 9RT
| | - V Patel
- Dept. Tissue Engineering & Biophotonics KCL Dental Institute, Guy's Campus, London, SE1 9RT.,Dept. Oral Surgery GSTFT & KCL Dental Institute, Guy's Campus, London, SE1 9RT
| | - F Festy
- Dept. Tissue Engineering & Biophotonics KCL Dental Institute, Guy's Campus, London, SE1 9RT
| | - N Hosny
- Dept. Tissue Engineering & Biophotonics KCL Dental Institute, Guy's Campus, London, SE1 9RT
| | - R J Cook
- Dept. Tissue Engineering & Biophotonics KCL Dental Institute, Guy's Campus, London, SE1 9RT.,Dept. of Oral Medicine, GSTFT & KCL Dental Institute, Guy's Campus, London, SE1 9RT
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Secondary surgical management of osteoradionecrosis using three-dimensional isodose curve visualization: a report of three cases. Int J Oral Maxillofac Surg 2018; 47:214-219. [DOI: 10.1016/j.ijom.2017.08.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/28/2017] [Accepted: 08/10/2017] [Indexed: 11/18/2022]
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Kumar S, Chandran C, Chacko R, Jesija JS, Paul A. Osteoradionecrosis of Jaw: An Institutional Experience. Contemp Clin Dent 2018; 9:242-248. [PMID: 29875568 PMCID: PMC5968690 DOI: 10.4103/ccd.ccd_843_17] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aims and Objectives: Osteoradionecrosis (ORN) of the jaw is a significant yet rare complication of radiotherapy (RT) associated with the management of head-and-neck malignancies. Recent decrease in the incidence of ORN following RT to the head and neck is being mainly attributed to refinement in RT techniques and improvement in our understanding of this morbid disease. The aim of this study is to assess the patients with ORN following head-and-neck RT to determine the various contributing risk factors involved in the development of ORN. Subjects and Methods: A retrospective data review from 2003 onward was conducted on the cases of ORN which presented to the Department of Dental and Oral Surgery, Christian Medical College, Vellore. Details of the patients with regard to the site of primary malignancy, type of treatment provided - RT alone or in combination of surgery and chemotherapy, dose of RT, presenting complaint, duration between the RT and presentation of ORN, and method of management considered were evaluated. Results: A total of 25 patients were evaluated. The average age of the 25 patients in our study was 58 years. Oropharynx (about 50%) was the leading site of primary malignancy. More than half of the patients in the study (52%) had undergone radical RT for the primary malignancy and all the patients were given >60 Gy dose of RT. About 48% of the patients in the study reported with pus discharge as their chief complaint. The average intervening time period from completion of RT to the presentation of ORN was 48 months. The mandibular alveolus was the most common site for ORN. Twelve of the 25 cases in the study were managed conservatively with only 3 patients requiring major resection. Conclusion: Due to its rare presentation, ORN still remains a challenge for the clinician in its management. Our study revealed that radical RT and concurrent chemo-RT for the oropharyngeal and base of the tongue malignancies have a higher risk of developing ORN. Patients subjected to the dose of RT above 60 Gy for head-and-neck malignancies have an increased risk of future ORN; henceforth, newer modality treatment like intensity-modulated RT regimen is recommended for such sites. Most of the patients in the study were satisfactorily managed of the symptoms with conservative modality treatment; hence, it is recommended to consider for surgical methods only in severe end-stage form of ORN.
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Affiliation(s)
- Saurabh Kumar
- Department of Dental and Oral Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Catherine Chandran
- Department of Dental and Oral Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Rabin Chacko
- Department of Dental and Oral Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - J S Jesija
- Department of Dental and Oral Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
| | - Arun Paul
- Department of Dental and Oral Surgery, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
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Politis C, Schoenaers J, Jacobs R, Agbaje JO. Wound Healing Problems in the Mouth. Front Physiol 2016; 7:507. [PMID: 27853435 PMCID: PMC5089986 DOI: 10.3389/fphys.2016.00507] [Citation(s) in RCA: 97] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 10/14/2016] [Indexed: 12/23/2022] Open
Abstract
Wound healing is a primary survival mechanism that is largely taken for granted. The literature includes relatively little information about disturbed wound healing, and there is no acceptable classification describing wound healing process in the oral region. Wound healing comprises a sequence of complex biological processes. All tissues follow an essentially identical pattern to complete the healing process with minimal scar formation. The oral cavity is a remarkable environment in which wound healing occurs in warm oral fluid containing millions of microorganisms. The present review provides a basic overview of the wound healing process and with a discussion of the local and general factors that play roles in achieving efficient would healing. Results of oral cavity wound healing can vary from a clinically healed wound without scar formation and with histologically normal connective tissue under epithelial cells to extreme forms of trismus caused by fibrosis. Many local and general factors affect oral wound healing, and an improved understanding of these factors will help to address issues that lead to poor oral wound healing.
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Affiliation(s)
- Constantinus Politis
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Katholieke Universiteit LeuvenLeuven, Belgium; Oral and Maxillofacial Surgery, Leuven University HospitalsLeuven, Belgium
| | - Joseph Schoenaers
- Oral and Maxillofacial Surgery, Leuven University Hospitals Leuven, Belgium
| | - Reinhilde Jacobs
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Katholieke Universiteit Leuven Leuven, Belgium
| | - Jimoh O Agbaje
- OMFS-IMPATH Research Group, Department of Imaging and Pathology, Katholieke Universiteit LeuvenLeuven, Belgium; Oral and Maxillofacial Surgery, Leuven University HospitalsLeuven, Belgium
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Villa A, Sonis S. Toxicities associated with head and neck cancer treatment and oncology-related clinical trials. Curr Probl Cancer 2016; 40:244-257. [DOI: 10.1016/j.currproblcancer.2016.06.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/09/2016] [Indexed: 12/21/2022]
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Use of the Integra skin regeneration system in an intraoral mandibular defect in osteoradionecrosis. Int J Oral Maxillofac Surg 2016; 45:1159-61. [PMID: 27068447 DOI: 10.1016/j.ijom.2016.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 02/17/2016] [Accepted: 03/24/2016] [Indexed: 11/20/2022]
Abstract
The objective was to trial the use of the Integra skin regeneration system intraorally to promote healing of an intraoral defect in osteoradionecrosis (ORN), thereby avoiding the necessity for mucosal flaps, free flaps, or skin grafts. A 54-year-old male patient presented with a pathological mandibular fracture at the angle, related to previous radiotherapy for tonsillar carcinoma, after the development of ORN. The fracture site was debrided and fixed with a reconstruction plate and the intraoral defect was dressed with the Integra two-layer system and an overlying pack. Three weeks later, the pack and silicone layer of the regeneration system were removed, showing early granulation over the previously exposed bone. At 8 weeks postoperative, the defect had healed completely with no need for further reconstruction. Using the method described, excellent healing was seen with the Integra skin regeneration system. A new use for the Integra skin regeneration system has been identified in the authors' unit. This method is minimally invasive and resulted in good healing in the case presented. The need for further reconstruction with associated increased patient morbidity was avoided in this case.
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