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Tadokoro Y, Hasegawa T, Takeda D, Murakami A, Yatagai N, Iwata E, Saito I, Kusumoto J, Akashi M. Factors Associated with Treatment Outcomes and Pathological Features in Patients with Osteoradionecrosis: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19116565. [PMID: 35682149 PMCID: PMC9180928 DOI: 10.3390/ijerph19116565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/19/2022] [Accepted: 05/26/2022] [Indexed: 12/10/2022]
Abstract
A standard treatment for osteoradionecrosis (ORN) has not yet been established because of the diversity. Therefore, identifying the risk factors for a poor prognosis is essential. This study retrospectively investigated the factors associated with the prognosis of ORN in 68 patients. Relevant clinical data of all patients were obtained. Of the patients, 16 who underwent extensive surgery underwent histopathological analysis. The necrotic changes of the anterior and posterior margins in the cortical and cancellous bones were investigated. Multivariate analyses showed statistically significant associations between poor prognosis in patients with ORN and high radiation dose (hazard ratio [HR] 1.15), orocutaneous fistula (HR 2.93), and absence of sequestration (HR 2.49). Histopathological analysis showed a viable anterior margin of the middle portion of the cortical bone for all recovered cases; in contrast, most cases (75%) with a poor prognosis showed necrotic changes. The anterior margin of the cancellous bone was viable and resilient to high irradiation, regardless of the prognosis. These results suggest that patients with orocutaneous fistula should receive early surgical intervention, even if the affected area is limited or asymptomatic. In extensive surgery, a sufficient safety margin of necrotic bone, particularly in the anterior region, is required to improve the prognosis.
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The Potential Therapeutic Role of Mesenchymal Stem Cells-Derived Exosomes in Osteoradionecrosis. JOURNAL OF ONCOLOGY 2021; 2021:4758364. [PMID: 34899907 PMCID: PMC8660232 DOI: 10.1155/2021/4758364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/07/2021] [Accepted: 11/12/2021] [Indexed: 02/05/2023]
Abstract
As one of the most serious complications of radiotherapy, osteoradionecrosis (ORN) seriously affects the quality of life of patients and even leads to death. Vascular injury and immune disorders are the main causes of bone lesions. The traditional conservative treatment of ORN has a low cure rate and high recurrent. Exosomes are a type of extracellular bilayer lipid vesicles secreted by almost all cell types. It contains cytokines, proteins, mRNA, miRNA, and other bioactive cargos, which contribute to several distinct processes. The favorable biological functions of mesenchymal stem cells-derived exosomes (MSC exosomes) include angiogenesis, immunomodulation, bone regeneration, and ferroptosis regulation. Exploring the characteristic of ORN and MSC exosomes can promote bone regeneration therapies. In this review, we summarized the current knowledge of ORN and MSC exosomes and highlighted the potential application of MSC exosomes in ORN treatment.
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Rosenfeld E, Eid B, Masri D, Popovtzer A, Mizrachi A, Chaushu G. Is the Risk to Develop Osteoradionecrosis of the Jaws Following IMRT for Head and Neck Cancer Related to Co-Factors? MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57050468. [PMID: 34064551 PMCID: PMC8151551 DOI: 10.3390/medicina57050468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 04/26/2021] [Accepted: 04/28/2021] [Indexed: 11/18/2022]
Abstract
Background and Objectives: Determine the contribution of coexisting factors to the risk to develop Osteoradionecrosis (ORN) of the jaws among patients who have received radiotherapy by intensity modulated radiation therapy (IMRT) for head and neck cancer (HNC) between 2013 and 2016, in a single medical center. Materials and Methods: The records of all patients treated with IMRT for HNC between 2013 and 2016 in The Davidoff Center for the treatment and Research of Cancer in Rabin Medical Center—Beilinson hospital, Petah-Tikva, Israel were screened. Patients who have received a minimum mean dose of 40 Gy to the oral cavity entered the research and their medical records were retrospectively reviewed. Collected background data included: age, gender, smoking, diabetes mellitus (DM), ASA score, mean and maximal radiation doses (Gy), and diseases characteristics including histological diagnosis, primary tumor site, and disease stage. Results: A total of 1232 patients were surveyed. Out of all screened patients, 93 received a minimum mean dose of 40 Gy to the oral cavity. Out of the 93 patients, 7 (7.52%) developed ORN (ORN+) and 86 did not develop ORN (ORN−). Tumor type in all seven patients in the ORN+ group was Squamous Cell Carcinoma (SCC). In three out of those seven patients (42.9%), the tumor was located in the mandible. Conclusions: within the limits of the relatively small cohort in the current study, we suggest that the development of ORN due to Radiation therapy (RT) with IMRT is related significantly only to the location of a tumor in the mandible. Other co-factors do not significantly increase the risk to develop ORN when RT is delivered via IMRT.
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Affiliation(s)
- Eli Rosenfeld
- Department of Oral & Maxillofacial Surgery, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel; (D.M.); (G.C.)
- Correspondence: ; Tel.: +972-50-7904090
| | - Bassel Eid
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6997801, Israel;
| | - Daya Masri
- Department of Oral & Maxillofacial Surgery, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel; (D.M.); (G.C.)
| | - Aron Popovtzer
- Sharett Institute of Oncology, Hadassah Medical Center, Jerusalem 9574401, Israel;
| | - Aviram Mizrachi
- Department of Otorhinolaryngology—Head and Neck Surgery, Rabin Medical Center, Petah Tikva 4941492, Israel;
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Gavriel Chaushu
- Department of Oral & Maxillofacial Surgery, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel; (D.M.); (G.C.)
- Department of Oral and Maxillofacial Surgery, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
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Is Adjunctive Hyperbaric Oxygen Treatment Alone or with Surgery the Proper Management for Active and Persistent Osteoradionecrosis? Adv Skin Wound Care 2021; 34:1-4. [PMID: 33443917 DOI: 10.1097/01.asw.0000725164.18431.a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT This study enrolled patients with stage 3 osteoradionecrosis. There were three treatment modalities: antibiotics, hyperbaric oxygen therapy (HBOT), and surgery. Complete healing was the primary outcome. Multiple logistic regression analysis demonstrated that surgery with HBOT improved wound healing better than HBOT alone.
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Renda L, Tsai TY, Huang JJ, Ito R, Hsieh WC, Kao HK, Hung SY, Huang Y, Huang YC, Chang YL, Cheng MH, Chang KP. A nomogram to predict osteoradionecrosis in oral cancer after marginal mandibulectomy and radiotherapy. Laryngoscope 2019; 130:101-107. [PMID: 30786034 DOI: 10.1002/lary.27870] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/15/2019] [Accepted: 01/25/2019] [Indexed: 11/10/2022]
Abstract
OBJECTIVE There is no useful tool to clinically predict the occurrence of osteoradionecrosis (ORN) of the mandible quantitatively. The aim was to investigate the risk factors, including different modalities of radiotherapy, for developing mandibular ORN in patients undergoing marginal mandibulectomy and postoperative radiotherapy. METHODS Between January 2006 and December 2012, 167 subjects who underwent marginal mandibulectomy and postoperative radiotherapy with different modalities were enrolled. The association of ORN with mandibular bone measurements and patient variables was analyzed, and a nomogram was established. RESULTS Fifteen (8.98%) of the 167 patients developed ORN during the follow-up period, and ORN was significantly associated with diabetes mellitus (DM), body mass index (BMI), remaining bone height, remaining bone height to original bone height ratio, resected bone height to original bone height ratio, and mandibular dose (P: < 0.001, 0.004, 0.042, 0.018, 0.010, 0.020, respectively). Interestingly, the risk of ORN had no significant difference between conformal and intensity modulation radiation therapy (P = 0.407). Multivariate analysis revealed that DM and resected bone height to original bone height ratio ≥ 50% were independent risk factors for postoperative ORN. A nomogram consisting of BMI, DM, resected bone height to original bone height ratio, mandibulotomy, and mandibular dose for predicting the ORN-free probability was established; and the c-index of the nomogram for ORN status was 0.803. CONCLUSION A nomogram based on the risk factors was plotted to strengthen the prediction of ORN quantitatively. Surgeons should be more discrete regarding the treatment plan for patients with higher probability of ORN. LEVEL OF EVIDENCE 3b Laryngoscope, 130:101-107, 2020.
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Affiliation(s)
- Levent Renda
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Antalya Research and Education Hospital, Antalya, Turkey
| | - Tsung-You Tsai
- Department of Pathology, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan
| | - Jung-Ju Huang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ran Ito
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan
| | - Wei-Chuan Hsieh
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan
| | - Huang-Kai Kao
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shao-Yu Hung
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan
| | - Yenlin Huang
- Department of Pathology, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan
| | - Yu-Chen Huang
- Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan
| | - Yu-Liang Chang
- Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan
| | - Ming-Huei Cheng
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Kai-Ping Chang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Kwei-Shan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Jenwitheesuk K, Mahakkanukrauh A, Punjaruk W, Jenwitheesuk K, Chowchuen B, Jinaporntham S, Uraiwan K, Limrattanapimpa P. Efficacy of Adjunctive Hyperbaric Oxygen Therapy in Osteoradionecrosis. Biores Open Access 2018; 7:145-149. [PMID: 30310729 PMCID: PMC6178923 DOI: 10.1089/biores.2018.0019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Osteoradionecrosis (ORN) is a common consequence resulting from radiation in patients with cancer. Presently, hyperbaric oxygen therapy (HBOT) is proposed to have a role in improving wound healing in ORN patients. There is no strong scientific evidence to confirm the benefits of HBOT for treatment of ORN as an adjunctive treatment. This study aimed to determine the benefits of adjunctive treatment of HBOT in ORN. A retrospective study was conducted at the Srinagarind Hospital, the Faculty of Medicine, Khon Kaen University, Thailand, between 2011 and 2017. The patients diagnosed with ORN, who received adjunctive HBOT before the operation, were enrolled. Complete healing of wounds was the primary outcome. There were 84 ORN patients with a mean age of 58.78 years; 54.76% were male and 45.24% were female. HBOT had a role significant in improving wound healing of ORN patients with stages 1 and 2. Poisson regression analysis showed that stage 3 of ORN negatively correlated with the number of HBOT dives (p = 0.001, incidence rates ratio = 0.85). In conclusion, HBOT improved wound healing of ORN patients with stages 1 and 2. In addition, stage 2 of ORN patients significantly required the highest number of HBOT dives compared to other types of ORN to promote wound healing, whereas stage 3 patients, who underwent bone debridement combined with HBOT, initiated to success of treatment process and required a smaller number of dives.
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Affiliation(s)
- Kamonwan Jenwitheesuk
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Ajanee Mahakkanukrauh
- Division of Allergy-Immunology-Rheumatology, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Wiyada Punjaruk
- Department of Physiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Kriangsak Jenwitheesuk
- General Surgery Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.,Sleep Apnea Research Group, Research Center in Back, Neck and Other Joint Pain and Human Performance, Khon Kaen University, Khon Kaen, Thailand
| | - Bowornsilp Chowchuen
- Plastic and Reconstructive Surgery Unit, Department of Surgery, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Suthin Jinaporntham
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Krittinant Uraiwan
- Department of Dental, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Phasuk Limrattanapimpa
- Hospital Hyperbaric Oxygen Therapy Unit, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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Chronopoulos A, Zarra T, Ehrenfeld M, Otto S. Osteoradionecrosis of the jaws: definition, epidemiology, staging and clinical and radiological findings. A concise review. Int Dent J 2017. [PMID: 28649774 DOI: 10.1111/idj.12318] [Citation(s) in RCA: 126] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Osteoradionecrosis (ORN) of the jaws is a pernicious complication of radiation therapy for head and neck tumours. This article aims to provide an update on data related to the definition, epidemiology, staging, and clinical and radiological findings of ORN of the jaws. Using certain keywords, an electronic search was conducted spanning the period from January 1922 to April 2014 to identify the available related investigations. Pooled data were then analysed. ORN is described as exposed irradiated bone that fails to heal over a period of 3 months without evidence of persisting or recurrent tumour. The prevalence of ORN varies in the literature. Several staging or scoring systems of ORN have been proposed. Clinical findings include ulceration or necrosis of the mucosa with exposure of necrotic bone. Radiological findings are not evident in the early stages of ORN. Furthermore ORN may not be apparent in imaging even when the disease is advanced. Taking into account the severity of ORN and the difficulties in diagnosing it early and accurately, the clinician should be aware of this complex entity in order to prevent its appearance or the development of more severe complications.
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Affiliation(s)
- Aristeidis Chronopoulos
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Theodora Zarra
- Department of Endodontology, Dental School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Michael Ehrenfeld
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Sven Otto
- Department of Oral and Maxillofacial Surgery, Ludwig-Maximilians-University of Munich, Munich, Germany
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Dhanda J, Pasquier D, Newman L, Shaw R. Current Concepts in Osteoradionecrosis after Head and Neck Radiotherapy. Clin Oncol (R Coll Radiol) 2016; 28:459-66. [PMID: 27038708 DOI: 10.1016/j.clon.2016.03.002] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 03/01/2016] [Accepted: 03/10/2016] [Indexed: 11/17/2022]
Abstract
Osteoradionecrosis (ORN) of the jaws is a feared complication of head and neck radiotherapy. ORN causes significant morbidity for patients and controversy among clinicians. This overview considers the variations in definition and classification of the condition that affect estimates of incidence and also the interpretation of evidence. The influence of newer radiotherapy techniques in reducing ORN through reduced dose and xerostomia is balanced against a probable increase in a vulnerable population through a rising head and neck cancer incidence. Theories of pathophysiology of ORN include radiation-induced osteomyelitis, hypoxic and hypovascular theory and fibroatrophic theory. Prevention strategies include restorative dentistry and radiation planning techniques. Treatments range from conservative 'watch and wait' through to more radical surgical strategies. Newer medical management strategies are available with a limited evidence base. The use of hyperbaric oxygen therapy remains controversial and the background and need for newer hyperbaric oxygen trials is discussed.
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Affiliation(s)
- J Dhanda
- Department of Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, UK.
| | - D Pasquier
- Academic Department of Radiation Oncology, Centre O. Lambret, Lille, CRIStAL UMR CNRS 9189, France
| | - L Newman
- Department of Maxillofacial Surgery, Queen Victoria Hospital, East Grinstead, UK
| | - R Shaw
- Department of Molecular and Clinical Cancer Medicine, North West Cancer Research Centre, The University of Liverpool Cancer Research Centre, Liverpool, UK
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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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Lambade PN, Lambade D, Goel M. Osteoradionecrosis of the mandible: a review. Oral Maxillofac Surg 2013; 17:243-249. [PMID: 23053252 DOI: 10.1007/s10006-012-0363-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Accepted: 09/19/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND Osteoradionecrosis is a serious complication of radiotherapy that often leads to severe facial deformity, pain, pathological fracture, sequestration of devitalized bone, and orocutaneous fistulas. Preventive measures for osteoradionecrosis are the best treatment plan to avoid osteoradionecrosis. Radical surgery is indicated when conservative methods fail or when severe bone and soft-tissue necrosis prevails. CASE REPORT The purpose of this paper is to explore the recent theories about the definition, classification, incidence, and pathophysiology of osteoradionecrosis (ORN) of the jaws. The predisposing and risk factors for the development of osteoradionecrosis based on the literature review along with case report are also discussed. DISCUSSION A better understanding on the risk factors responsible for causing ORN and the underlying pathophysiology may improve our ability to prevent this complication and help to improve the prognosis for those being treated for osteoradionecrosis.
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Affiliation(s)
- Pravin N Lambade
- Department of Oral and Maxillofacial Surgery, Swargiya Dadasaheb Kalmegh Smruti Dental College and Hospital, Nagpur, 441110, Maharashtra, India,
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Chrcanovic BR, Reher P, Sousa AA, Harris M. Osteoradionecrosis of the jaws--a current overview--part 1: Physiopathology and risk and predisposing factors. Oral Maxillofac Surg 2010; 14:3-16. [PMID: 20119841 DOI: 10.1007/s10006-009-0198-9] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
PURPOSE The aim of this paper is to explore the current theories about definition, classification, incidence and physiopathology of osteoradionecrosis (ORN) of the jaws. Moreover, it is discussed the predisposing and risk factors for the development of osteoradionecrosis based on the literature review. DISCUSSION Osteoradionecrosis is one of the most serious oral complications of head and neck cancer treatment. Osteoradionecrosis is a severe delayed radiation-induced injury, characterised by bone tissue necrosis and failure to heal. Osteoradionecrosis either stabilises or gradually worsens and is notoriously difficult to manage. The most widely accepted theory to explain its cause until recently was the theory of hypoxia, hypovascularity and hypocellularity. A new theory for the pathogenesis of osteoradionecrosis was proposed. The clinical presentations of osteoradionecrosis are pain, drainage and fistulation of the mucosa or skin that is related to exposed bone in an area that has been irradiated. The tumour size and location, radiation dose, local trauma, dental extractions, infection, immune defects and malnutrition can predispose its development. CONCLUSIONS A better understanding of risk factors for the development ORN and of the underlying pathophysiology may improve our ability to prevent this complication and help to improve the prognosis for those being treated for osteoradionecrosis.
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KHAN ALIYAA, SÁNDOR GEORGEK, DORE EDWARD, MORRISON ARCHIBALDD, ALSAHLI MAZEN, AMIN FAIZAN, PETERS EDMUND, HANLEY DAVIDA, CHAUDRY SULTANR, LENTLE BRIAN, DEMPSTER DAVIDW, GLORIEUX FRANCISH, NEVILLE ALANJ, TALWAR REENAM, CLOKIE CAMERONM, MARDINI MAJDAL, PAUL TERRI, KHOSLA SUNDEEP, JOSSE ROBERTG, SUTHERLAND SUSAN, LAM DAVIDK, CARMICHAEL ROBERTP, BLANAS NICK, KENDLER DAVID, PETAK STEVEN, STE-MARIE LOUISGEORGES, BROWN JACQUES, EVANS A, RIOS LORENA, COMPSTON JULIETE. Bisphosphonate Associated Osteonecrosis of the Jaw. J Rheumatol 2009; 36:478-90. [DOI: 10.3899/jrheum.080759] [Citation(s) in RCA: 132] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
In 2003, the first reports describing osteonecrosis of the jaw (ONJ) in patients receiving bisphosphonates (BP) were published. These cases occurred in patients with cancer receiving high-dose intravenous BP; however, 5% of the cases were in patients with osteoporosis receiving low-dose bisphosphonate therapy. We present the results of a systematic review of the incidence, risk factors, diagnosis, prevention, and treatment of BP associated ONJ. We conducted a comprehensive literature search for relevant studies on BP associated ONJ in oncology and osteoporosis patients published before February 2008.All selected relevant articles were sorted by area of focus. Data for each area were abstracted by 2 independent reviewers. The results showed that the diagnosis is made clinically. Prospective data evaluating the incidence and etiologic factors are very limited. In oncology patients receiving high-dose intravenous BP, ONJ appears to be dependent on the dose and duration of therapy, with an estimated incidence of 1%–12% at 36 months of exposure. In osteoporosis patients, it is rare, with an estimated incidence < 1 case per 100,000 person-years of exposure. The incidence of ONJ in the general population is not known. Currently, there is insufficient evidence to confirm a causal link between low-dose BP use in the osteoporosis patient population and ONJ. We concluded BP associated ONJ is associated with high-dose BP therapy primarily in the oncology patient population. Prevention and treatment strategies are currently based on expert opinion and focus on maintaining good oral hygiene and conservative surgical intervention.
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Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment. Br J Oral Maxillofac Surg 2008; 46:653-60. [DOI: 10.1016/j.bjoms.2008.04.006] [Citation(s) in RCA: 204] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2008] [Indexed: 11/18/2022]
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Assouline-Dayan Y, Chang C, Greenspan A, Shoenfeld Y, Gershwin ME. Pathogenesis and natural history of osteonecrosis. Semin Arthritis Rheum 2003. [PMID: 12430099 DOI: 10.1053/sarh.2002.33724b] [Citation(s) in RCA: 450] [Impact Index Per Article: 21.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Osteonecrosis (avascular necrosis) is a relatively common disorder seen by both rheumatologists and orthopedic surgeons. The vast majority of cases are secondary to trauma. However, for non-traumatic cases, there often remains a diagnostic challenge in defining the cause of bone death. The goal of this article is to review data extensively in the medical literature with respect to the pathogenesis of osteonecrosis, its natural history, and treatment. METHODS A review of 524 studies on osteonecrosis was performed, of which 213 were selected and cited. RESULTS Non-traumatic osteonecrosis has been associated with corticosteroid usage, alcoholism, infections, hyperbaric events, storage disorders, marrow infiltrating diseases, coagulation defects, and some autoimmune diseases. However, a large number of idiopathic cases of osteonecrosis have been described without an obvious etiologic factor. Although corticosteroids can produce osteonecrosis, careful history is always warranted to identify other risk factors. The pathogenesis of non-traumatic osteonecrosis appears to involve vascular compromise, bone and cell death, or defective bone repair as the primary event. Our understanding of the pathogenesis of osteonecrosis is now much better defined and skeletal scintigraphy and magnetic resonance imaging have enhanced diagnosis greatly. Early detection is important because the prognosis depends on the stage and location of the lesion, although the treatment of femoral head osteonecrosis remains primarily a surgical one. CONCLUSIONS Osteonecrosis has been associated with a wide range of conditions. Many theories have been proposed to decipher the mechanism behind the development of osteonecrosis but none have been proven. Because osteonecrosis may affect patients with a variety of risk factors, it is important that caregivers have a heightened index of suspicion. Early detection may affect prognosis because prognosis is dependent on the stage and location of the disease. In particular, the disease should be suspected in patients with a history of steroid usage, especially in conjunction with other illnesses that predispose the patient to osteonecrosis. RELEVANCE A better understanding of the pathophysiology, diagnosis and treatment of osteonecrosis will help the physician determine which patients are at risk for osteonecrosis, facilitating early diagnosis and better treatment options.
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Affiliation(s)
- Yehudith Assouline-Dayan
- Division of Rheumatology, Allergy and Clinical Immunology, Department of Radiology, University of California at Davis, Davis, CA 95616, USA
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Epstein JB. Discussion. J Oral Maxillofac Surg 2000. [DOI: 10.1053/joms.2000.9563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Wong JK, Wood RE, McLean M. Conservative management of osteoradionecrosis. ORAL SURGERY, ORAL MEDICINE, ORAL PATHOLOGY, ORAL RADIOLOGY, AND ENDODONTICS 1997; 84:16-21. [PMID: 9247943 DOI: 10.1016/s1079-2104(97)90287-0] [Citation(s) in RCA: 106] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A retrospective records analysis of 32 patients with mandibular osteoradionecrosis seen between August 1960 and September 1995 was undertaken to determine the effectiveness of nonsurgical/nonhyperbaric oxygen conservative management. Two patients died before final analysis. Of those alive, 65.5% of patients were spared resection, having lesions resolve (48.3%), improve (3.4%), or asymptomatically stabilize (13.8%). Sequestrum production allowing "gentle" removal predicted a more favorable clinical course when managed conservatively compared with nonsequestrating lesions (p < 0.05). Criteria to define clinical osteoradionecrosis are proposed.
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Affiliation(s)
- J K Wong
- Ontario Cancer Institute/Princess Margaret Hospital, Department of Dentistry, Toronto, Canada
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