151
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Lai TY, Wang TH, Liu CJ, Chao TF, Chen TJ, Hu YW. Risk factors for osteonecrosis of the jaw in oral cancer patients after surgery and eventual adjuvant treatment: The potential role of chemotherapy. Radiother Oncol 2017; 123:406-411. [PMID: 28532609 DOI: 10.1016/j.radonc.2017.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 04/13/2017] [Accepted: 05/04/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE To identify the risk factors for osteonecrosis of the jaw (ONJ) in oral cancer patients after surgery with and without adjuvant therapy in a nationwide, population-based study. MATERIAL AND METHODS Using the Taiwan National Health Insurance Research Dataset, we recruited patients with newly diagnosed oral cancer between 1997 and 2011. All of them underwent primary surgery. Data regarding demographic characteristics; tooth extractions; medications; and cancer treatments, including types of mandibular surgery, radiotherapy and platinum-based chemotherapy, were collected for analysis. RESULTS We identified 25,858 patients who suffered 2802 ONJ events. The ONJ incidence rate was 3.45 per 100 person-years. Lip cancer was associated with the highest risk of ONJ, followed by buccal mucosa, gum, mouth floor and tongue cancer. Using a time-dependent Cox regression model, multivariable analysis demonstrated that mandibulotomy (hazard ratio (HR), 1.25; 95% confidence interval (CI), 1.01-1.55; p<0.001), radiotherapy (HR, 1.39; 95% CI, 1.26-1.54; p<0.001) and platinum-based chemotherapy (HR, 1.94; 95% CI, 1.56-2.41; p<0.001) were significant risk factors for ONJ. In the subgroup analysis of patients receiving radiotherapy and patients not receiving radiotherapy, platinum-based chemotherapy remained a risk factor for ONJ. CONCLUSIONS Mandibulotomy, radiotherapy and platinum-based chemotherapy were associated with an increased ONJ risk. Chemotherapy was a risk factor regardless of whether radiotherapy was administered.
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Affiliation(s)
- Tzu-Yu Lai
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taiwan
| | - Ti-Hao Wang
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taiwan; Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Wen Hu
- Division of Radiation Oncology, Department of Oncology, Taipei Veterans General Hospital, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
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152
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Maroulakos G, Nagy WW, Ahmed A, Artopoulou II. Prosthetic rehabilitation following lateral resection of the mandible with a long cantilever implant-supported fixed prosthesis: A 3-year clinical report. J Prosthet Dent 2017; 118:678-685. [PMID: 28461046 DOI: 10.1016/j.prosdent.2017.01.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Revised: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 11/30/2022]
Abstract
This clinical report describes the prosthetic management of the surgical reconstruction of a patient after mandibular resection. Complete oral rehabilitation was achieved with a maxillary complete denture and a mandibular implant-supported fixed prosthesis with a custom titanium framework and a long unilateral cantilever.
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Affiliation(s)
- Georgios Maroulakos
- Assistant Professor, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wis.
| | - William W Nagy
- Professor and Director, Graduate Prosthodontics, Department of Restorative Sciences, Texas A&M University College of Dentistry, Dallas, Texas
| | - Ayman Ahmed
- Clinical Assistant Professor, Department of General Dental Sciences, Marquette University School of Dentistry, Milwaukee, Wis
| | - Ioli I Artopoulou
- Lecturer, Department of Prosthodontics, National and Kapodistrian University of Athens, School of Dentistry, Athens, Greece
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153
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Wang TH, Liu CJ, Chao TF, Chen TJ, Hu YW. Risk factors for and the role of dental extractions in osteoradionecrosis of the jaws: A national-based cohort study. Head Neck 2017; 39:1313-1321. [PMID: 28370713 DOI: 10.1002/hed.24761] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 01/08/2017] [Accepted: 02/02/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the risk factors, especially the use of certain drugs and the dental procedures, for osteoradionecrosis of the jaw (ORNJ) in patients with head and neck cancer undergoing irradiation as their primary treatment. METHODS The cohort was composed of 23,527 patients with head and neck cancer. Cox proportional hazard models were used for risk factors analysis. RESULTS The overall incidence of ORNJ is 3.93 per 100 person-years. Buccal cancer carried the highest ORNJ risk. The use of steroids had a protective effect. Preradiotherapy extraction posed no excess risk, whereas postradiotherapy extraction was associated with gradually increased risk of ORNJ over time that peaked at 4 to 5 years. CONCLUSION ORNJ warrants life-long attention for head and neck cancer survivors. The present study strongly confirms the role of preirradiation dental extractions. Meanwhile, efforts should be made to prevent posttreatment extractions, especially in the first posttreatment 4 years. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1313-1321, 2017.
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Affiliation(s)
- Ti-Hao Wang
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Radiation Oncology, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tze-Fan Chao
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine and Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Wen Hu
- Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
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154
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Sultan A, Hanna GJ, Margalit DN, Chau N, Goguen LA, Marty FM, Rabinowits G, Schoenfeld JD, Sonis ST, Thomas T, Tishler RB, Treister NS, Villa A, Woo SB, Haddad R, Mawardi H. The Use of Hyperbaric Oxygen for the Prevention and Management of Osteoradionecrosis of the Jaw: A Dana-Farber/Brigham and Women's Cancer Center Multidisciplinary Guideline. Oncologist 2017; 22:343-350. [PMID: 28209748 DOI: 10.1634/theoncologist.2016-0298] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/05/2016] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Osteoradionecrosis of the jaw (ORN) is an infrequent yet potentially devastating complication of radiation therapy to the head and neck region. Treatment options include antimicrobial therapy, local sequestrectomy, resection, and the use of hyperbaric oxygen (HBO). Published data on ORN are difficult to compare because of the lack of a universally accepted classification and staging system, and the literature on the use of HBO to either prevent or successfully manage ORN is controversial and inconclusive. Therefore, we aimed to establish a standard approach for using HBO at our institution. MATERIALS AND METHODS A literature search was conducted of articles published in the English language between January 1980 and January 2016. Retrieved articles were evaluated by two independent reviewers. Isolated case reports, abstracts, case series, review articles, and cohort studies without a control group were excluded; summary data were extracted from the remaining studies. A panel of experts from Head and Neck Oncology and Oral Medicine from the Dana-Farber Cancer Institute and Brigham and Women's Hospital reviewed the summary data and established multidisciplinary guidelines on the use of HBO for the prevention and management of ORN. RESULTS Seven studies were evaluated and reviewed by the multidisciplinary panel. There was no consistent evidence in support of HBO for either the prevention or management of ORN. CONCLUSION Based on the available evidence and expert opinion, routine use of HBO for the prevention or management of ORN is not recommended and is rarely used at our institution. The Oncologist 2017;22:343-350 IMPLICATIONS FOR PRACTICE: The Division of Head and Neck Oncology of Dana-Farber/Brigham and Women's Cancer Center does not recommend the routine use of HBO for the prevention or management of ORN. Adjunctive HBO may be considered for use on a case-by-case basis in patients considered to be at exceptionally high risk who have failed conservative therapy and subsequent surgical resection.
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Affiliation(s)
- Ahmed Sultan
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Glenn J Hanna
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA;
| | - Danielle N Margalit
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nicole Chau
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA;
| | - Laura A Goguen
- Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Francisco M Marty
- Division of Infectious Diseases, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Guilherme Rabinowits
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA;
| | - Jonathan D Schoenfeld
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Stephen T Sonis
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute, Boston, Massachusetts, USA;
| | - Tom Thomas
- Division of Otolaryngology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Roy B Tishler
- Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Radiation Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Nathaniel S Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute, Boston, Massachusetts, USA;
| | - Alessandro Villa
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute, Boston, Massachusetts, USA;
| | - Sook-Bin Woo
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Department of Oral Medicine, Infection, and Immunity, Harvard School of Dental Medicine, Boston, Massachusetts, USA
- Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute, Boston, Massachusetts, USA;
| | - Robert Haddad
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA;
- Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute, Boston, Massachusetts, USA;
| | - Hani Mawardi
- Department of Diagnostic Sciences, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia
- Division of Oral Medicine and Dentistry, Dana-Farber Cancer Institute, Boston, Massachusetts, USA;
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155
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Aggarwal K, Goutam M, Singh M, Kharat N, Singh V, Vyas S, Singh HP. Prophylactic Use of Pentoxifylline and Tocopherol in Patients Undergoing Dental Extractions Following Radiotherapy for Head and Neck Cancer. Niger J Surg 2017; 23:130-133. [PMID: 29089739 PMCID: PMC5649429 DOI: 10.4103/njs.njs_40_16] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND In head and neck cancer patients undergoing radiotherapy, osteoradionecrosis (ORN) of the jaw is one of the major but uncommon complications. Satisfactorily results have been observed while treating ORN patients with upcoming treatment modalities such as combination therapy of pentoxifylline and Vitamin E (PVe). It is believed that in patients undergoing dental extractions, these treatment modalities can be used prophylactically for lowering the risk of development of ORN. Hence, keeping all these things in mind, we planned the present study to assess the prophylactic role of pentoxifylline and tocopherol in patients who require dental extractions after radiotherapy for cancer of head and neck. MATERIALS AND METHODS A total of 110 patients were included in this retrospective study, which had radiotherapy for cancer of the head and neck. After radiotherapy, a total of 450 dental extractions were done in these 110 patients. RESULTS External beam therapy was given in 92.72% of the patients. 7.27% and 40% of the patients received intensity modulated radiotherapy combination of chemotherapy and intensity modulated radiotherapy, respectively. ORN developed only in 2 patients. Patients had taken PVe for a mean of 12 (24) weeks preoperatively and 14 (18) weeks postoperatively. The incidence was lower than that normally associated with dental extractions in irradiated patients. CONCLUSION In patients undergoing dental extractions, after receiving radiotherapy of head and neck region, combination therapy of pentoxifylline and tocopherol are sufficiently effective.
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Affiliation(s)
- Karun Aggarwal
- Department of Oral and Maxillofacial Surgery, Jodhpur Dental College and Hospital, Jodhpur, Rajasthan, India
| | - Manish Goutam
- Dentica Oral Care and Implant Centre, Ranchi, Jharkhand, India
| | - Madhavi Singh
- Dentica Oral Care and Implant Centre, Ranchi, Jharkhand, India
| | - Neetu Kharat
- Department of Conservative Dentistry and Endodontics, Bhabha College of Dental Sciences, Bhopal, Madhya Pradesh, India
| | - Vandana Singh
- Department of Oral Medicine and Radiology, Bhabha College of Dental Sciences, Bhopal, Madhya Pradesh, India
| | - Suyash Vyas
- Department of Oral Medicine, RKDF College of Dental Sciences and Research Centre, Bhopal, Madhya Pradesh, India
| | - Harkanwal Preet Singh
- Department of Oral Pathology and Microbiology, Dasmesh Institute of Research and Dental Sciences, Faridkot, Punjab, India
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156
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Wanifuchi S, Akashi M, Ejima Y, Shinomiya H, Minamikawa T, Furudoi S, Otsuki N, Sasaki R, Nibu KI, Komori T. Cause and occurrence timing of osteoradionecrosis of the jaw: a retrospective study focusing on prophylactic tooth extraction. Oral Maxillofac Surg 2016; 20:337-342. [PMID: 27401528 DOI: 10.1007/s10006-016-0570-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 07/03/2016] [Indexed: 05/01/2023]
Abstract
PURPOSE This retrospective study aimed to analyze the relationship between tooth extraction and osteoradionecrosis (ORN) occurrence. The irradiation field, dose, and time interval between radiotherapy (RT) and ORN were reviewed. We also discuss appropriate guidelines for prophylactic tooth extraction. METHODS A total of 33 patients treated for grade ≥2 (clinical) ORN in our department from 2002 to 2014 were enrolled. The following epidemiological data were retrospectively gathered: age, sex, histological diagnosis, primary tumor sites, radiation dose, chemotherapy, site of ORN, relationship between tooth extraction and ORN occurrence, and time interval between tooth extraction and the initiation or end of RT. RESULTS Twenty-one percent of ORN cases resulted from tooth extraction. The most common site of ORN (82 %) was the mandibular molar region. About half of ORN cases (49 %) occurred within 2 years after RT. All patients who received tooth extraction after RT developed ORN (100 %) independently of time interval between tooth extraction and the end of RT (median interval, 37.5 months; range, 27-120 months). In contrast, only 50 % of patients who received tooth extraction before RT developed ORN. There may have been an association between the irradiation field and the site of ORN development CONCLUSIONS: ORN occurrence due to tooth extraction was 21 %. Occurrence timing of ORN did not depend on time interval between tooth extraction and the end of RT. The irradiation field is certainly related to the site of ORN; therefore, prophylactic tooth extraction should be performed in consideration of the proposed radiation field and dose.
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Affiliation(s)
- Satoshi Wanifuchi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-1, Chuo-ku, Kobe, 650-0017, Japan
| | - Masaya Akashi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-1, Chuo-ku, Kobe, 650-0017, Japan.
| | - Yasuo Ejima
- Department of Radiation Oncology, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-1, Chuo-ku, Kobe, 650-0017, Japan
| | - Hirotaka Shinomiya
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-1, Chuo-ku, Kobe, 650-0017, Japan
| | - Tsutomu Minamikawa
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-1, Chuo-ku, Kobe, 650-0017, Japan
| | - Shungo Furudoi
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-1, Chuo-ku, Kobe, 650-0017, Japan
| | - Naoki Otsuki
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-1, Chuo-ku, Kobe, 650-0017, Japan
| | - Ryohei Sasaki
- Department of Radiation Oncology, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-1, Chuo-ku, Kobe, 650-0017, Japan
| | - Ken-Ichi Nibu
- Department of Otolaryngology-Head and Neck Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-1, Chuo-ku, Kobe, 650-0017, Japan
| | - Takahide Komori
- Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-1, Chuo-ku, Kobe, 650-0017, Japan
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157
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Kim JW, Hwang JH, Ahn KM. Fibular flap for mandible reconstruction in osteoradionecrosis of the jaw: selection criteria of fibula flap. Maxillofac Plast Reconstr Surg 2016; 38:46. [PMID: 27995119 PMCID: PMC5122601 DOI: 10.1186/s40902-016-0093-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Accepted: 10/25/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoradionecrosis is the most dreadful complication after head and neck irradiation. Orocutaneous fistula makes patients difficult to eat food. Fibular free flap is the choice of the flap for mandibular reconstruction. Osteocutaneous flap can reconstruct both hard and soft tissues simultaneously. This study was to investigate the success rate and results of the free fibular flap for osteoradionecrosis of the mandible and which side of the flap should be harvested for better reconstruction. METHODS A total of eight consecutive patients who underwent fibula reconstruction due to jaw necrosis from March 2008 to December 2015 were included in this study. Patients were classified according to stages, primary sites, radiation dose, survival, and quality of life. RESULTS Five male and three female patients underwent operation. The mean age of the patients was 60.1 years old. Two male patients died of recurred disease of oral squamous cell carcinoma. The mean dose of radiation was 70.5 Gy. All fibular free flaps were survived. Five patients could eat normal diet after operation; however, three patients could eat only soft diet due to loss of teeth. Five patients reported no change of speech after operation, two reported worse speech ability, and one patient reported improved speech after operation. The ipsilateral side of the fibular flap was used when intraoral soft tissue defect with proximal side of the vascular pedicle is required. The contralateral side of the fibular flap was used when extraoral skin defect with proximal side of the vascular pedicle is required. CONCLUSIONS Osteonecrosis of the jaw is hard to treat because of poor healing process and lack of vascularity. Free fibular flap is the choice of the surgery for jaw bone reconstruction and soft tissue fistula repair. The design and selection of the right or left fibular is dependent on the available vascular pedicle and soft tissue defect sites.
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Affiliation(s)
- Ji-Wan Kim
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Ulsan, Republic of Korea
| | - Jong-Hyun Hwang
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Ulsan, Republic of Korea
| | - Kang-Min Ahn
- Department of Oral and Maxillofacial Surgery, College of Medicine, University of Ulsan, Asan Medical Center, Ulsan, Republic of Korea
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158
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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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159
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Osteoradionecrosis following treatment for head and neck cancer and the effect of radiotherapy dosimetry: the Guy's and St Thomas' Head and Neck Cancer Unit experience. Oral Surg Oral Med Oral Pathol Oral Radiol 2016; 122:28-34. [DOI: 10.1016/j.oooo.2016.01.007] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 01/05/2016] [Accepted: 01/09/2016] [Indexed: 11/23/2022]
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160
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Morita H, Imai Y, Yoneda M, Hirofuji T. Applying orthodontic tooth extrusion in a patient treated with bisphosphonate and irradiation: a case report. SPECIAL CARE IN DENTISTRY 2016; 37:43-46. [PMID: 27358247 DOI: 10.1111/scd.12190] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Bisphosphonates and irradiation are useful medical treatments, but can often cause oral complications such as medication-related oral necrosis of the jaw (MRONJ) and osteoradionecrosis (ORN) during oral surgery, including tooth extraction. Therefore, we should take all risks into consideration carefully before choosing dental treatment for patients with a medical history of such therapies. A 55-year-old woman who underwent cord blood transplantation to treat extranodal natural killer T (NK/T) cell lymphoma (nasal type IVB) had a medical history of bisphosphonate and irradiation treatments. We treated her residual tooth root by applying orthodontic extrusion to avoid extraction and successfully restored the tooth. Application of an orthodontic tooth extrusion technique for conservative treatment of a residual tooth is a useful means of avoiding MRONJ or ORN in patients who have a medical history of bisphosphonate and irradiation treatments.
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Affiliation(s)
- Hiromitsu Morita
- Section of General Dentistry, Department of General Dentistry, Fukuoka, Japan.,Special Patient Oral Care Unit, Kyushu University Hospital, Fukuoka, Japan
| | - Yuko Imai
- Special Patient Oral Care Unit, Kyushu University Hospital, Fukuoka, Japan
| | - Masahiro Yoneda
- Section of General Dentistry, Department of General Dentistry, Fukuoka, Japan
| | - Takao Hirofuji
- Section of General Dentistry, Department of General Dentistry, Fukuoka, Japan
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161
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Prophylactic use of pentoxifylline and tocopherol in patients who require dental extractions after radiotherapy for cancer of the head and neck. Br J Oral Maxillofac Surg 2016; 54:547-50. [DOI: 10.1016/j.bjoms.2016.02.024] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 02/18/2016] [Indexed: 11/21/2022]
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162
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Costa DA, Costa TP, Netto EC, Joaquim N, Ventura I, Pratas AC, Winckler P, Silva IP, Pinho AC, Sargento IG, Guerreiro FG, Moreira AR. New perspectives on the conservative management of osteoradionecrosis of the mandible: A literature review. Head Neck 2016; 38:1708-1716. [PMID: 27240248 DOI: 10.1002/hed.24495] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 02/15/2016] [Accepted: 03/22/2016] [Indexed: 12/18/2022] Open
Abstract
Over the last decades, several therapeutic options were considered in the treatment of the osteoradionecrosis (ORN) of the mandible, including supportive measures, ultrasound therapy, corticosteroids, hyperbaric oxygen, surgical resection with reconstruction, and, more recently, drugs capable of reversing the fibroatrophic process. Once established, the ORN does not spontaneously disappear and a standard treatment has not yet been defined. The clear clinical effectiveness of hyperbaric oxygen therapy (HBOT) varies according to the literature and there are some economic/logistic issues to be considered; the triplet tocopherol/pentoxifylline/clodronate demands greater evidence from randomized clinical trials and also resilience from the patient, given the long treatment duration and its possible side effects. Controversy around the ideal treatment of the initial stage ORN of the mandible persists. More rigorous randomized prospective trials are essential. The purpose of this article was to review the relevant literature on the physiopathology of ORN of the mandible and discuss the new perspectives of its conservative treatment. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.
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Affiliation(s)
- Diogo Alpuim Costa
- Medical Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal. .,Underwater and Hyperbaric Medicine Center, Portuguese Navy, Lisbon, Portugal. .,Naval Research Center, Almada, Portugal. .,Nova Medical School, Lisbon, Portugal.
| | - Tiago Porfírio Costa
- Otorhinolaryngology Department, Centro Hospitalar de Lisboa Norte, Hospital de Santa Maria, E.P.E., Lisbon, Portugal.,Underwater and Hyperbaric Medicine Center, Portuguese Navy, Lisbon, Portugal
| | - Eduardo Carlinhos Netto
- Radiation Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Natércia Joaquim
- Biomedical Sciences and Medicine Department, Universidade do Algarve, Faro, Portugal
| | - Isabel Ventura
- Stomatology Department, Hospital do Espírito Santo, E.P.E., Évora, Portugal
| | - Ana Cristina Pratas
- Maxillofacial Surgery Department, Centro Hospitalar de Lisboa Central, Hospital de São José, E.P.E., Lisbon, Portugal.,Underwater and Hyperbaric Medicine Center, Portuguese Navy, Lisbon, Portugal.,Naval Research Center, Almada, Portugal
| | - Patrícia Winckler
- Medical Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Inês Pires Silva
- Medical Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Ana Catarina Pinho
- General Surgery Department, Centro Hospitalar de Lisboa Central, Hospital de São José, E.P.E., Lisbon, Portugal
| | - Isabel Goulão Sargento
- Medical Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
| | - Francisco Gamito Guerreiro
- Underwater and Hyperbaric Medicine Center, Portuguese Navy, Lisbon, Portugal.,Naval Research Center, Almada, Portugal
| | - António Rita Moreira
- Medical Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal.,Clinical Trials Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal
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163
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Ceponis P, Keilman C, Guerry C, Freiberger JJ. Hyperbaric oxygen therapy and osteonecrosis. Oral Dis 2016; 23:141-151. [PMID: 27062390 DOI: 10.1111/odi.12489] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 03/24/2016] [Indexed: 12/18/2022]
Abstract
Osteonecrosis of the jaw may be caused by radiation, medication, or infection. Optimal therapy requires a multimodal approach that combines surgery with adjuvant treatments. This review focuses on the use of adjunctive hyperbaric oxygen therapy for this condition. In addition to evidence regarding the basic and clinical science behind hyperbaric oxygen therapy, controversies in the field and economic implications are discussed.
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Affiliation(s)
- P Ceponis
- Hyperbaric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.,Royal Canadian Medical Service, Canadian Armed Forces, Ottawa, ON, Canada
| | - C Keilman
- Hyperbaric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - C Guerry
- Hyperbaric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
| | - J J Freiberger
- Hyperbaric Division, Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA
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164
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Patel V, Gadiwalla Y, Sassoon I, Sproat C, Kwok J, McGurk M. Use of pentoxifylline and tocopherol in the management of osteoradionecrosis. Br J Oral Maxillofac Surg 2016; 54:342-5. [DOI: 10.1016/j.bjoms.2015.11.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
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165
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Kuo TJ, Leung CM, Chang HS, Wu CN, Chen WL, Chen GJ, Lai YC, Huang WC. Jaw osteoradionecrosis and dental extraction after head and neck radiotherapy: A nationwide population-based retrospective study in Taiwan. Oral Oncol 2016; 56:71-7. [PMID: 27086489 DOI: 10.1016/j.oraloncology.2016.03.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 03/04/2016] [Accepted: 03/07/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Osteoradionecrosis of the jaws (ORNJ) is painful for patients and relatively difficult to treat clinically. The high risk of ORNJ for post radiotherapy R/T dental extraction is known; however, many patients still have to have teeth extracted after head and neck R/T. The objective of the present study is to review post R/T dental extraction and determine the ORNJ risk. MATERIALS AND METHODS We preformed a retrospective cohort study of 1759 patients with head and neck cancer s/p R/T from a random sample of 1,000,000 insurants in the National Health Insurance Research Database during 2000-2013 in Taiwan. Statistical methods included two-proportion Z-test. RESULTS We evaluated two cohorts: 522 patients with post R/T dental extraction and 1237 patients without post R/T extraction. Overall moderate-to-severe ORNJ after R/T was 2.22% (39/1759), and a total of 39 ORNJ cases were noted during an average of 3.02years (range: 0.62-8.89years, ±2.07). ORNJ prevalence in the overall post R/T extraction-exposed cohort (5.17%, 27/522) was significantly greater than that in the unexposed cohort (0.97%, 12/1237). In a group of patients with ⩽5 post R/T dental extractions (n=373), the ORNJ risk was 2.4% (ORNJ case n=9); in a group of patients with >5 dental extractions (n=149), the ORNJ risk was 12.1% (ORNJ case n=18) (Z-score=4.5062; p-value<0.0001). In the extraction-exposed cohort, the ORNJ risk is higher if the index day to first extraction day was ⩽0.5year (n=103) compared with the group with the index day to first extraction day >0.5year (n=419) (Z-score=-2.1506; p-value=0.0315). CONCLUSION A tooth extraction time less than half a year after R/T or during the head and neck R/T period, and extraction tooth number ⩽5 would significant lower the ORNJ prevalence.
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Affiliation(s)
- Tsu-Jen Kuo
- Department of Stomatology, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Chung-Man Leung
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Hao-Sheng Chang
- Department of Stomatology, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Chao-Nan Wu
- Department of Dentistry, Kaohsiung Veterans General Hospital, Taiwan, ROC.
| | - Wei-Li Chen
- Department of Stomatology, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Guang-Jhong Chen
- Department of Stomatology, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Yu-Cheng Lai
- Department of Orthopedics, Kaohsiung Veterans General Hospital, Taiwan, ROC
| | - Wei-Chun Huang
- Section of Critical Care Medicine, Kaohsiung Veterans General Hospital, Taiwan, ROC
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166
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Prevention of osteoradionecrosis of the jaws by low-intensity ultrasound in the dog model. Int J Oral Maxillofac Surg 2016; 45:1170-6. [PMID: 26917007 DOI: 10.1016/j.ijom.2016.01.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 11/26/2015] [Accepted: 01/25/2016] [Indexed: 11/20/2022]
Abstract
The prevention of osteoradionecrosis of the jaws (ORNJ) is very important because of the current absence of effective therapies for this disease. The aim of this study was to determine whether low-intensity ultrasound has a preventive effect on ORNJ. Sixty healthy adult dogs were divided randomly into three groups: group A (radiotherapy alone), group B (radiotherapy followed by low-intensity ultrasound treatment), and a control group. The development of ORNJ was assessed and the rate of occurrence of ORNJ was compared between groups A and B. Micro-computed tomography, haematoxylin-eosin staining, and immunofluorescence were used to evaluate the microstructure of the mandible and changes in microvascular density in all groups. All animals in group A and group B (ultrasound applied for 30 days) developed ORNJ. Alveolar bone density was 609.48±53.77HU in group A and 829.65±81.46HU in group B (P=0.008). The trabecular bone volume fraction, bone surface area/bone volume ratio, trabecular thickness, and trabecular number were all lower in group A than in group B (P=0.037, P=0.022, P=0.017, and P=0.034, respectively). Haematoxylin-eosin staining showed that the Haversian canals in the osteons had expanded significantly in group A, with collagen fibres losing their circular orientation; group B tended to show typical osteons. The microvascular density in group A was decreased. In conclusion, the use of low-intensity ultrasound in the dog appears not to prevent the incidence of ORNJ, however it does somewhat improve vascularity and bone quality at the microscopic level, which contribute to ORNJ healing.
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167
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Buglione M, Cavagnini R, Di Rosario F, Sottocornola L, Maddalo M, Vassalli L, Grisanti S, Salgarello S, Orlandi E, Paganelli C, Majorana A, Gastaldi G, Bossi P, Berruti A, Pavanato G, Nicolai P, Maroldi R, Barasch A, Russi EG, Raber-Durlacher J, Murphy B, Magrini SM. Oral toxicity management in head and neck cancer patients treated with chemotherapy and radiation: Dental pathologies and osteoradionecrosis (Part 1) literature review and consensus statement. Crit Rev Oncol Hematol 2016; 97:131-42. [DOI: 10.1016/j.critrevonc.2015.08.010] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Accepted: 08/05/2015] [Indexed: 11/29/2022] Open
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168
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Davis C, Sikes J, Namaranian P, Laramore G, Dillon JK. Neutron Beam Radiation Therapy: An Overview of Treatment and Oral Complications When Treating Salivary Gland Malignancies. J Oral Maxillofac Surg 2015; 74:830-5. [PMID: 26611376 DOI: 10.1016/j.joms.2015.10.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/12/2015] [Accepted: 10/14/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE There is limited information in the literature regarding the oral complications of neutron radiotherapy, with an associated lack of guidelines for their management. The purpose of this study was to review the indications, dosing, prognosis, and oral complications of neutron radiotherapy for salivary gland malignancies. MATERIALS AND METHODS This is a retrospective case series of patients with salivary gland malignancies treated with neutron radiotherapy by the Radiation Oncology Department at the University of Washington from 1997 to 2006. Variables included patient demographics, tumor staging and characteristics, operative treatment, final diagnosis, operative and pathologic findings (ie, perineural invasion, lymph node involvement, and skull base invasion), dosing, complications, and locoregional control and survival rates. Data were extracted from patients' charts and by telephone for follow-up and quality-of-life information. RESULTS The sample was composed of 140 patients (49% men, 51% women) with a mean age of 53 years (standard deviation, 15 yr). Adenoid cystic carcinoma of the submandibular gland was the most common tumor type and location. Post-treatment trismus occurred in 56%. Acute mucositis and xerostomia occurred in approximately 88 and 89% of patients, respectively. Osteoradionecrosis was reported in 5.7% of patients. The 6-year survival rate was 58% and the 6-year locoregional control was 72%. The current standard neutron dose for head and neck tumors is 1.15 neutron Gray (nGy) 4 times per week for 4 weeks (total, 18.4 nGy), which is an equivalent amount of radiation as the standard 60 to 70 Gy given for 6 to 7 weeks with conventional photon radiation. CONCLUSION The 6-year overall survival of 58% found in this study compares favorably to the survival rate reported in the literature for traditional photon radiation treatment of advanced salivary gland tumors. The dental profession should be educated regarding neutron radiotherapy and its indications, dosing methods, and oral complications.
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Affiliation(s)
- Chris Davis
- Dental Student, University of Washington School of Dentistry, Seattle, WA
| | - Justin Sikes
- Former Resident, Department of Oral and Maxillofacial Surgery, Harborview Medical Center, University of Washington, Seattle, WA
| | - Parshan Namaranian
- Former Resident, Department of Oral and Maxillofacial Surgery, Harborview Medical Center, University of Washington, Seattle, WA
| | - George Laramore
- Professor, Department of Radiology, University of Washington, Seattle, WA
| | - Jasjit K Dillon
- Clinical Associate Professor, Program Director, and Acting Chief of Service, Department of Oral and Maxillofacial Surgery, Harborview Medical Center, University of Washington, Seattle, WA.
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169
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Radiation-induced caries as the late effect of radiation therapy in the head and neck region. Contemp Oncol (Pozn) 2015; 20:287-90. [PMID: 27688724 PMCID: PMC5032152 DOI: 10.5114/wo.2015.54081] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 04/07/2015] [Indexed: 11/26/2022] Open
Abstract
Overall improvement in the nationwide system of medical services has consequently boosted the number of successfully treated patients who suffer from head and neck cancer. It is essential to effectively prevent development of radiation-induced caries as the late effect of radiation therapy. Incidence and severity of radiationinduced changes within the teeth individually vary depending on the patient's age, actual radiation dose, size of radiation exposure field, patient's general condition and additional risk factors. Inadequately managed treatment of caries may lead to loss of teeth, as well as prove instrumental in tangibly diminishing individual quality of life in patients. Furthermore, the need to have the teeth deemed unyielding or unsuitable for the application of conservative methods of treatment duly extracted is fraught for a patient with an extra hazard of developing osteoradionecrosis (ORN), while also increasing all attendant therapeutic expenditures. The present paper aims to offer some practical insights into currently available methods of preventing likely development of radiation-induced caries.
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170
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Patel V, Kelleher M, Sproat C, Kwok J, McGurk M. New cancer therapies and jaw necrosis. Br Dent J 2015; 219:203-7. [DOI: 10.1038/sj.bdj.2015.680] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 12/12/2022]
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171
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Chen JA, Wang CC, Wong YK, Wang CP, Jiang RS, Lin JC, Chen CC, Liu SA. Osteoradionecrosis of mandible bone in patients with oral cancer-associated factors and treatment outcomes. Head Neck 2015; 38:762-8. [DOI: 10.1002/hed.23949] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jyun-An Chen
- Department of Otolaryngology; Taichung Veterans General Hospital; Taichung Taiwan
| | - Chen-Chi Wang
- Department of Otolaryngology; Taichung Veterans General Hospital; Taichung Taiwan
- Faculty of Medicine; School of Medicine, National Yang-Ming University; Taipei Taiwan
| | - Yong-Kie Wong
- Department of Oral and Maxillofacial Surgery; Taichung Veterans General Hospital; Taichung Taiwan
| | - Ching-Ping Wang
- Department of Otolaryngology; Taichung Veterans General Hospital; Taichung Taiwan
| | - Rong-San Jiang
- Department of Otolaryngology; Taichung Veterans General Hospital; Taichung Taiwan
| | - Jin-Ching Lin
- Department of Radiation Oncology; Taichung Veterans General Hospital; Taichung Taiwan
- Faculty of Medicine; School of Medicine, National Yang-Ming University; Taipei Taiwan
| | - Chien-Chih Chen
- Department of Radiation Oncology; Taichung Veterans General Hospital; Taichung Taiwan
| | - Shih-An Liu
- Department of Otolaryngology; Taichung Veterans General Hospital; Taichung Taiwan
- Faculty of Medicine; School of Medicine, National Yang-Ming University; Taipei Taiwan
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172
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Ali R, Altaie A, Nattress B. Rehabilitation of oncology patients with hard palate defects. Part 1: The surgical planning phase. ACTA ACUST UNITED AC 2015; 42:326-8, 331-2, 335. [PMID: 26062257 DOI: 10.12968/denu.2015.42.4.326] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article is the first in a series of three papers that will discuss the conventional non-implant retained prosthodontic rehabilitation of oncology patients with surgically acquired hard palate defects. In this first paper, the dental challenges posed by the oncology patients will briefly be discussed. The interface between the specialist restorative dentist and the maxillofacial surgeon when planning the conventional dental rehabilitation of an oncology patient with a hard palate defect will be discussed in detail. Clinical Relevance: To highlight the importance of the restorative dentistry/surgical interface when planning a treatment for a patient requiring a maxillectomy and conventional obturation.
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173
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Nemec A, Arzi B, Hansen K, Murphy BG, Lommer MJ, Peralta S, Verstraete FJM. Osteonecrosis of the Jaws in Dogs in Previously Irradiated Fields: 13 Cases (1989-2014). Front Vet Sci 2015; 2:5. [PMID: 26664934 PMCID: PMC4672169 DOI: 10.3389/fvets.2015.00005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2015] [Accepted: 03/19/2015] [Indexed: 11/13/2022] Open
Abstract
The aim of this report was to characterize osteonecrosis of the jaws (ONJ) in previously irradiated fields in dogs that underwent radiotherapy (RT) for oral tumors. Osteoradionecrosis of the jaw (ORNJ) was further defined as osteonecrosis in a previously irradiated field in the absence of a tumor. Thirteen dogs clinically diagnosed with 15 ONJ lesions were included in this retrospective case series. Medical records were reviewed for: breed, sex, weight, and age of the patient, tumor type, location in the oral cavity and size, location of the ONJ, time from RT to ONJ onset, known duration of the ONJ, and tumor presence. Where available, histological assessment of tissues obtained from the primary tumor, and tissues obtained from the ONJ lesion, was performed, and computed tomographic (CT) images and dental radiographs were reviewed. RT and other treatment details were also reviewed. Twelve dogs developed ONJ in the area of the previously irradiated tumor or the jaw closest to the irradiated mucosal tumor. Recurrence of neoplasia was evident at the time of ONJ diagnosis in five dogs. Time from RT start to ONJ onset varied from 2 to 44 months. In three cases, ORNJ developed after dental extractions in the irradiated field. Dental radiographs mostly revealed a moth-eaten pattern of bone loss, CT mostly revealed osteolysis, and histopathology was consistent with osteonecrosis. To conclude, development of ONJ/ORNJ following RT is a rare, but potentially fatal complication. Patients undergoing RT may benefit from a comprehensive oral and dental examination and treatment prior to RT.
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Affiliation(s)
- Ana Nemec
- Clinic for Surgery and Small Animals, Veterinary Faculty, University of Ljubljana , Ljubljana , Slovenia ; Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California at Davis , Davis, CA , USA
| | - Boaz Arzi
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California at Davis , Davis, CA , USA
| | - Katherine Hansen
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California at Davis , Davis, CA , USA
| | - Brian G Murphy
- Department of Pathology, Microbiology and Immunology, School of Veterinary Medicine, University of California at Davis , Davis, CA , USA
| | - Milinda J Lommer
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California at Davis , Davis, CA , USA ; Aggie Animal Dental Center , Mill Valley, CA , USA
| | - Santiago Peralta
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University , Ithaca, NY , USA
| | - Frank J M Verstraete
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California at Davis , Davis, CA , USA
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175
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Arnež ZM, Novati FC, Ramella V, Papa G, Biasotto M, Gatto A, Bonini P, Tofanelli M, Tirelli G. How we fix free flaps to the bone in oral and oropharyngeal reconstructions. Am J Otolaryngol 2015; 36:166-72. [PMID: 25467297 DOI: 10.1016/j.amjoto.2014.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 10/12/2014] [Accepted: 10/13/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE The use of suture anchors has been described in orthopedic, hand, oculoplastic, temporomandibular joint and in aesthetic surgery, but no study reports the use of the Mitek® anchors (Depuy Mitek Surgical Products, Inc. Raynham, Massachusetts) for fixing the free flaps used in oncologic oral and oropharyngeal reconstruction. MATERIALS AND METHODS In this prospective non-randomized study, 9 patients underwent surgical resection of oral or oropharyngeal cancer followed by a free flap reconstruction; mini anchors were used to fix the flap directly to the bone. We collected data regarding the patients, the tumor stage, the surgical procedure, the radiotherapy and the number of anchors used. RESULTS The average follow-up was 28months (range 24-38).We observed no complications with trans-oral, sub-mandibular and trans-mandibular approach in both oral and oropharyngeal reconstructions. All anchors became osteo-integrated and no complications occurred after radiotherapy. CONCLUSIONS In our opinion this device favors free flap adhesion to the bone. We registered no postoperative complications related to the use of the device which looks suitable for use in irradiated tissues. The radiotherapy did not cause any long-term complications related to the use of Mitek® mini bone anchors.
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176
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Zhou Z, Fan W, Lang M, Wang Y. Transdermal bFGF delivery using low-frequency sonophoresis: An innovative potential therapy for osteoradionecrosis of jaws. JOURNAL OF MEDICAL HYPOTHESES AND IDEAS 2015. [DOI: 10.1016/j.jmhi.2014.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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177
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Schuurhuis JM, Stokman MA, Witjes MJ, Dijkstra PU, Vissink A, Spijkervet FK. Evidence supporting pre-radiation elimination of oral foci of infection in head and neck cancer patients to prevent oral sequelae. A systematic review. Oral Oncol 2015; 51:212-20. [DOI: 10.1016/j.oraloncology.2014.11.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/20/2014] [Accepted: 11/24/2014] [Indexed: 10/24/2022]
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178
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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; 218:65-8. [DOI: 10.1038/sj.bdj.2015.28] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 11/09/2022]
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179
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Jawad H, Hodson NA, Nixon PJ. A review of dental treatment of head and neck cancer patients, before, during and after radiotherapy: part 2. Br Dent J 2015; 218:69-74. [DOI: 10.1038/sj.bdj.2015.29] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2014] [Indexed: 11/09/2022]
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180
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Tahir ARM, Westhuyzen J, Dass J, Collins MK, Webb R, Hewitt S, Fon P, McKay M. Hyperbaric oxygen therapy for chronic radiation-induced tissue injuries: Australasia's largest study. Asia Pac J Clin Oncol 2014; 11:68-77. [PMID: 25382755 DOI: 10.1111/ajco.12289] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2014] [Indexed: 12/26/2022]
Abstract
AIM Chronic radiation injuries, although uncommon, are associated with poor quality of life in oncology patients. The present study assesses the efficacy and safety of hyperbaric oxygen therapy in the management of chronic radiation-induced tissue injuries. METHODS A retrospective analysis was performed in 276 consecutive patients treated with hyperbaric oxygen therapy for chronic radiation-induced tissue injuries at the Hyperbaric Medicine Unit, Townsville, Queensland, between March 1995 and March 2008. Of these patients, 189 (68%) had complete follow-up data and were assessed. RESULTS A total of 265 events of chronic radiation tissue injury were experienced by the 189 patients treated with hyperbaric oxygen therapy. Osteoradionecrosis prophylaxis due to radiation-induced dental disease had an overall response rate of 96% (P=0.00003; Wilcoxon matched-pairs signed-rank test). The overall response rates for established osteoradionecrosis of mandible, soft tissue necrosis of head and neck, and xerostomia were 86% (P=0.00001), 85% (P=0.002) and 64% (P=0.0001), respectively. The overall response rates for soft tissue necrosis at other sites, chronic radiation proctitis and hemorrhagic cystitis were 84% (P=0.03), 95% (P=0.0001) and 85% (P=0.03), respectively. The total complication rate after hyperbaric oxygen therapy was 15.9%, comprising reversible ear barotrauma (10.6%), reversible ocular barotrauma (4.2%), dental complications (0.5%) and myocardial infarction (0.5%). CONCLUSION Our study demonstrates that hyperbaric oxygen therapy can be effectively used in a variety of chronic radiation-induced tissue injuries; its favorable risk profile suggests it should be considered for patients with radiation-induced tissue injuries.
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Affiliation(s)
- Abdul Rahim Mohd Tahir
- Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia; North Coast Cancer Institute, Coffs Harbour, Australia
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Fan H, Kim SM, Cho YJ, Eo MY, Lee SK, Woo KM. New approach for the treatment of osteoradionecrosis with pentoxifylline and tocopherol. Biomater Res 2014; 18:13. [PMID: 26331064 PMCID: PMC4552457 DOI: 10.1186/2055-7124-18-13] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 09/12/2014] [Indexed: 12/26/2022] Open
Abstract
Osteoradionecrosis (ORN) of the jaw is a significant complication of radiotherapy for oral cavity cancer. In addition to antibiotic medication, treatment options such as hyperbaric oxygen therapy, surgical approaches, and combined therapy with pentoxifylline and tocopherol have been recently introduced. In this review article, we will discuss the definition and classifications of osteoradionecrosis, its etiology and pathophysiology, previous treatment options, oral and maxillofacial complications of radiotherapy, basic information on pentoxifylline and tocopherol, recent reports of pentoxifylline and tocopherol combined therapy, and, finally, ORN-induced animal models and future approaches.
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Affiliation(s)
- Huan Fan
- />Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 62-1 Changgyeonggungno, Jongno-gu, Seoul, 110-768 South Korea
| | - Soung Min Kim
- />Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 62-1 Changgyeonggungno, Jongno-gu, Seoul, 110-768 South Korea
| | - Yun Ju Cho
- />Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 62-1 Changgyeonggungno, Jongno-gu, Seoul, 110-768 South Korea
| | - Mi Young Eo
- />Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, 62-1 Changgyeonggungno, Jongno-gu, Seoul, 110-768 South Korea
| | - Suk Keun Lee
- />Department of Oral Pathology, College of Dentistry, Gangneung-Wonju National University, Gangneung, South Korea
| | - Kyung Mi Woo
- />Department of Dental Pharmacology & Therapeutics, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, South Korea
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Bryce G, Bomfim DI, Bassi GS. Pre- and post-operative management of dental implant placement. Part 2: management of early-presenting complications. Br Dent J 2014; 217:171-6. [DOI: 10.1038/sj.bdj.2014.702] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2014] [Indexed: 11/09/2022]
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Jiang YM, Zhu XD, Qu S. Incidence of osteoradionecrosis in patients who have undergone dental extraction prior to radiotherapy: A systematic review and meta-analysis. JOURNAL OF ORAL AND MAXILLOFACIAL SURGERY MEDICINE AND PATHOLOGY 2014. [DOI: 10.1016/j.ajoms.2014.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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185
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Dewan K, Kelly RD, Bardsley P. A national survey of consultants, specialists and specialist registrars in restorative dentistry for the assessment and treatment planning of oral cancer patients. Br Dent J 2014; 216:E27. [DOI: 10.1038/sj.bdj.2014.544] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2013] [Indexed: 11/09/2022]
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186
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Ray-Chaudhuri A, Shah K, Porter RJ. The oral management of patients who have received radiotherapy to the head and neck region. Br Dent J 2014; 214:387-93. [PMID: 23619856 DOI: 10.1038/sj.bdj.2013.380] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2012] [Indexed: 01/22/2023]
Abstract
Several thousand patients are diagnosed annually with head and neck cancer (HANC) in the United Kingdom. This represents a significant proportion of all cancers that are diagnosed and a common treatment modality for this is radiotherapy to the head and neck region. Radiotherapy can be highly successful in managing HANC but also has several side-effects in the oral cavity and associated structures. These sequelae present considerable short and long-term problems for dental professionals involved in the care of HANC suffers.
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Affiliation(s)
- A Ray-Chaudhuri
- Restorative Dentistry, St George's Hospital, London, SW17 OQT, UK
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187
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Hoggan BL, Cameron AL. Systematic review of hyperbaric oxygen therapy for the treatment of non-neurological soft tissue radiation-related injuries. Support Care Cancer 2014; 22:1715-26. [PMID: 24794980 DOI: 10.1007/s00520-014-2198-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 03/02/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE The purpose of this paper was to provide an evidence-based evaluation of the safety and effectiveness of hyperbaric oxygen therapy (HBOT) for the treatment of non-neurological soft tissue radiation-related injuries (STRI). METHODS Systematic searches of medical bibliographic databases, the Internet, and lists of references were conducted in December 2010 and April 2013 to identify relevant primary studies. Inclusion and classification of papers was resolved through the application of a predetermined protocol. Information on both the safety and effectiveness of HBOT was analyzed. RESULTS Forty-one articles were included, with 11 comparing HBOT to a regimen without HBOT. Comparative evidence varied considerably in methodological quality, and numerous limitations were identified. Absolute data showed that serious adverse events after HBOT were rare, while more common adverse events were minor and self-limiting. Compared to observation, conventional, or sham therapies, evidence of benefit in clinical outcomes was shown for HBOT for radiation proctitis and wounds in irradiated soft tissue of the head and neck, but not for postirradiation soft tissue edema or radiation cystitis. Clinical outcomes differed little between HBOT and argon plasma coagulation for radiation proctitis and between HBOT and hyaluronic acid for radiation cystitis. CONCLUSIONS HBOT is a safe intervention which may offer clinical benefits to patients suffering from radiation proctitis and non-neurological STRI of the head and neck. However, differing clinical responses across STRI demonstrate a need for further well-designed clinical trials to validate the use of HBOT for individual STRI, both as an adjunct to conventional treatments and relative to definitive treatments.
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Affiliation(s)
- Benjamin L Hoggan
- Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S), Royal Australasian College of Surgeons, 199 Ward Street, North Adelaide, 5006, SA, Australia
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188
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Discussion. Plast Reconstr Surg 2014; 133:322e-323e. [DOI: 10.1097/prs.0000000000000038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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189
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Beech N, Robinson S, Porceddu S, Batstone M. Dental management of patients irradiated for head and neck cancer. Aust Dent J 2014; 59:20-8. [PMID: 24495127 DOI: 10.1111/adj.12134] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2013] [Indexed: 12/12/2022]
Abstract
Patients undergoing radiation therapy as either primary, adjuvant, combination therapy or palliative management of head and neck malignancies are prone to a range of dental complications. Strategies for prevention and management of such complications may be controversial. This article aims to highlight the current understanding and management of the dental needs for patients before, during and after radiation therapy.
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Affiliation(s)
- N Beech
- Royal Brisbane and Women's Hospitals, The University of Queensland
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190
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Clinical Practice Statements and the American Academy of Oral Medicine. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:129-31. [DOI: 10.1016/j.oooo.2013.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
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191
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Histomorphometric evaluation of the effect of systemic and topical ozone on alveolar bone healing following tooth extraction in rats. Int J Oral Maxillofac Surg 2014; 43:777-83. [PMID: 24491848 DOI: 10.1016/j.ijom.2013.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 11/28/2013] [Accepted: 12/30/2013] [Indexed: 01/07/2023]
Abstract
The aim of this study was to investigate the effects of systemic and topical ozone applications on alveolar bone healing following tooth extraction. One hundred and twelve male Wistar rats were divided into eight groups of 14 rats each; seven groups were experimental (A-G) and one formed the control group (K). The experimental groups were further divided into two sub-groups, with seven rats in each - sacrificed on days 14 and 28 (subgroups 1 and 2). The maxillary right central incisors were extracted under general anaesthesia following the administration of local anaesthesia. After sacrifice, semi-serial histological sections were prepared, and mineralized and trabecular bone and osteoid and osteoblast surfaces were measured. Measurements of the trabecular bone showed statistically higher values in the groups treated with systemic ozone (D(2): 50.01 ± 2.12; E(2): 49.03 ± 3.03; F(2): 48.76 ± 2.61; G(2): 50.24 ± 3.37) than in the groups that underwent topical ozone administration (A(2): 46.01 ± 3.07; B(2): 46.79 ± 3.09; C(2): 47.07 ± 2.12; P = 0.030 (G(2)-A(2), G(2)-B(2), G(2)-C(2))). Within the limitations of the current study, it may be concluded that postoperative long-term systemic ozone application can accelerate alveolar bone healing following extraction. However, additional studies are required to clarify the effects of the different ozone applications on new bone formation.
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192
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Helmers R, Milstein DMJ, van Hulst RA, de Lange J. Hyperbaric oxygen therapy accelerates vascularization in keratinized oral mucosal surgical flaps. Head Neck 2013; 36:1241-7. [PMID: 23913629 DOI: 10.1002/hed.23437] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2012] [Revised: 05/16/2013] [Accepted: 07/24/2013] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Hyperbaric oxygen therapy (HBOT) is thought to promote vascular regeneration in wounds. The purpose of this study was to investigate the role of HBOT in advancing vascular regeneration in healing oral mucosal surgical flaps. METHODS A palatine partial-thickness mucosal flap was raised in 10 male-specific pathogen-free New Zealand White rabbits. Randomized into 2 groups of 5 animals each (control and HBOT), functional capillary density was measured preoperatively (baseline), and immediately postoperatively until day 21 using sidestream dark-field video microscopy. Ten HBOT sessions were administered over the course of 2 weeks at 2.5 atmospheres (2.5 bar O2 /90 minutes). RESULTS Repeated measures analysis of variance was used to compare the HBOT and control group on the sequential functional capillary density measurements. A significant interaction effect was present between time and group (F [8, 64] = 9.60; p < .0001) resulting from a significant increase in microcirculation in the HBOT group relative to the control group on days 7, 9, and 11. CONCLUSION Our results suggest that HBOT is capable of advancing wound vascular regeneration in healing keratinized oral mucosal flaps.
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Affiliation(s)
- Renée Helmers
- Department of Oral and Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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193
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Beadle BM, Liao KP, Chambers MS, Elting LS, Buchholz TA, Kian Ang K, Garden AS, Guadagnolo BA. Evaluating the impact of patient, tumor, and treatment characteristics on the development of jaw complications in patients treated for oral cancers: a SEER-Medicare analysis. Head Neck 2013; 35:1599-605. [PMID: 23150453 DOI: 10.1002/hed.23205] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2012] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Jaw complications, including osteoradionecrosis, are significant sequelae of radiation therapy (RT) for oral cancers. This study identifies the impact of patient, tumor, and treatment characteristics on the development of jaw complications in patients treated with RT. METHODS The Surveillance, Epidemiology, and End Results (SEER)-Medicare database was used to identify patients treated with RT for oral cancers from 1999 to 2007. Jaw complications were identified by International Classification of Diseases 9th revision (ICD-9) diagnosis codes and/or related procedures using Current Procedural Terminology (CPT) and ICD-9 codes. RESULTS A total of 1848 patients were identified. With a median follow-up of 2.5 years, 297 patients (16.1%) developed jaw complications: 226 patients had a diagnosis, 41 patients had a procedure, and 30 patients had both. On multivariate analysis, female sex, lack of chemotherapy use, and fewer comorbidities were associated with a statistically significant increase in jaw complications. CONCLUSIONS Even with modern techniques, jaw complications are a notable and potentially devastating side effect of RT for oral cancers.
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Affiliation(s)
- Beth M Beadle
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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194
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Zaghi S, Danesh J, Hendizadeh L, Nabili V, Blackwell KE. Changing indications for maxillomandibular reconstruction with osseous free flaps: A 17-year experience with 620 consecutive cases at UCLA and the impact of osteoradionecrosis. Laryngoscope 2013; 124:1329-35. [DOI: 10.1002/lary.24383] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/21/2013] [Accepted: 08/05/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Soroush Zaghi
- Department of Head and Neck Surgery; David Geffen School of Medicine at UCLA; Los Angeles California U.S.A
| | - Jennifer Danesh
- Department of Head and Neck Surgery; David Geffen School of Medicine at UCLA; Los Angeles California U.S.A
| | - Leenoy Hendizadeh
- Department of Head and Neck Surgery; David Geffen School of Medicine at UCLA; Los Angeles California U.S.A
| | - Vishad Nabili
- Department of Head and Neck Surgery; David Geffen School of Medicine at UCLA; Los Angeles California U.S.A
| | - Keith E. Blackwell
- Department of Head and Neck Surgery; David Geffen School of Medicine at UCLA; Los Angeles California U.S.A
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195
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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. [PMID: 24025531 PMCID: PMC3847525 DOI: 10.1186/1916-0216-42-46] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2012] [Accepted: 09/02/2013] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Osteoradionecrosis (ORN) defines exposed irradiated bone, which fails to heal over a period of 3-6 months without evidence of residual or recurrent tumor. In the previous decades, a staging and treatment protocol suggested by Marx, has dominated the approach to ORN. However, recently this paradigm is shifting. The purpose of this study was to evaluate our institutional experience in managing ORN through a retrospective review of case series from a large urban academic cancer centre. METHODS A retrospective chart review was conducted to include all ORN cases from 2003 to 2009 diagnosed at the Department of Otolaryngology - Head and Neck Surgery and the Department of Dentistry. The staging of ORN was assessed as affected by tumor site, tumor stage, radiotherapy modality and dose, chemotherapy, dental work, and time to diagnosis. The effectiveness of hyperbaric oxygen therapy (HBO) and surgery in the management of ORN was evaluated. RESULTS Fourteen cases of ORN were documented (incidence 0.84%). Primary subsites included tonsils, tongue, retromolar trigone, parotid gland, soft palate and buccal mucosa. There were 5 (35.7%) stage 1, 3 (21.4%) stage 2, and 6 (42.9%) stage 3 cases. ORN severity was not significantly associated with gender, smoking, alcohol use, tumor site, T stage, N stage, AJCC stage, or treatment modality (radiation alone, surgery with adjuvant radiation or adjuvant chemoradiation). Patients treated with intensity-modulated radiotherapy developed less severe ORN compared to those treated with conventional radiotherapy (p < 0.015). ORN stage did not correlate with radiation dose. In one patient only dental procedures were performed following radiation and could be implicated as the cause of ORN. HBO therapy failed to prevent ORN progression. Surgical treatment was required for most stage 2 (partial resections and free tissue transfers) and stage 3 patients (mandibulectomies and free tissue transfers, including two flaps in one patient). At an average follow up of 26 months, all patients were cancer-free, and there was no evidence of ORN in 84% of patients. CONCLUSIONS In early ORN, we advocate a conservative approach with local care, while reserving radical resections with robust reconstruction with vascularized free tissue for advanced stages.
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Affiliation(s)
- Artur Gevorgyan
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M1-102, Toronto, ON, M4N 3M5, Canada
| | - Kevin Wong
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M1-102, Toronto, ON, M4N 3M5, Canada
| | - Ian Poon
- Department of Radiation Oncology, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M1-102, Toronto, ON, M4N 3M5, Canada
| | - Nick Blanas
- Department of Dentistry, Sunnybrook Health Sciences Centre and Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | - Danny J Enepekides
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M1-102, Toronto, ON, M4N 3M5, Canada
| | - Kevin M Higgins
- Department of Otolaryngology - Head and Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Room M1-102, Toronto, ON, M4N 3M5, Canada
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196
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de Menezes B, de Souza Noronha V, Carvalho A, da Silva Freire A, Jham B. Incidence of osteoradionecrosis following oral and maxillofacial surgery in irradiated head and neck cancer patients. ACTA ACUST UNITED AC 2013. [DOI: 10.1111/ors.12054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
| | | | | | | | - B.C. Jham
- College of Dental Medicine - Illinois; Midwestern University; Downers Grove IL USA
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197
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Bascones-Martínez A, Muñoz-Corcuera M, Gómez-Font R. [Oral secondary effects of radiotherapy and chemotherapy in cancer of the cervicofacial region]. Med Clin (Barc) 2013; 141:77-81. [PMID: 23664688 DOI: 10.1016/j.medcli.2013.03.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Revised: 03/15/2013] [Accepted: 03/21/2013] [Indexed: 10/26/2022]
Affiliation(s)
- Antonio Bascones-Martínez
- Departamento de Medicina y Cirugía Bucofacial, Facultad de Odontología, Universidad Complutense de Madrid, Madrid, España.
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198
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Anedda T, Serioli L, Clivio A, Rossi A, Chiapasco M. Iter diagnostico per la diagnosi delle lesioni radiotrasparenti dei mascellari. DENTAL CADMOS 2013. [DOI: 10.1016/s0011-8524(13)70050-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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199
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Ray-Chaudhuri A, Shah K, Porter RJ. Radiotherapy: Oral management of patients who have received radiotherapy to the head and neck region. ACTA ACUST UNITED AC 2013. [DOI: 10.1038/vital1650] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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200
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Tanaka TI, Chan HL, Tindle DI, Maceachern M, Oh TJ. Updated clinical considerations for dental implant therapy in irradiated head and neck cancer patients. J Prosthodont 2013; 22:432-8. [PMID: 23388045 DOI: 10.1111/jopr.12028] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2012] [Indexed: 11/29/2022] Open
Abstract
An increasing number of reports indicate successful use of dental implants (DI) during oral rehabilitation for head and neck cancer patients undergoing tumor surgery and radiation therapy. Implant-supported dentures are a viable option when patients cannot use conventional dentures due to adverse effects of radiation therapy, including oral dryness or fragile mucosa, in addition to compromised anatomy; however, negative effects of radiation, including osteoradionecrosis, are well documented in the literature, and early loss of implants in irradiated bone has been reported. There is currently no consensus concerning DI safety or clinical guidelines for their use in irradiated head and neck cancer patients. It is important for health care professionals to be aware of the multidimensional risk factors for these patients when planning oral rehabilitation with DIs, and to provide optimal treatment options and maximize the overall treatment outcome. This paper reviews and updates the impact of radiotherapy on DI survival and discusses clinical considerations for DI therapy in irradiated head and neck cancer patients.
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Affiliation(s)
- Takako Imai Tanaka
- Department of Biomedical & Diagnostic Sciences, University of Detroit Mercy School of Dentistry, Detroit, MI, USA.
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