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Sweeny L, Long SM, Pipkorn P, Wax MK, Thomas CM, Curry JM, Yang S, Lander D, Chowdhury F, Amin D, Kane AC, Miles BA, Salama A, Cannady SB, Tasche K, Mann D, Jackson R. Microvascular reconstruction of medication related osteonecrosis of the head and neck. Head Neck 2024; 46:1902-1912. [PMID: 38294050 DOI: 10.1002/hed.27653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 01/04/2024] [Accepted: 01/13/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Medication related osteonecrosis of the jaw (MRONJ) requiring free flap (FF) reconstruction is uncommon with limited reported findings. METHODS Multicenter, retrospective case series of 49 consecutive adult patients presenting with advanced MRONJ requiring FF reconstruction from 2010 to 2022. Perioperative complications and outcomes were analyzed. RESULTS Eighty-two percent (n = 40) of cases were of the mandible and 18% (n = 9) were of the maxilla. The mean follow-up was 15 months (±19.6). The majority of FF survived (96%, n = 47). FF reconstructions of the maxilla were more likely to require postoperative debridement (56%, 95% CI [27, 81%] vs. 15%, 95% CI [7, 25%], p = 0.008) or develop intraoral bone exposure (56%, 95% CI [27, 81%] vs. 18%, 95% CI [9, 27%], p = 0.02). Most patients (71%, n = 35) received preoperative antibiotics which was associated with a higher rate of FF survival (100% vs. 86%, 95% CI [60, 96%], p = 0.02) and fewer complications. CONCLUSIONS Patients undergoing FF reconstruction for MRONJ do well with high rates of FF success. MRONJ of the maxilla have a higher rate of some complications. Preoperative antibiotics correlated with higher FF survival and fewer postoperative complications.
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Affiliation(s)
- Larissa Sweeny
- Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, Florida, USA
- Surgical Care Division, Miami Veterans Affairs Health Care System, Miami, Florida, USA
| | - Sallie M Long
- Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, Florida, USA
| | - Patrik Pipkorn
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, Missouri, USA
| | - Mark K Wax
- Oregon Health and Science University School of Medicine, Oregon, Portland, USA
| | - Carissa M Thomas
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Sara Yang
- Oregon Health and Science University School of Medicine, Oregon, Portland, USA
| | - Daniel Lander
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, Missouri, USA
| | - Farshad Chowdhury
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Dev Amin
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Anne C Kane
- Department of Otolaryngology, University of Mississippi, Jackson, Mississippi, USA
| | - Brett A Miles
- Department Otolaryngology Head and Neck Oncology, Northwell Health System, New York, New York, USA
| | - Andrew Salama
- Division Oral and Maxillofacial Surgery, Northwell Health System, New York, New York, USA
| | - Steven B Cannady
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Kendall Tasche
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Derek Mann
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Ryan Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University in St. Louis, Missouri, USA
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Otto S, Shreeja S, Kakoschke SC, Albittar MM, Widenhorn A, Kakoschke TK. Pre- and Post-Operative Quality of Life in Patients with Osteoradionecrosis of the Jaw. Cancers (Basel) 2024; 16:2256. [PMID: 38927961 PMCID: PMC11201672 DOI: 10.3390/cancers16122256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/02/2024] [Accepted: 06/07/2024] [Indexed: 06/28/2024] Open
Abstract
Osteoradionecrosis of the jaw (ORNJ) is a feared complication following radiation therapy performed for oncological treatment of head and neck cancers (HNC). To date, there is no clear evidence regarding the impact of surgical treatment of ORNJ on the quality of life (QoL) of affected patients. However, understanding the significance of the surgical treatment approach and its effects on QoL is an essential factor in the decision-making process for optimal, individualized therapy. In this prospective clinical study, QoL was assessed in relation to health related QoL (HRQoL) and oral health related QoL (OHQoL) before and after surgical treatment of ORNJ using standardized questionnaires (EORTC QLQ-C30, QLQ-HN35, OHIP-14). The overall QoL scores as well as individual domains of the collected scales regarding functional and symptom-related complaints were statistically analyzed. Subgroups concerning age, gender, different risk factors and type of ORNJ therapy were compared using Kruskal Wallis test. In addition, clinical and demographic patient data were collected and analyzed. QoL improvement correlated with the type of surgical ORNJ and the length of hospitalization. Better QoL scores were achieved post-operatively regarding different symptoms like pain, swallowing and mouth opening. Long-term effects of radiation therapy remained visibly restrictive to QoL and worsen over time.
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Affiliation(s)
- Sven Otto
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337 Munich, Germany; (S.O.)
| | - Shreeja Shreeja
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337 Munich, Germany; (S.O.)
- Deggendorf Institute of Technology, European Campus Rottal-Inn, Max-Breiherr-Strasse 32, 84347 Pfarrkirchen, Germany;
| | - Sara Carina Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337 Munich, Germany; (S.O.)
- Department of General, Visceral, and Transplant Surgery, University Hospital, LMU Munich, Marchioninistrasse 15, 81337 Munich, Germany
| | - Mohammed Michael Albittar
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337 Munich, Germany; (S.O.)
| | - Andreas Widenhorn
- Deggendorf Institute of Technology, European Campus Rottal-Inn, Max-Breiherr-Strasse 32, 84347 Pfarrkirchen, Germany;
- Economics and Quantitative Methods Department, International School of Management, Karlstrasse 35, 80333 Munich, Germany
| | - Tamara Katharina Kakoschke
- Department of Oral and Maxillofacial Surgery and Facial Plastic Surgery, University Hospital, LMU Munich, Lindwurmstrasse 2a, 80337 Munich, Germany; (S.O.)
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Pamias-Romero J, Saez-Barba M, de-Pablo-García-Cuenca A, Vaquero-Martínez P, Masnou-Pratdesaba J, Bescós-Atín C. Quality of Life after Mandibular Reconstruction Using Free Fibula Flap and Customized Plates: A Case Series and Comparison with the Literature. Cancers (Basel) 2023; 15:cancers15092582. [PMID: 37174048 PMCID: PMC10177401 DOI: 10.3390/cancers15092582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/18/2023] [Accepted: 04/28/2023] [Indexed: 05/15/2023] Open
Abstract
A single-center retrospective study was conducted to assess health-related quality of life (HRQoL) in 23 consecutive patients undergoing mandibular reconstruction using the computer-aided design (CAD) and computer-aided manufacturing (CAM) technology, free fibula flap, and titanium patient-specific implants (PSIs). HRQoL was evaluated after at least 12 months of surgery using the University of Washington Quality of Life (UW-QOL) questionnaire for head and neck cancer patients. In the 12 single question domains, the highest mean scores were found for "taste" (92.9), "shoulder" (90.9), "anxiety" (87.5), and "pain" (86.4), whereas the lowest scores were observed for "chewing" (57.1), "appearance" (67.9), and "saliva" (78.1). In the three global questions of the UW-QOL questionnaire, 80% of patients considered that their HRQoL was as good as or even better than it was compared to their HRQoL before cancer, and only 20% reported that their HRQoL had worsened after the presence of the disease. Overall QoL during the past 7 days was rated as good, very good or outstanding by 81% of patients, respectively. No patient reported poor or very poor QoL. In the present study, restoring mandibular continuity with free fibula flap and patient-specific titanium implants designed with the CAD-CAM technology improved HRQoL.
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Affiliation(s)
- Jorge Pamias-Romero
- Service of Oral and Maxillofacial Surgery, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, E-08035 Barcelona, Spain
- CIBBM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Reserca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, E-08035 Barcelona, Spain
| | - Manel Saez-Barba
- Service of Oral and Maxillofacial Surgery, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, E-08035 Barcelona, Spain
- CIBBM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Reserca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, E-08035 Barcelona, Spain
| | - Alba de-Pablo-García-Cuenca
- Service of Oral and Maxillofacial Surgery, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, E-08035 Barcelona, Spain
- CIBBM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Reserca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, E-08035 Barcelona, Spain
| | - Pablo Vaquero-Martínez
- Service of Oral and Maxillofacial Surgery, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, E-08035 Barcelona, Spain
- CIBBM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Reserca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, E-08035 Barcelona, Spain
| | - Joan Masnou-Pratdesaba
- Radiology Department, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, E-08035 Barcelona, Spain
| | - Coro Bescós-Atín
- Service of Oral and Maxillofacial Surgery, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig Vall d'Hebron 119-129, E-08035 Barcelona, Spain
- CIBBM-Nanomedicine, Noves Tecnologies i Microcirurgia Craniofacial, Vall d'Hebron Institut de Reserca (VHIR), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, E-08035 Barcelona, Spain
- Unitat Docent Vall d'Hebron, Facultat de Medicina UAB, Universitat Autònoma de Barcelona, E-08035 Barcelona, Spain
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Tassone P, Clookey S, Topf M, Galloway T, Dooley L, Zitsch R. Quality of life after segmental mandibulectomy and free flap for mandibular osteonecrosis: Systematic review. Am J Otolaryngol 2022; 43:103586. [PMID: 35961223 DOI: 10.1016/j.amjoto.2022.103586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 08/02/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Review QOL outcomes among patients undergoing segmental mandibulectomy and bony free flap reconstruction for ONJ. DATA SOURCES PubMed was searched for MeSH terms "Quality of life," "Osteonecrosis," "Osteoradionecrosis," "Bisphosphonate-associated osteonecrosis of the jaw," "Free tissue flaps," and "Mandibular reconstruction." REVIEW METHODS English language studies with QOL outcomes data for patients undergoing free flap reconstruction for advanced ONJ were included. 197 records were initially screened; 18 full texts assessed; 10 full texts included. PRISMA guidelines were followed. RESULTS Ten studies were included in this systematic review: six retrospective, three retrospective with comparison groups, and one prospective. In studies with comparison groups, ONJ patients have worse self-reported QOL than the general population as well as head and neck cancer patients without ONJ. Nearly all patients with QOL measurements (220/235 patients) had ONJ from prior radiation. Segmental mandibulectomy and bony free flap improved overall QOL in over half of patients, as well as pain associated with ONJ in 70-75 % of patients. Surgery did not improve long-term effects of radiation such as chewing, swallowing, and salivary production. Donor site morbidity rarely affects QOL. CONCLUSIONS Osteonecrosis of the jaw (ONJ) worsens quality-of-life, and advanced disease often requires segmental mandibulectomy and bony free flap reconstruction. Patients and surgeons may expect improvement in some, but not all, domains of patient-reported QOL by the use of segmental mandibulectomy and reconstruction for advanced ONJ.
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Affiliation(s)
- Patrick Tassone
- Department of Otolaryngology, University of Missouri School of Medicine, Columbia, MO, USA
| | | | - Michael Topf
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tabitha Galloway
- Department of Otolaryngology, University of Missouri School of Medicine, Columbia, MO, USA
| | - Laura Dooley
- Department of Otolaryngology, University of Missouri School of Medicine, Columbia, MO, USA
| | - Robert Zitsch
- Department of Otolaryngology, University of Missouri School of Medicine, Columbia, MO, USA
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A Comparative Study of Analog Preoperative Planning Versus Virtual Preoperative Planning for Mandibular Reconstruction With Fibula Free Flap. J Craniofac Surg 2022; 33:e680-e685. [PMID: 35148530 DOI: 10.1097/scs.0000000000008539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/18/2022] [Indexed: 10/19/2022] Open
Abstract
ABSTRACT Mandibular reconstruction is a challenging procedure, especially in cancer patients with defects that are greater than 6 cm. Free vascularized fibular flap is the gold standard treatment in these cases since it allows three-dimensional restoration of the lost segments after ablative surgery in addition to providing the possibility of a subsequent implant-supported rehabilitation improving the functional and aesthetic outcomes of the surgery.To obtain accurate results, preoperative planning must be done with detail. Approaches for the preoperative planning include both the conventional analog planning and the virtual planning that are valid alternatives in meeting the trans-surgical requirements.This study makes a comparative analysis of 2 clinical cases with a diagnosis of squamous cell carcinoma that were reconstructed using a vascularized fibular free flap. The first case was planned using the conventional analog method whereas the second case was planned using the virtual planning approach.The impact of virtual planning and conventional analog planning on preoperative planning time, ischemia period, and total surgical time is analyzed according to the experience obtained in the cases presented. In addition, the authors described the technique used for each planning method along with a literature review in which the results are contrasted and discussed.
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Niño-Sandoval TC, Jaque RA, González FA, Vasconcelos BCE. Mandibular shape prediction model using machine learning techniques. Clin Oral Investig 2022; 26:3085-3096. [PMID: 34997358 DOI: 10.1007/s00784-021-04291-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 11/08/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To create a mandibular shape prediction model using machine learning techniques and geometric morphometrics. MATERIALS AND METHODS Six hundred twenty-nine radiographs were used to select the most appropriate craniomaxillary variables in different craniofacial pattern classifications using a support vector machine. To obtain the three-dimensional mandibular shape, a Procrustes fit was used on 55 tomograms, in which 17 three-dimensional landmarks were digitized. A partial least square regression was employed to find the best covariation between craniomaxillary angles and the symmetric components of mandibular shape. The model was applied to a new sample of six tomograms and evaluated by the mean absolute error. Each mandible predicted was assessed using the Hausdorff distance (HDu) and a color scale. The model was also exploratively applied to six new radiographs. RESULTS Covariation was 88.66% with a significance of < 0.0001 explained by twelve craniomaxillary variables. Low differences between the original and predicted models were obtained, with a mean absolute error of 0.0143. The mean distance between meshes ranged from 0.0033 to 0.0059 HDu and each color scale demonstrated general similarity between the surfaces. CONCLUSIONS This approach offered promising results in obtaining a mandibular prediction model that enhances shape properties in an economical way and is applicable to a Latin American population. Clinical proof of this method will require further studies with larger samples. CLINICAL RELEVANCE This method offers a reliable, economic alternative to traditional mandibular prediction methods and is applicable to the Latin American population.
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Affiliation(s)
- Tania Camila Niño-Sandoval
- Department of Oral and Maxillofacial Surgery and Traumatology, Postgraduate Program in Oral and Maxillofacial Surgery and Traumatology. Universidade de Pernambuco - School of Dentistry (UPE/FOP), University Hospital Oswaldo Cruz, Rua Arnóbio Marquês, 310 - Santo Amaro, CEP: 50.100-130, Recife, PE, Brazil
| | - Robinson Andrés Jaque
- Department of Computing Systems and Industrial Engineering, Faculty of Engineering, MindLab Research Group, Universidad Nacional de Colombia (UNAL), Avenida NQS (Carrera 30) No. 45-03 Ciudad Universitaria Edificio 453, 111321, Bogotá, Colombia
| | - Fabio A González
- Department of Computing Systems and Industrial Engineering, Faculty of Engineering, MindLab Research Group, Universidad Nacional de Colombia (UNAL), Avenida NQS (Carrera 30) No. 45-03 Ciudad Universitaria Edificio 453, 111321, Bogotá, Colombia
| | - Belmiro C E Vasconcelos
- Department of Oral and Maxillofacial Surgery and Traumatology, Coordinator of the Postgraduate Program in Oral and Maxillofacial Surgery and Traumatology, University of Pernambuco - School of Dentistry (UPE/FOP), University Hospital Oswaldo Cruz, Rua Arnóbio Marquês, 310 - Santo Amaro, CEP: 50.100-130, Recife, PE, Brazil.
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El-Rabbany M, Blanas N, Sutherland S, Lam DK, Shah PS, Azarpazhooh A. Surgical Therapy in Patients with Medication-Related Osteonecrosis of the Jaw is Associated with Disease Resolution and Improved Quality of Life: A Prospective Cohort Study. J Oral Maxillofac Surg 2022; 80:1084-1093. [DOI: 10.1016/j.joms.2022.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 10/19/2022]
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El-Rabbany M, Blanas N, Sutherland S, Shah PS, Lam DK, Azarpazhooh A. Development and evaluation of the clinimetric properties of the Medication-Related Osteonecrosis of the Jaw Quality of Life Questionnaire (MRONJ-QoL). Int J Oral Maxillofac Surg 2021; 51:768-775. [PMID: 34924268 DOI: 10.1016/j.ijom.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 08/10/2021] [Accepted: 11/12/2021] [Indexed: 12/14/2022]
Abstract
The purpose of this study was to develop a self-administered questionnaire (MRONJ-QoL) to assess the quality of life (QoL) of patients with medication-related osteonecrosis of the jaw (MRONJ). A prospective study was performed to develop and evaluate the questionnaire. The MRONJ-QoL was formulated through a review of the literature and interviews of experts and patients. Following development, it was administered to 60 patients with a diagnosis of MRONJ. The sensibility of the questionnaire was assessed by evaluating feasibility (via interviews of patients), face validity (via interviews of patients and experts), and content validity (via evaluation of internal consistency, floor/ceiling effects, and factor analysis). Reliability was evaluated by measuring intra-rater reliability. Construct validity of the questionnaire was evaluated by both cross-sectional and longitudinal comparisons, including comparing scores of the MRONJ-QoL to disease resolution at 6 months. The final MRONJ-QoL questionnaire consisted of 14 questions, demonstrating high internal consistency (Cronbach's alpha of 0.85) and good reliability (weighted kappa score of 0.65). At the 6-month follow-up, disease resolution was found to be significantly associated with improved MRONJ-QoL scores, suggesting validity of the questionnaire (P < 0.01). Therefore, this is a sensible, reliable, and valid questionnaire for evaluating the QoL of patients with MRONJ.
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Affiliation(s)
- M El-Rabbany
- Florida Craniofacial Institute, Tampa, Florida, USA
| | - N Blanas
- Department of Dentistry, Sunnybrook Hospital, Toronto, Ontario, Canada; Department of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - S Sutherland
- Department of Dentistry, Sunnybrook Hospital, Toronto, Ontario, Canada; Department of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - P S Shah
- Department of Pediatrics, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada; Institute of Health, Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - D K Lam
- Department of Oral and Maxillofacial Surgery, Stony Brook School of Dental Medicine, Stony Brook, New York, USA; Department of Surgery, Stony Brook School of Medicine, Stony Brook, New York, USA; Stony Brook Cancer Center, Stony Brook, New York, USA
| | - A Azarpazhooh
- Department of Dentistry, University of Toronto, Toronto, Ontario, Canada; Divisions of Endodontics and Research, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Ma C, Gao W, Liu Z, Zhu D, Zhu F, Li X, He Y. Radiation-Induced Soft Tissue Injuries in Patients With Advanced Mandibular Osteoradionecrosis: A Preliminary Evaluation and Management of Various Soft Tissue Problems Around Radiation-Induced Osteonecrosis Lesions. Front Oncol 2021; 11:641061. [PMID: 33996554 PMCID: PMC8113699 DOI: 10.3389/fonc.2021.641061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 03/29/2021] [Indexed: 11/17/2022] Open
Abstract
Objectives Radiation-induced soft-tissue injuries (STIs) in mandibular osteoradionecrosis (ORN) are not well studied regarding their correlations with nearby bone lesions. The aim of this study is to investigate the severity of radiation-induced STIs in advanced mandibular ORN and its relationship with hard-tissue damage and postoperative outcomes. Methods A retrospective study was performed in our institution from January 2017 to December 2019. Aside from demographic factors, the associations between the triad ORN variables (irradiation doses, ORN stages, ORN sizes) and radiation-related STI factors, vascular characteristics, and postoperative functional recovery were assessed. In addition, the severity of STI was also compared with treatment outcomes. Such correlations were established via both univariate and multivariable analyses. Results A total number of 47 patients were included. The median follow-up reached 27 months. Nasopharyngeal cancer was the histology type among most patients (n = 21, 44.7%). The median irradiation doses reached 62 Gy (range, 40–110 Gy). For STI, the symptom scoring equaled an average of 5.4 (range from 1 to 12), indicative of the severity of STI problems. During preoperative MRI examinations, signs of hypertrophy or edema (n = 41, 87.2%) were frequently discerned. Most patients (n = 23, 48.9%) also had extensive muscular fibrosis and infection, which required further debridement and scar release. Surprisingly, most STI factors, except cervical fibrosis (p = 0.02), were not in parallel with the ORN levels. Even the intraoperative soft-tissue defect changes could not be extrapolated by the extent of ORN damage (p = 0.096). Regarding the outcomes, a low recurrence rate (n = 3, 6.9%) was reported. In terms of soft tissue-related factors, we found a strong correlation (p = 0.004) between symptom scores and recurrence. In addition, when taking trismus into consideration, both improvements in mouth-opening distance (p < 0.001) and facial contour changes (p = 0.004) were adversely affected. Correlations were also observed between the intraoperative soft-tissue defect changes and complications (p = 0.024), indicative of the importance of STI evaluation and management. Conclusions The coexistence of hard- and soft-tissue damage in radiation-induced advanced mandibular ORN patients reminds surgeons of the significance in assessing both aspects. It is necessary to take the same active measures to evaluate and repair both severe STIs and ORN bone lesions.
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Affiliation(s)
- Chunyue Ma
- Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Weijin Gao
- Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Zhonglong Liu
- Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Dan Zhu
- Department of Radiology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Fengshuo Zhu
- Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xiaoguang Li
- Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yue He
- Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Zavala A, Al Deek NF, Chang YM, Tsai CY, Wei FC. Reconstruction of mandibular defects involving the central segment with fibula osteoseptocutaneous free flap following ameloblastoma resection: Patient-reported outcomes. J Plast Reconstr Aesthet Surg 2021; 74:3022-3030. [PMID: 34158274 DOI: 10.1016/j.bjps.2021.03.090] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/28/2021] [Accepted: 03/13/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES Mandibular defects involving the central segment are challenging. This study analyzes the impact of defect extent and reconstruction method on quality of life (QOL) and obstructive sleep apnea (OSA). MATERIALS AND METHODS Twenty-nine ameloblastoma patients received segmental mandibulectomy involving the C-segment and immediate fibula free flap reconstruction were recruited. Defects: (C: 2, LC: 11, LCL: 19). Mean defect length: 8.79 cm (± 2.34). Inset: Low-single-barrel (n: 19), with secondary distraction osteogenesis (n: 8/19), high-single-barrel (n: 7), double barrel (n: 3). Patients were surveyed using University of Washington Quality of Life (UW-QOL) and Berlin risk of postoperative sleep apnea questionnaires. RESULTS Flap failure: None. Mean follow-up: 109.6 ± 92.8 months. UW-QOL Physical function 91.83 (± 14.92); social function 90.17 (± 17.19). No statistical difference between C, LC, and LCL was found, but C group which received low-single-barrel had the lowest score in appearance and chewing domains. In health-related QOL (HR-QOL) compared with 1 month before cancer, 69% reported best results. "Appearance" was the most important issue for the past 7 days, followed by "Chewing," prevailing in LC and C groups that predominately reconstructed by low-single-barrel. Berlin score: 7 patients (4 LCL, 3 LC≥8 cm) were at high risk for postoperative OSA. CONCLUSION "Like-with-like" reconstruction with immediate endosteal dental implants yields the best results. Inset of fibula bone could affect outcomes, favoring double-barrel or single-high-barrel inset. Appearance and chewing remain the main concerns, largely, in those with low-single-barrel inset and no dental restoration. After long/extensive LCL and LC mandibulectomies, postoperative OSA warrants further investigation, and modification of resection/reconstruction techniques.
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Affiliation(s)
- Abraham Zavala
- Department of Plastic and Reconstructive Surgery, Chang Gung University Medical College, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei 10591, Taiwan
| | - Nidal F Al Deek
- Department of Plastic and Reconstructive Surgery, Chang Gung University Medical College, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei 10591, Taiwan
| | - Yang-Ming Chang
- Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan
| | - Chi-Ying Tsai
- Department of Oral and Maxillofacial Surgery, Chang Gung Memorial Hospital, Chang Gung Medical College and Chang Gung University, Taipei, Taiwan
| | - Fu-Chan Wei
- Department of Plastic and Reconstructive Surgery, Chang Gung University Medical College, Chang Gung Memorial Hospital, 199 Tun-Hwa North Road, Taipei 10591, Taiwan.
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11
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Chieng CY, Davies A, Aziz A, Lowe D, Rogers SN. Health related quality of life and patient concerns in patients with osteoradionecrosis. Br J Oral Maxillofac Surg 2021; 59:1061-1066. [PMID: 34325946 DOI: 10.1016/j.bjoms.2021.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/18/2021] [Indexed: 11/25/2022]
Abstract
The number of patients presenting with osteoradionecrosis (ORN) is likely to increase in future and health related quality of life (HRQOL) is a key outcome. This study aimed to report patient concerns and HRQOL in an osteoradionecrosis cohort over 12 years. Patients attended routine follow-up clinics between 2008 to 2020, where patient reported outcome (PRO) assessment was used before consultations as standard practice. The two PROs were the Patient Concerns Inventory (PCI) and the University of Washington quality of life questionnaire (UW-QOL v4). The study sample comprised 109 patients with ORN seen in 445 clinics when PCI and UW-QOL were used. At clinic, patients were in one of six ORN states: before ORN (26 with data), at diagnosis (12), and following treatment either improved (27), progressed (46), stable (63) or resolved (37). Worst HRQOL outcomes were reported in the progressive group with 50% reporting overall QOL as less than good. Pain was a major dysfunction (63%) as was physical and social-emotional functioning and this group reported many PCI issues, median (IQR) 7 (4-11). Kaplan-Meier estimates of survival with 95% CI after diagnosis with ORN were 96% (90-99%) at 12 months, 89% (81-94%) at 24 months and 73% (61-82%) at 60 months. This study indicates that ORN is a chronic condition with long-term survivorship consequences. More data through cohort studies and trials are needed to assist in decision making for individual patients.
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Affiliation(s)
- C Y Chieng
- Regional Maxillofacial Unit, Aintree University Hospital, Lower Lane, Liverpool, UK.
| | - A Davies
- Regional Maxillofacial Unit, Aintree University Hospital, Lower Lane, Liverpool, UK.
| | - A Aziz
- Regional Maxillofacial Unit, Aintree University Hospital, Lower Lane, Liverpool, UK.
| | - D Lowe
- Astraglobe Ltd, Congleton, Cheshire, UK.
| | - S N Rogers
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, L39 4QP, UK; Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK.
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Sweeny L, Mayland E, Swendseid BP, Curry JM, Kejner AE, Thomas CM, Kain JJ, Cannady SB, Tasche K, Rosenthal EL, DiLeo M, Luginbuhl AJ, Theeuwen H, Sarwary JR, Petrisor D, Wax MK. Microvascular Reconstruction of Osteonecrosis: Assessment of Long-term Quality of Life. Otolaryngol Head Neck Surg 2021; 165:636-646. [PMID: 33618563 DOI: 10.1177/0194599821990682] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Review long-term clinical and quality-of-life outcomes following free flap reconstruction for osteonecrosis. STUDY DESIGN Retrospective multi-institutional review. SETTING Tertiary care centers. METHODS Patients included those undergoing free flap reconstructions for osteonecrosis of the head and neck (N = 232). Data included demographics, defect, donor site, radiation history, perioperative management, diet status, recurrence rates, and long-term quality-of-life outcomes. Quality-of-life outcomes were measured using the University of Washington Quality of Life (UW-QOL) survey. RESULTS Overall flap success rate was 91% (n = 212). Relative to preoperative diet, 15% reported improved diet function at 3 months following reconstruction and 26% at 5 years. Osteonecrosis recurred in 14% of patients (32/232); median time to onset was 11 months. Cancer recurrence occurred in 13% of patients (29/232); median time to onset was 34 months. Results from the UW-QOL questionnaire were as follows: no pain (45%), minor or no change in appearance (69%), return to baseline endurance level (37%), no limitations in recreation (40%), no changes in swallowing following reconstruction (28%), minor or no limitations in mastication (29%), minor or no speech difficulties (93%), no changes in shoulder function (84%), normal taste function (19%), normal saliva production (27%), generally excellent mood (44%), and no or minimal anxiety about cancer (94%). CONCLUSION The majority of patients maintained or had advancement in diet following reconstruction, with low rates of osteonecrosis or cancer recurrence and above-average scores on UW-QOL survey suggesting good return of function and quality of life.
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Affiliation(s)
- Larissa Sweeny
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center-New Orleans, New Orleans, Louisiana, USA
| | - Erica Mayland
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center-New Orleans, New Orleans, Louisiana, USA
| | - Brian P Swendseid
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Joseph M Curry
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexandra E Kejner
- Department of Otolaryngology-Head and Neck Surgery, University of Kentucky, Lexington, Kentucky, USA
| | - Carissa M Thomas
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Joshua J Kain
- Department of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Steve B Cannady
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Kendall Tasche
- Department of Otolaryngology-Head and Neck Surgery, University of Pennsylvania Health System, Philadelphia, Pennsylvania, USA
| | - Eben L Rosenthal
- Department of Otolaryngology, Stanford University, Palo Alto, California, USA
| | - Michael DiLeo
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Health Science Center-New Orleans, New Orleans, Louisiana, USA
| | - Adam J Luginbuhl
- Department of Otolaryngology-Head and Neck Surgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Juliana R Sarwary
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Daniel Petrisor
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Mark K Wax
- School of Medicine, Oregon Health and Science University, Portland, Oregon, USA
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Novel Technique with Double Free Flap Design for Advanced Mandibular Osteoradionecrosis: A Case Series. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2020; 8:e3149. [PMID: 33133983 PMCID: PMC7544289 DOI: 10.1097/gox.0000000000003149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/04/2020] [Indexed: 11/26/2022]
Abstract
Advanced mandibular osteoradionecrosis is arguably among the most challenging cases for reconstructive head and neck surgeons. Several reconstructive methods for complex mandibular defects have been reported; however, for advanced mandibular osteoradionecrosis, a safe option that minimizes the risk of renewed fistulation and infections is needed. For this purpose, we present a new technique using a fascia-sparing vertical rectus abdominis musculocutaneous flap as protection for a vascularized free fibula graft (FFG). This technique also optimizes recipient site healing and functionality while minimizing donor site morbidity. Our initial experiences from a 4 patient case series are included. Mean operative time was 551 minutes (SD: 81 minutes). All donor sites were closed primarily. Mean time to discharge was 13 days (SD: 7 days), and mean time to full mobilization was 2 days (SD: 1 days). This double free flap technique completely envelops the FFG and plate with nonirradiated muscle. It allows for the transfer of an FFG without a skin island, thus avoiding the need for split skin graft closure. This results in faster healing and minimizes the risk of fibula donor site morbidity. The skin island of the vertical rectus abdominis musculocutaneous flap has the added benefit of providing intraoral lining, which minimizes contractures and trismus. Although prospective long-term studies comparing this approach to other double flap procedures are needed, we argue that this technique is an optimal approach to safeguard the mandibular FFG reconstruction against the inherent risks of renewed complications in irradiated unhealthy tissue.
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El‐Rabbany M, Duchnay M, Raziee HR, Zych M, Tenenbaum H, Shah PS, Azarpazhooh A. Interventions for preventing osteoradionecrosis of the jaws in adults receiving head and neck radiotherapy. Cochrane Database Syst Rev 2019; 2019:CD011559. [PMID: 31745986 PMCID: PMC6953365 DOI: 10.1002/14651858.cd011559.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Osteoradionecrosis (ORN) of the jaws is among the most serious oral complications of head and neck cancer radiotherapy, arising from radiation-induced fibro-atrophic tissue injury, manifested by necrosis of osseous tissues and failure to heal, often secondary to operative interventions in the oral cavity. It is associated with considerable morbidity and has important quality of life ramifications. Since ORN is very difficult to treat effectively, preventive measures to limit the onset of this disease are needed; however, the effects of various preventive interventions has not been adequately quantified. OBJECTIVES To assess the effects of interventions for preventing ORN of the jaws in adult patients with head and neck cancer undergoing curative or adjuvant (i.e. non-palliative) radiotherapy. SEARCH METHODS Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 5 November 2019), the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 10) in the Cochrane Library (searched 5 November 2019), MEDLINE Ovid (1946 to 5 November 2019), Embase Ovid (1980 to 5 November 2019), Allied and Complementary Medicine (AMED) Ovid (1985 to 5 November 2019), Scopus (1966 to 5 November 2019), Proquest Dissertations and Theses International (1861 to 5 November 2019) and Web of Science Conference Proceedings (1990 to 5 November 2019). The US National Institutes of Health Ongoing Trials Register (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA We selected randomised controlled trials (RCTs) or quasi-RCTs of adult patients 18 years or older with head and neck cancer who had undergone curative or adjuvant radiotherapy to the head and neck, who had received an intervention to prevent the onset of ORN. Eligible patients were those subjected to pre- or post-irradiation dental evaluation. Management of these patients was to be with interventions independent of their cancer therapy, including but not limited to local, systemic, or behavioural interventions. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials from search results, assessed risk of bias, and extracted relevant data for inclusion in the review. Authors of included studies were contacted to request missing data. We used standard methodological procedures expected by Cochrane. MAIN RESULTS Four studies were identified that met pre-determined eligibility criteria, evaluating a total of 342 adults. From the four studies, all assessed as at high risk of bias, three broad interventions were identified that may potentially reduce the risk of ORN development: one study showed no reduction in ORN when using platelet-rich plasma placed in the extraction sockets of prophylactically removed healthy mandibular molar teeth prior to radiotherapy (odds ratio (OR) 3.32, 95% confidence interval (CI) 0.58 to 19.09; one trial, 44 participants; very low-certainty evidence). Another study involved comparing fluoride gel and high-content fluoride toothpaste (1350 parts per million (ppm)) in prevention of post-radiation caries, and found no difference between their use as no cases of ORN were reported (one trial, 220 participants; very low-certainty evidence). The other two studies involved the use of perioperative hyperbaric oxygen (HBO) therapy and antibiotics. One study showed that treatment with HBO caused a reduction in the development of ORN in comparison to patients treated with antibiotics following dental extractions (risk ratio (RR) 0.18, 95% CI 0.43 to 0.76; one trial, 74 participants; very low-certainty evidence). Another study found no difference between combined HBO and antibiotics compared to antibiotics alone prior to dental implant placement (RR 3.00, 95% CI 0.14 to 65.16; one trial, 26 participants; very low-certainty evidence). Adverse effects of the different interventions were not reported clearly or were not important. AUTHORS' CONCLUSIONS Given the suboptimal reporting and inadequate sample sizes of the included studies, evidence regarding the interventions evaluated by the trials included in this review is uncertain. More well-designed RCTs with larger samples are required to make conclusive statements regarding the efficacy of these interventions.
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Affiliation(s)
| | - Michael Duchnay
- University of TorontoFaculty of DentistrySuite 511124 Edward StreetTorontoONCanadaM5G 1G6
| | - Hamid Reza Raziee
- BC Cancer‐SurreyUniversity of British Columbia13750 96th AvenueSurreyBCCanadaV3V 1Z2
| | - Maria Zych
- Faculty of Dentistry, University of TorontoTorontoCanada
| | - Howard Tenenbaum
- University of TorontoFaculty of DentistrySuite 511124 Edward StreetTorontoONCanadaM5G 1G6
| | - Prakeshkumar S Shah
- University of Toronto Mount Sinai HospitalDepartment of Paediatrics and Institute of Health Policy, Management and Evaluation600 University AvenueTorontoONCanadaM5G 1XB
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16
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Menapace DC, Van Abel KM, Jackson RS, Moore EJ. Primary vs Secondary Endosseous Implantation After Fibular Free Tissue Reconstruction of the Mandible for Osteoradionecrosis. JAMA FACIAL PLAST SU 2019; 20:401-408. [PMID: 29801119 DOI: 10.1001/jamafacial.2018.0263] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance The clinical and financial implications of the timing of dental rehabilitation after a fibula free tissue transfer (FFTT) for osteoradionecrosis (ORN) and osteonecrosis (ON) of the mandible have yet to be established. Objective To compare the outcomes of primary implantation vs secondary implantation after FFTT for ORN and ON of the mandible. Design, Setting, and Participants A retrospective review was conducted of 23 patients at a single tertiary academic referral center undergoing primary implantation or secondary implantation after FFTT for ORN and ON from January 1, 2006, to November 10, 2015. Interventions All patients underwent FFTT with primary implantation (n = 12) or secondary implantation (n = 11). Main Outcomes and Measures Outcomes of FFTT, dental implantation, implant use, diet, speech, and disease-free survival were reviewed. Fixed unit costs were estimated based on the mean cost analysis. Results Twenty-three patients (7 women and 16 men; mean [SD] age, 62.4 [8.2] years [range, 24-81 years]) met the inclusion criteria. Of these, 18 had ORN and 5 had ON. Dental implantation was performed at the time of FFTT for 12 patients and was performed secondarily for 11 patients. There were a mean of 5.2 implants per patient performed, for a total of 121 implants. There was 1 complete flap failure in the primary implantation group. Neither flap nor implant complications were affected by the timing of the implantation. Overall, the implant survival rate was 95% (55 of 58) in the primary implantation group and 98% (62 of 63) in the secondary implantation group. Time from FFTT to abutment placement (primary implantation, 19.6 weeks; secondary implantation, 61.0 weeks) was significantly shorter after primary implantation (P < .001). There was no clinical difference in postoperative complications and implant outcomes for ORN vs ON. Improvement in speech and oral competence in the primary implantation group vs the secondary implantation group was not statistically significant, given an experiment-adjusted P = .001 set as significant (normal speech, 9 vs 3; P = .02; and normal oral competence, 9 vs 3; P = .02). Disease-free survival was 91% (20 of 22 patients) overall. Fixed unit (U) costs were 1.0 U for primary implantation and 1.24 U for secondary implantation. Conclusions and Relevance Patients undergoing primary implantation after FFTT for ORN and ON had a similar rate of complications compared with those undergoing secondary implantation. However, primary implantation allowed a faster return than secondary implantation to oral nutrition and prosthesis use. The fixed unit cost was reduced for those undergoing primary implantation. Although dental implantation was safe and effective in both groups, the decreased time to use and the decreased overall cost should prompt surgeons to consider primary implantation after FFTT for ORN and ON. Level of Evidence 3.
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Affiliation(s)
- Deanna C Menapace
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
| | | | - Ryan S Jackson
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St Louis, Missouri
| | - Eric J Moore
- Department of Otorhinolaryngology, Mayo Clinic, Rochester, Minnesota
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17
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El-Rabbany M, Lam DK, Shah PS, Azarpazhooh A. Surgical Management of Medication-Related Osteonecrosis of the Jaw Is Associated With Improved Disease Resolution: A Retrospective Cohort Study. J Oral Maxillofac Surg 2019; 77:1816-1822. [PMID: 31054989 DOI: 10.1016/j.joms.2019.03.040] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/25/2019] [Accepted: 03/27/2019] [Indexed: 01/29/2023]
Abstract
PURPOSE Optimal management approaches for medication-related osteonecrosis of the jaw (MRONJ) using either surgical or nonsurgical approaches remain inconclusive. Our objective was to compare the effects of surgical versus nonsurgical therapy on the resolution of MRONJ. METHODS We conducted a retrospective review of eligible patients with a diagnosis of MRONJ at Mount Sinai Hospital, Toronto, Ontario, Canada, who either were seen in the outpatient clinic from January 2014 to December 2016 or received major surgical intervention from January 2011 to December 2016. A multivariate logistic regression was conducted to evaluate the effects of surgical therapy on disease resolution. RESULTS A total of 78 patients were included in this study. Of these, 56 (72%) received surgical therapy. Antiresorptive agents were being taken for the treatment of osteoporosis by 46 patients (82%) in the surgical group compared with 20 nonsurgical patients (91%) (P = .28). The median follow-up period was 15.5 months (interquartile range, 8.0 to 34.3 months) in the surgical group compared with 11.0 months (interquartile range, 8.0 to 20.5 months) in the nonsurgical group (P = .75). Disease resolution occurred in 39 surgical patients (70%) compared with 8 nonsurgical patients (36%). Surgical therapy was associated with disease resolution compared with nonsurgical therapy alone, after adjustment for age, duration of antiresorptive or antiangiogenic therapy, whether the antiresorptive or antiangiogenic agents were used for oncologic purposes, and the stage of MRONJ at initial presentation (adjusted odds ratio, 4.33; 95% confidence interval, 1.28 to 14.60). CONCLUSIONS Surgical therapy compared with nonsurgical therapy was associated with disease resolution in patients with MRONJ. High-quality evidence of the superiority of any specific surgical approach in the treatment of MRONJ is needed.
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Affiliation(s)
- Mohamed El-Rabbany
- Resident and PhD Student in Oral and Maxillofacial Surgery, University of Toronto, Toronto, Ontario, Canada
| | - David K Lam
- Professor and Chair, Department of Oral & Maxillofacial Surgery, Stony Brook School of Dental Medicine; Professor, Department of Surgery, Stony Brook School of Medicine; and Surgeon-Scientist, Stony Brook Cancer Center, Stony Brook, NY
| | - Prakesh S Shah
- Professor, Department of Pediatrics, Mount Sinai Hospital; University of Toronto; and Institute of Health, Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Amir Azarpazhooh
- Associate Professor, Dental Public Health and Endodontics, University of Toronto; and Head, Divisions of Endodontics and Research, Department of Dentistry, Mount Sinai Hospital, Toronto, Ontario, Canada.
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Petrovic I, Panchal H, De Souza Franca PD, Hernandez M, McCarthy CC, Shah JP. A systematic review of validated tools assessing functional and aesthetic outcomes following fibula free flap reconstruction of the mandible. Head Neck 2018; 41:248-255. [PMID: 30548509 DOI: 10.1002/hed.25452] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/06/2018] [Accepted: 07/12/2018] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Segmental mandibulectomy impairs health-related quality of life (QoL), by altering speech, mastication, swallowing, and facial aesthetics. Fibula free flap (FFF) used for mandible reconstruction is known to improve outcomes; however, minimal information exists in the literature regarding patient-reported outcomes. We aim to assess how current studies evaluate patient perception following segmental mandibulectomy and FFF mandible reconstruction. METHODS Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a search was conducted for publications involving FFF mandible reconstruction from 2005 to 2017 using PubMed, Cochrane, EMBASE, Web of Science, and PsychInfo. RESULTS Of 2212 articles identified initially, only 7 studies were deemed suitable. Six studies used the University of Washington Quality of Life questionnaire, 3 Oral Health Impact Profile, and 1 used European Organization for Research and Treatment of Cancer Head and Neck (EORTC-H&N35). CONCLUSIONS There is a paucity of information in published reports on QoL outcomes following mandible reconstruction with FFF. In the era of patient-centered health care, observations warrant attention from researchers for physician-assessed patient-reported measures to factor in QoL expectation during surgical decision-making about the choice of reconstruction.
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Affiliation(s)
- Ivana Petrovic
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Hina Panchal
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Marisol Hernandez
- Medical Library, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Colleen C McCarthy
- Plastic and Reconstructive Surgery Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jatin P Shah
- Head and Neck Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
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Zhang W, Zhang X, Yang P, Blanchard P, Garden AS, Gunn B, Fuller CD, Chambers M, Hutcheson KA, Ye R, Lai SY, Radwan MAS, Zhu XR, Frank SJ. Intensity-modulated proton therapy and osteoradionecrosis in oropharyngeal cancer. Radiother Oncol 2017; 123:401-405. [PMID: 28549794 DOI: 10.1016/j.radonc.2017.05.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 03/11/2017] [Accepted: 05/05/2017] [Indexed: 11/27/2022]
Abstract
PURPOSE We compared mandibular doses and osteoradionecrosis in patients with oropharyngeal cancer after intensity-modulated radiation therapy (IMRT) or intensity-modulated proton therapy (IMPT). METHODS AND MATERIALS We identified 584 patients who received definitive radiotherapy for oropharyngeal cancer from January 2011 through June 2014 at MD Anderson Cancer Center (534 IMRT and 50 IMPT). The dosimetric variables and osteoradionecrosis were compared with Chi-square test or Fisher's exact test. RESULTS Median follow-up time for all patients (534 IMRT and IMPT) was 33.8months (33.8months IMRT vs. 34.6months IMPT, P=0.854), and median time to osteoradionecrosis was 11.4months (range 6.74-16.1months). Mandibular doses were lower for patients treated with IMPT (minimum 0.8 vs. 7.3Gy; mean 25.6 vs. 41.2Gy; P<0.001), and osteoradionecrosis rates were lower as well: 2% IMPT (1 grade 1), 7.7% IMRT (12 grade 4, 5 grade 3, 1 grade 2 and 23 grade 1). Osteoradionecrosis location depended on the primary tumor site and high-dose field in the mandible. CONCLUSIONS Osteoradionecrosis events were significantly associated with higher dose irradiation to mandibular. Use of IMPT minimized excess irradiation of the mandible and consequently reduced the risk of osteoradionecrosis for oropharyngeal cancer.
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Affiliation(s)
- Wencheng Zhang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Radiation Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China
| | - Xiaodong Zhang
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - Pei Yang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Pierre Blanchard
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Adam S Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Brandon Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - C David Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Mark Chambers
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Katherine A Hutcheson
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Rong Ye
- Department of Quantitative Research, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Stephen Y Lai
- Department of Head & Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Mohamed Abdallah Sherif Radwan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA; Department of Clinical Oncology and Nuclear Medicine, Faculty of Medicine, University of Alexandria, Egypt
| | - X Ron Zhu
- Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA.
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Mandibular reconstruction with vascularised bone flaps: a systematic review over 25 years. Br J Oral Maxillofac Surg 2017; 55:113-126. [DOI: 10.1016/j.bjoms.2016.12.010] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 12/02/2016] [Indexed: 11/19/2022]
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Lawal HS, Adebola RA, Arotiba JT, Amole IO, Efunkoya AA, Omeje UK, Amole TG, Adeoye JB. Quality of life of patients surgically treated for ameloblastoma. Niger Med J 2016; 57:91-8. [PMID: 27226682 PMCID: PMC4872498 DOI: 10.4103/0300-1652.182069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: The surgical management of ameloblastoma can have a profound functional and psychological effect on a patient's quality of life (QoL). The aim of this study was to compare the pre- and post-operative QoL outcomes of patients requiring surgical treatment for ameloblastoma. Patients and Methods: A total number of 30 patients were identified as fulfilling the criteria for this study. They included 18 males and 12 females, aged between 14 and 47 years with a mean of 27.3 years (standard deviation 10.2). Each patient completed a modified version of the University of Washington QoL questionnaire version 4, a day to surgery and postoperatively on the 7th day, 3 months, and 6 months. Results: Following surgical treatment of patients for ameloblastoma, the QoL decreased immediately after surgery. It then gradually improved over time and exceeded the preoperative value at 6 months postoperatively. When analyzed with respect to location, posteriorly placed tumors had the best postoperative QoL outcome. Patients expressed concern more about their appearance preoperatively while postoperative concerns were mostly focused on their ability to chew. Conclusion: Significant improvement occurred in QoL scores following surgical management of ameloblastoma. The small sample size utilized in this study limits a definitive conclusion. A larger multicenter study is therefore recommended.
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Affiliation(s)
- Hammed Sikiru Lawal
- Department of Dental and Maxillofacial Surgery, Federal Medical Center, Birnin-Kudu, Jigawa, Nigeria
| | | | - Juwon Tunde Arotiba
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Ibadan, Oyo, Nigeria
| | | | | | - Uchenna Kelvin Omeje
- Department of Oral and Maxillofacial Surgery, Bayero University Kano, Kano, Nigeria
| | - Taiwo Gboluwaga Amole
- Department of Community Medicine, Faculty of Clinical Sciences, Bayero University Kano, Kano, Nigeria
| | - Joshua Biodun Adeoye
- Department of Preventive Dentistry, Faculty of Dentistry, Bayero University Kano, Kano, Nigeria
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Fibula free flap in the treatment of mandibular osteoradionecrosis. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:7-11. [DOI: 10.1016/j.anorl.2015.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Longitudinal evaluation of health-related quality of life after osteoradionecrosis of the mandible. Br J Oral Maxillofac Surg 2015; 53:854-7. [DOI: 10.1016/j.bjoms.2015.07.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 07/10/2015] [Indexed: 11/17/2022]
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IMF-screws or arch bars as conservative treatment for mandibular condyle fractures: Quality of life aspects. J Craniomaxillofac Surg 2015; 43:1004-9. [DOI: 10.1016/j.jcms.2015.05.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 04/05/2015] [Accepted: 05/19/2015] [Indexed: 11/24/2022] Open
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Jacobsen HC, Wahnschaff F, Trenkle T, Sieg P, Hakim SG. Oral rehabilitation with dental implants and quality of life following mandibular reconstruction with free fibular flap. Clin Oral Investig 2015; 20:187-92. [DOI: 10.1007/s00784-015-1487-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Accepted: 05/04/2015] [Indexed: 10/23/2022]
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Rice N, Polyzois I, Ekanayake K, Omer O, Stassen LF. The management of osteoradionecrosis of the jaws – A review. Surgeon 2015; 13:101-9. [DOI: 10.1016/j.surge.2014.07.003] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2014] [Revised: 07/02/2014] [Accepted: 07/04/2014] [Indexed: 01/10/2023]
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Fan S, Wang YY, Lin ZY, Zhang DM, Yu X, Chen WX, Zhong JL, Li QX, Feng YH, Chen WL, Pan CB, Dias-Ribeiro E, Sonoda CK, Ye JT, Li JS. Synchronous reconstruction of bilateral osteoradionecrosis of the mandible using a single fibular osteocutaneous flap in patients with nasopharyngeal carcinoma. Head Neck 2015; 38 Suppl 1:E607-12. [PMID: 25783596 DOI: 10.1002/hed.24049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/06/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The reconstruction of bilateral osteoradionecrosis (ORN) of mandibular defects using a single free bone flap is rarely performed because extensively radiated neck tissue with severe fibrosis is usually unsuitable for vascularized reconstruction. METHODS Thirty-one patients with nasopharyngeal carcinoma (NPC) underwent bilateral reconstruction of advanced ORN in the mandible using a single fibular osteocutaneous flap. Clinical factors associated with the operation were assessed, including classification of mandible defects, types of recipient vessels, perioperative complications, and postoperative outcomes. RESULTS All of the fibular osteocutaneous flaps survived completely, with the exception of 1 inner skin paddle that presented partial necrosis in a reconstruction of through-and-through defects. All patients experienced an improvement in cosmetic results 6 months after the reconstruction, whereas 23 patients experienced improved mouth opening compared to the preoperative condition. CONCLUSION Advanced bilateral ORN in patients with NPC could be synchronously reconstructed with a single fibular osteocutaneous flap. © 2015 Wiley Periodicals, Inc. Head Neck 38: E-E, 2016.
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Affiliation(s)
- Song Fan
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - You-Yuan Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhao-Yu Lin
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Da-Ming Zhang
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Xin Yu
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei-Xiong Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jiang-Long Zhong
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qun-Xing Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yu-Huan Feng
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Wei-Liang Chen
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Chao-Bin Pan
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Eduardo Dias-Ribeiro
- Department of Oral and Maxillofacial Surgery, Dental School of Araçatuba, Universidade Estadual Paulista (UNESP), Araçatuba, São Paulo, Brazil
| | - Celso Koogi Sonoda
- Department of Oral and Maxillofacial Surgery, Dental School of Araçatuba, Universidade Estadual Paulista (UNESP), Araçatuba, São Paulo, Brazil
| | - Jian-Tao Ye
- Department of Prosthodontics, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jin-Song Li
- Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital of Sun Yat-Sen University, Guangzhou, China
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Duchnay M, Tenenbaum H, Wood R, Raziee HR, Shah PS, Azarpazhooh A. Interventions for preventing osteoradionecrosis of the jaws in people receiving head and neck radiotherapy. Hippokratia 2015. [DOI: 10.1002/14651858.cd011559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Michael Duchnay
- University of Toronto; Faculty of Dentistry; Suite 511 124 Edward Street Toronto ON Canada M5G 1G6
| | - Howard Tenenbaum
- University of Toronto; Faculty of Dentistry; Suite 511 124 Edward Street Toronto ON Canada M5G 1G6
| | - Robert Wood
- Princess Margaret Hospital, University Health Network; Department of Dental Oncology, Ocular and Maxillofacial Prosthetics; 610 University Avenue Toronto ON Canada M5G 2M9
| | - Hamid Reza Raziee
- Princess Margaret Hospital, University of Toronto; Department of Radiation Oncology, Faculty of Medicine; 610 University Avenue Toronto ON Canada M5G 2M9
| | - Prakeshkumar S Shah
- University of Toronto Mount Sinai Hospital; Department of Paediatrics and Health Policy, Management and Evaluation; 600 University Avenue Toronto ON Canada M5G 1XB
| | - Amir Azarpazhooh
- Faculty of Dentistry, University of Toronto; Discipline of Dental Public Health, Discipline of Endodontics; 515-C, 124 Edward St Toronto ON Canada M5G 1G6
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Kim MG, Lee ST, Park JY, Choi SW. Reconstruction with fibular osteocutaneous free flap in patients with mandibular osteoradionecrosis. Maxillofac Plast Reconstr Surg 2015; 37:7. [PMID: 25685753 PMCID: PMC4322236 DOI: 10.1186/s40902-015-0007-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 01/13/2015] [Indexed: 11/10/2022] Open
Abstract
Background Osteoradionecrosis is a delayed complication from radiation therapy which causes chronic pain, infection and constant deformity after necrosis. Most of the osteoradionecrosis occurs spontaneously or after the primary oncologic surgery, dental extraction or by trauma of prosthesis. The treatment of osteoradionecrosis relies on both conservative measures and surgical measures. The fibular osteocutaneous free flap has become more popular choice for reconstruction of maxillofacial defects as a treatment of osteoradionecrosis. Methods We presented our experiences from 7 patients with osteoradionecrosis who have had reconstruction surgery with fibular osteocutaneous free flap at National Cancer Center during the recent 5 years. We performed segmental mandibular resection with fibular osteocutaneous free flap for all 7 patients of advanced osteoradionecrosis who were not controlled by conservative treatment such as wound irrigation, debridement, and antibiotics. Results A wide range of techniques were available for the reconstruction of composite defects resulted from the treatment of advanced mandibular osteoradionecrosis. Significant improvement was noted in relieving pain and treating trismus after the surgery however difficulty in swallowing and xerostomia showed less improvement. Conclusions We concluded that fibular osteocutaneous free flap can be performed safely in patients with osteoradionecrosis and yields positive outcomes with significantly increased success rate. The fibular osteocutaneous free flap was our preferred choice for the mandibular reconstruction due to its versatility and predictability.
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Affiliation(s)
- Min Gyun Kim
- Oral Oncology Clinic, Research Institute and Hospital, National Cancer Center, Il san east, Il san road 323, 2nd floor, Goyang, South Korea
| | - Seung Tae Lee
- Oral Oncology Clinic, Research Institute and Hospital, National Cancer Center, Il san east, Il san road 323, 2nd floor, Goyang, South Korea
| | - Joo Yong Park
- Oral Oncology Clinic, Research Institute and Hospital, National Cancer Center, Il san east, Il san road 323, 2nd floor, Goyang, South Korea
| | - Sung Weon Choi
- Oral Oncology Clinic, Research Institute and Hospital, National Cancer Center, Il san east, Il san road 323, 2nd floor, Goyang, South Korea
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Li X, Zhu K, Liu F, Li H. Assessment of quality of life in giant ameloblastoma adolescent patients who have had mandible defects reconstructed with a free fibula flap. World J Surg Oncol 2014; 12:201. [PMID: 25004805 PMCID: PMC4113126 DOI: 10.1186/1477-7819-12-201] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 06/29/2014] [Indexed: 12/01/2022] Open
Abstract
Background The reconstruction of mandibular defects after giant ameloblastoma resection is one of the most challenging problems facing reconstructive surgeons. Mandibular resection has been associated with a poor quality of life (QOL), particularly in adolescent patients reconstructed with a free fibula flap. This study aims to evaluate QOL outcomes in adolescent patients who have had mandibular resections of giant ameloblastoma and reconstruction with a free fibula flap and to collect information about their socio-cultural situation. Methods The present study assessed 45 adolescent patients who had undergone immediate mandible reconstruction with a free fibula flap for faint ameloblastoma using University of Washington Quality of Life (UW-QOL) and 14-item Oral Health Impact Profile (OHIP-14) questionnaires. Results Thirty-five of the 54 questionnaires were returned (64.81%). In the UW-QOL, of the twelve disease-specific domains, the best three scores from the patients related to pain, shoulder and appearance and the worst three scores related to chewing, anxiety and saliva. In the OHIP-14, the lowest-scoring domain was handicap, followed by physical pain and social disability. Conclusions Mandibular reconstruction with a free fibular flap significantly influenced the adolescent patients’ QOL. Adolescent patients pay more attention to postoperative facial appearance; this should be considered in surgical planning.
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Affiliation(s)
| | | | | | - Hongwen Li
- Dermatology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou university, Zhengzhou, Henan 450052, China.
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Hillerup S, Elberg JJ, Thorn JJ, Andersen M. Reconstruction of irradiated mandible after segmental resection of osteoradionecrosis-a technique employing a microvascular latissimus dorsi flap and subsequent particulate iliac bone grafting. Craniomaxillofac Trauma Reconstr 2014; 7:190-6. [PMID: 25136407 DOI: 10.1055/s-0034-1371003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 05/27/2013] [Indexed: 10/25/2022] Open
Abstract
The fibula osteocutaneous flap has revolutionized the options of mandibular segmental defect bridging in osteoradionecrosis (ORN). In selected cases, however, the fibula flap is not an option because of atherosclerosis or other features that compromise the vascularity of the lower leg and foot. The aim of this study is to present an alternative method of mandibular segmental reconstruction employing a latissimus dorsi (LD) flap and subsequent particulate iliac free bone graft reconstruction. In 15 patients with ORN, a mandibular segmental defect was bridged with a reconstruction plate, and the defect site was primed with a LD musculocutaneous flap wrapped around the reconstruction plate to bring in vascularized tissue and optimize healing conditions for a subsequent particulate iliac free bone graft reconstruction. The management of defect closure was successful in all 15 patients. Twelve patients had a subsequent bone grafting from the posterior ileum for repair of defects up to 14 cm length. Three patients had no bone graft for various reasons. In three patients dental rehabilitation was achieved with implant supported prosthodontic appliances. Ten patients met the success criteria of uneventful graft healing with restitution of osseous continuity, mandibular height, symmetry and function, and avoidance of reconstruction plate fracture.
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Affiliation(s)
- Soren Hillerup
- Department of Oral and Maxillofacial Surgery, Rigshospitalet, University of Copenhagen
| | - Jens Jorgen Elberg
- Department of Plastic and Reconstructive Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Jorgen Thorn
- Department of Oral and Maxillofacial Surgery, Hospital of South-West Denmark, Esbjerg, Denmark
| | - Mikael Andersen
- Department of Plastic and Reconstructive Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Zhu J, Yang Y, Li W. Assessment of quality of life and sociocultural aspects in patients with ameloblastoma after immediate mandibular reconstruction with a fibular free flap. Br J Oral Maxillofac Surg 2014; 52:163-7. [DOI: 10.1016/j.bjoms.2013.10.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 10/31/2013] [Indexed: 12/01/2022]
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Luo R, li P, Li W, Li Y, Qi J. Measures of Health-related Quality of Life in Huge Ameloblastoma Young Patients after Mandible Reconstruction with Free Fibula Flap. J HARD TISSUE BIOL 2014. [DOI: 10.2485/jhtb.23.261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Mücke T, Koschinski J, Rau A, Loeffelbein DJ, Deppe H, Mitchell DA, Kanatas A, Wolff KD. Surgical outcome and prognostic factors after treatment of osteoradionecrosis of the jaws. J Cancer Res Clin Oncol 2012; 139:389-94. [DOI: 10.1007/s00432-012-1337-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 10/09/2012] [Indexed: 10/27/2022]
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Nguyen NP, Vock J, Chi A, Ewell L, Vos P, Mills M, Khan R, Almeida F, Davis R, Betz M, Jang S, Gelumbauskas S, Vo RP, Vinh-Hung V. Effectiveness of intensity-modulated and image-guided radiotherapy to spare the mandible from excessive radiation. Oral Oncol 2012; 48:653-7. [DOI: 10.1016/j.oraloncology.2012.01.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 01/24/2012] [Accepted: 01/25/2012] [Indexed: 11/28/2022]
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Sweeny L, Lancaster WP, Dean NR, Magnuson JS, Carroll WR, Louis PJ, Rosenthal EL. Use of recombinant bone morphogenetic protein 2 in free flap reconstruction for osteonecrosis of the mandible. J Oral Maxillofac Surg 2011; 70:1991-6. [PMID: 22177824 DOI: 10.1016/j.joms.2011.08.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 07/22/2011] [Accepted: 08/28/2011] [Indexed: 12/21/2022]
Abstract
PURPOSE Osteoradionecrosis of the mandible is a debilitating consequence of radiation therapy for head-and-neck malignancy. It can result in pain, bone exposure, fistula formation, and pathologic fracture. Recombinant human bone morphogenetic protein 2 (rhBMP-2) has shown promise in reconstruction of bone defects. The purpose of this study is to determine whether the addition of rhBMP-2 at the union of vascularized bone and native bone improves surgical outcomes in patients with osteonecrosis of the mandible. MATERIALS AND METHODS This study was a retrospective analysis of patients who were treated between 2006 and 2010 for osteonecrosis of the mandible. Patients requiring definitive reconstruction after failure of a course of conservative management were included. Patients were divided into 2 cohorts depending on whether rhBMP-2 was used during the reconstruction. The primary outcome measure was defined as stable mandibular union. RESULTS Seventeen patients were included. The development of malunion was similar in both groups (13% for rhBMP-2 group vs 11% for non-rhBMP-2 group). Infectious complications were similar between the groups (25% in rhBMP-2 group vs 56% in non-rhBMP-2 group, P = .33). The rates of hardware removal were similar for the 2 groups (33% in non-rhBMP-2 group vs 25% in rhBMP-2 group, P = .10). No cancer recurrences were observed in patients receiving rhBMP-2. CONCLUSIONS The use of rhBMP-2 is safe in free flap reconstruction of the mandible, but its ability to significantly improve patient outcomes, as measured by rates of malunion, reoperation, or infection, is still unknown.
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Affiliation(s)
- Larissa Sweeny
- National Institutes of Health Research Fellow, Department of Surgery, Division of Otolaryngology-Head and Neck Surgery, University of Alabama at Birmingham, Birmingham, AL 35294-0012, USA
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Chang EI, Leon P, Hoffman WY, Schmidt BL. Quality of life for patients requiring surgical resection and reconstruction for mandibular osteoradionecrosis: 10-year experience at the university of California San Francisco. Head Neck 2011; 34:207-12. [DOI: 10.1002/hed.21715] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2010] [Indexed: 11/10/2022] Open
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Nabil S, Samman N. Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review. Int J Oral Maxillofac Surg 2011; 40:229-43. [DOI: 10.1016/j.ijom.2010.10.005] [Citation(s) in RCA: 152] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 10/06/2010] [Indexed: 10/18/2022]
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Laraway DC, Rogers SN. A structured review of journal articles reporting outcomes using the University of Washington Quality of Life Scale. Br J Oral Maxillofac Surg 2011; 50:122-31. [PMID: 21239091 DOI: 10.1016/j.bjoms.2010.12.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2010] [Accepted: 12/15/2010] [Indexed: 02/07/2023]
Abstract
The University of Washington Quality of Life Scale (UW-QoL) is one of the most frequently reported health-related quality of life (HR-QoL) questionnaires in head and neck cancer, and since its first publication in 1993 has been used in many different cohorts. There is a considerable amount of information to assimilate and, to date, we know of no attempt that has been made to summarise publications specific to its use in a peer review journal. The aim of this review was to systematically search published papers that report its use, identify common themes, and present a tabulated summary. Several search engines were used (PubMed, Medline, Medical-Journals.com, eMedicine), and 222 abstracts were found and hand searched. A total of 66 papers were eligible for inclusion, 21 on functional outcome, 25 on predictors of HR-QoL, 19 on development or validation of the questionnaire, and one clinical trial. The review includes a diversity of studies and a range of HR-QoL outcomes following head and neck cancer. It provides clinicians and their colleagues in multidisciplinary teams with a source of quick reference to relevant papers reporting the UW-QoL, and gives a short summary of the pertinent conclusions drawn from each paper.
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Affiliation(s)
- D C Laraway
- Liverpool Dental School, Pembroke Place, University of Liverpool, Liverpool L69 3BX, UK.
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