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Callahan N, Pu JJ, Richard Su YX, Zbarsky SJD, Weyh A, Viet CT. Benefits and Controversies of Midface and Maxillary Reconstruction. Atlas Oral Maxillofac Surg Clin North Am 2024; 32:109-116. [PMID: 39059870 DOI: 10.1016/j.cxom.2023.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Affiliation(s)
- Nicholas Callahan
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, 801 South Paulina Street, Chicago, IL 60612, USA.
| | - Jane Jingya Pu
- Division of Oral and Maxillofacial Surgery, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China
| | - Yu-Xiong Richard Su
- Division of Oral and Maxillofacial Surgery, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong SAR, China
| | - Steven J D Zbarsky
- Department of Oral & Maxillofacial Surgery, Loma Linda University, 11092 Anderson Street 3304, Loma Linda, CA 92350, USA
| | - Ashleigh Weyh
- Department of Oral and Maxillofacial Surgery, University of Illinois Chicago, 801 South Paulina Street, Chicago, IL 60612, USA
| | - Chi T Viet
- Oral Maxillofacial Surgery, Loma Linda University, 11092 Anderson Street 3304, Loma Linda, CA 92350, USA
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2
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Watson EE, Hueniken K, Lee J, Huang SH, El Maghrabi A, Xu W, Moreno AC, Tsai CJ, Hahn E, McPartlin AJ, Yao CMKL, Goldstein DP, De Almeida JR, Waldon JN, Fuller CD, Hope AJ, Ruggiero SL, Glogauer M, Hosni AA. Development and Standardization of an Osteoradionecrosis Classification System in Head and Neck Cancer: Implementation of a Risk-Based Model. J Clin Oncol 2024; 42:1922-1933. [PMID: 38691822 DOI: 10.1200/jco.23.01951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/01/2023] [Accepted: 02/26/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE Osteoradionecrosis of the jaw (ORN) can manifest in varying severity. The aim of this study is to identify ORN risk factors and develop a novel classification to depict the severity of ORN. METHODS Consecutive patients with head and neck cancer (HNC) treated with curative-intent intensity-modulated radiation therapy (IMRT) (≥45 Gy) from 2011 to 2017 were included. Occurrence of ORN was identified from in-house prospective dental and clinical databases and charts. Multivariable logistic regression model was used to identify risk factors and stratify patients into high-risk and low-risk groups. A novel ORN classification system was developed to depict ORN severity by modifying existing systems and incorporating expert opinion. The performance of the novel system was compared with 15 existing systems for their ability to identify and predict serious ORN event (jaw fracture or requiring jaw resection). RESULTS ORN was identified in 219 of 2,732 (8%) consecutive patients with HNC. Factors associated with high risk of ORN were oral cavity or oropharyngeal primaries, received IMRT dose ≥60 Gy, current/ex-smokers, and/or stage III to IV periodontal condition. The ORN rate for high-risk versus low-risk patients was 12.7% versus 3.1% (P < .001) with an AUC of 0.71. Existing ORN systems overclassified serious ORN events and failed to recognize maxillary ORN. A novel ORN classification system, ClinRad, was proposed on the basis of vertical extent of bone necrosis and presence/absence of exposed bone/fistula. This system detected serious ORN events in 5.7% of patients and statistically outperformed existing systems. CONCLUSION We identified risk factors for ORN and proposed a novel ORN classification system on the basis of vertical extent of bone necrosis and presence/absence of exposed bone/fistula. It outperformed existing systems in depicting the seriousness of ORN and may facilitate clinical care and clinical trials.
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Affiliation(s)
- Erin E Watson
- Department of Dental Oncology, Princess Margaret Cancer Centre, Toronto, ON
- Faculty of Dentistry, University of Toronto, Toronto, ON
| | - Katrina Hueniken
- Department of Biostatistics, University Health Network, Toronto, ON
| | - Junhyung Lee
- Department of Dental Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - Shao Hui Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON
| | - Amr El Maghrabi
- Department of Dental Oncology, Princess Margaret Cancer Centre, Toronto, ON
| | - Wei Xu
- Department of Biostatistics, University Health Network, Toronto, ON
| | | | - C Jillian Tsai
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON
| | - Andrew J McPartlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON
| | - Christopher M K L Yao
- Department of Otolaryngology-Head & Neck Surgery, University Health Network/University of Toronto, Toronto, ON
| | - David P Goldstein
- Department of Otolaryngology-Head & Neck Surgery, University Health Network/University of Toronto, Toronto, ON
| | - John R De Almeida
- Department of Otolaryngology-Head & Neck Surgery, University Health Network/University of Toronto, Toronto, ON
- Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - John N Waldon
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON
| | - Clifton D Fuller
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON
| | - Andrew J Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON
| | - Salvatore L Ruggiero
- Department of Oral and Maxillofacial Surgery, Stony Brook University, Stony Brook, NY
- Hofstra North Shore-LIJ School of Medicine, Uniondale, NY
| | | | - Ali A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, ON
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Lee J, Hueniken K, Cuddy K, Pu J, El Maghrabi A, Hope A, Hosni A, Glogauer M, Watson E. Dental Extractions Before Radiation Therapy and the Risk of Osteoradionecrosis in Patients With Head and Neck Cancer. JAMA Otolaryngol Head Neck Surg 2023; 149:1130-1139. [PMID: 37856115 PMCID: PMC10587826 DOI: 10.1001/jamaoto.2023.3429] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 09/07/2023] [Indexed: 10/20/2023]
Abstract
Importance Patients with head and neck cancer undergo extraction of teeth with poor prognoses to minimize post-radiation therapy (RT) extractions, which are known to cause osteoradionecrosis (ORN). However, many patients are required to start RT before the extraction sites are completely healed. The role of pre-RT extractions in the development of ORN has been disputed in literature. Objective To determine whether the timing of pre-RT dental extractions is associated with ORN development in patients with head and neck cancer. Design, Setting, and Participants This retrospective cohort study was conducted at a single institution (Princess Margaret Cancer Centre, Toronto, Canada) between January 1, 2011, and January 1, 2018, and included 879 patients with head and neck cancer who underwent pre-RT dental extractions before curative RT of 45 Gy or greater. Patient demographic information and clinical characteristics (eg, primary cancer site, nodal involvement, chemotherapy, smoking status, dental pathology) were considered. Data analyses were performed from July to December 2022. Main outcomes and measures Timing (number of days) from dental extractions to RT start date and pre-RT extractions categorized as healed, minor bone spicules (MBS), or ORN. Results The study population consisted of 879 patients with a median (range) age of 62 (20-96) years, with 685 men (78%) and 194 women (22%). Of these, 847 (96.3%) healed from pre-RT dental extractions, 16 (1.8%) developed MBS, and 16 (1.8%) developed ORN. The median (range) time in number of days from pre-RT extraction(s) to start of RT was 9 (0-98) days in the healed cohort, 6 (3-23) days in the MBS cohort, and 6 (0-12) days in the ORN cohort. There was a large difference in the timing of pre-RT extractions between the healed and the MBS cohorts (mean 11.9 vs 7.4 days to radiation; difference 4.4; 95% CI, 1.5-7.3), and the healed and the ORN cohorts (mean 11.9 vs 7.1 days; difference 4.8 days; 95% CI, 2.6-7.1). Conclusion The findings of this retrospective cohort study suggest that there was an important association between the timing of pre-RT dental extractions and ORN when extractions occurred within 7 days of the RT start date. Despite this, ORN after pre-RT extractions is relatively rare. These findings indicate that patients with head and neck cancer who are to undergo RT should not delay treatment for extractions when it might compromise oncologic control.
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Affiliation(s)
- Junhyung Lee
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Katrina Hueniken
- Department of Biostatistics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Karl Cuddy
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Toronto, Ontario, Canada
| | - Jiajie Pu
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Amr El Maghrabi
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Andrew Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Ali Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Michael Glogauer
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
| | - Erin Watson
- Department of Dental Oncology and Maxillofacial Prosthetics, Princess Margaret Cancer Centre, Toronto, Ontario, Canada
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
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Watson EE, Hueniken K, Lee J, Huang SH, Maghrabi A AE, Xu W, Moreno AC, Tsai CJ, Hahn E, McPartlin AJ, Yao CM, Goldstein DP, De Almeida JR, Waldon JN, Fuller CD, Hope AJ, Ruggiero SL, Glogauer M, Hosni AA. Development and Standardization of a Classification System for Osteoradionecrosis: Implementation of a Risk-Based Model. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.09.12.23295454. [PMID: 37745576 PMCID: PMC10516072 DOI: 10.1101/2023.09.12.23295454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Purpose Osteoradionecrosis of the jaw (ORN) can manifest in varying severity. The aim of this study is to identify ORN risk factors and develop a novel classification to depict the severity of ORN. Methods Consecutive head-and-neck cancer (HNC) patients treated with curative-intent IMRT (≥ 45Gy) in 2011-2018 were included. Occurrence of ORN was identified from in-house prospective dental and clinical databases and charts. Multivariable logistic regression model was used to identify risk factors and stratify patients into high-risk and low-risk groups. A novel ORN classification system was developed to depict ORN severity by modifying existing systems and incorporating expert opinion. The performance of the novel system was compared to fifteen existing systems for their ability to identify and predict serious ORN event (jaw fracture or requiring jaw resection). Results ORN was identified in 219 out of 2732 (8%) consecutive HNC patients. Factors associated with high-risk of ORN were: oral-cavity or oropharyngeal primaries, received IMRT dose ≥60Gy, current/ex-smokers, and/or stage III-IV periodontal disease. The ORN rate for high-risk vs low-risk patients was 12.7% vs 3.1% (p<0.001) with an area-under-the-receiver-operating-curve (AUC) of 0.71. Existing ORN systems overclassified serious ORN events and failed to recognize maxillary ORN. A novel ORN classification system, RadORN, was proposed based on vertical extent of bone necrosis and presence/absence of exposed bone/fistula. This system detected serious ORN events in 5.7% of patients and statistically outperformed existing systems. Conclusion We identified risk factors for ORN, and proposed a novel ORN classification system based on vertical extent of bone necrosis and presence/absence of exposed bone/fistula. It outperformed existing systems in depicting the seriousness of ORN, and may facilitate clinical care and clinical trials.
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Affiliation(s)
- Erin E Watson
- Department of Dental Oncology, Princess Margaret Cancer Centre
- Faculty of Dentistry, University of Toronto
| | | | - Junhyung Lee
- Department of Dental Oncology, Princess Margaret Cancer Centre
| | - Sophie H Huang
- Department of Radiation Oncology, Princess Margaret Cancer Centre; University of Toronto
| | | | - Wei Xu
- Department of Biostatistics, University Health Network
| | - Amy C Moreno
- The University of Texas MD Anderson Cancer Center, Department of Radiaion Oncology
| | - C Jillian Tsai
- Department of Radiation Oncology, Princess Margaret Cancer Centre; University of Toronto
| | - Ezra Hahn
- Department of Radiation Oncology, Princess Margaret Cancer Centre; University of Toronto
| | - Andrew J McPartlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre; University of Toronto
| | - Christopher Mkl Yao
- Department of Otolaryngology - Head & Neck Surgery, University Health Network; University of Toronto
| | - David P Goldstein
- Department of Otolaryngology - Head & Neck Surgery, University Health Network; University of Toronto
| | - John R De Almeida
- Department of Otolaryngology - Head & Neck Surgery, University Health Network; University of Toronto
- Institute for Health Policy, Management and Evaluation, University of Toronto
| | - John N Waldon
- Department of Radiation Oncology, Princess Margaret Cancer Centre; University of Toronto
| | - Clifton David Fuller
- The University of Texas MD Anderson Cancer Center, Department of Radiaion Oncology
| | - Andrew J Hope
- Department of Radiation Oncology, Princess Margaret Cancer Centre; University of Toronto
| | - Salvatore L Ruggiero
- Department of Oral and Maxillofacial Surgery, Stony Brook University
- Hofstra North Shore-LIJ School of Medicine
| | | | - Ali A Hosni
- Department of Radiation Oncology, Princess Margaret Cancer Centre; University of Toronto
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Mejía-Chuquispuma NJ, Flores-Jiménez KV, Castro-Auqui AC, Mattos-Vela MA. Manejo odontológico de las manifestaciones orales inducidas por radioterapia de cabeza y cuello. BIONATURA 2023. [DOI: 10.21931/rb/2023.08.01.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023] Open
Abstract
La radioterapia es una de las primeras opciones de tratamiento para el cáncer de cabeza y cuello; sin embargo, puede ocasionar diversas manifestaciones secundarias en la cavidad oral tales como mucositis oral, xerostomía, infecciones orales oportunistas, osteorradionecrosis y trismo. El presente artículo tiene como objetivo describir el manejo preventivo y terapéutico de las complicaciones orales inducidas por radioterapia de cabeza y cuello en la práctica odontológica propuestos hasta la actualidad. Se encontraron diversas medidas que han logrado reducir la incidencia y gravedad de dichas manifestaciones orales; sin embargo, aún existen algunas que requieren de más estudios para confirmar su efectividad.
Palabras clave: cáncer de cabeza y cuello; manifestaciones bucales; radioterapia; terapéutica.
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McIlwain W, Inman J, Namin A, Kazi A, Shumrick C, Ducic Y. Management of Palatal Defects after Free-Flap Reconstruction and Radiotherapy. Semin Plast Surg 2023; 37:39-45. [PMID: 36776801 PMCID: PMC9911226 DOI: 10.1055/s-0042-1759797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Palatal fistulas have significant effects on quality of life. Traditional prosthetic rehabilitation and surgical reconstruction of palate defects in radiation-naïve tissues are well described. However, palatal fistulas developing after initial tumor extirpation, free-flap reconstruction, and adjuvant radiation or chemoradiation are associated with challenging secondary tissue effects. In this review, we will discuss the management of palatal fistulas after surgical reconstruction and radiotherapy.
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Affiliation(s)
- Wesley McIlwain
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Jared Inman
- Otolaryngology/Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Arya Namin
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| | - Aasif Kazi
- Otolaryngology/Head and Neck Surgery, Loma Linda University Medical Center, Loma Linda, California
| | - Christopher Shumrick
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
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Schlafstein A, Shu HK. Osteoradionecrosis of the craniotomy flap: a rare complication of stereotactic radiosurgery. Oxf Med Case Reports 2022; 2022:omac032. [PMID: 35464899 PMCID: PMC9021968 DOI: 10.1093/omcr/omac032] [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: 12/01/2021] [Revised: 02/09/2022] [Accepted: 02/14/2022] [Indexed: 11/17/2022] Open
Abstract
Osteoradionecrosis (ORN), ischemic necrosis of irradiated bone without evidence of persisting or recurrent tumor, is a known complication of radiation therapy. ORN of the skull has not been reported following stereotactic radiosurgery (SRS). We report two cases of ORN of the skull following SRS for recurrent meningiomas post-resection. Both patients developed ORN in their craniotomy flaps in areas that received high doses of radiation due to their proximity to the recurrent tumors. In each case, the ORN was asymptomatic and was detected on surveillance magnetic resonance imaging. Both patients were followed closely with imaging that ultimately revealed either stability or improvement in the ORN, confirming the diagnosis without the need for biopsy. The cases reveal a role for close imaging surveillance instead of immediate biopsy in patients with new enhancement involving bone in high-dose radiation treatment regions.
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Affiliation(s)
- Ashley Schlafstein
- Department of Radiation Oncology, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA
| | - Hui-Kuo Shu
- Department of Radiation Oncology, Emory University School of Medicine, 1365 Clifton Road, Atlanta, GA 30322, USA
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Materials and Manufacturing Techniques for Polymeric and Ceramic Scaffolds Used in Implant Dentistry. JOURNAL OF COMPOSITES SCIENCE 2021. [DOI: 10.3390/jcs5030078] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Preventive and regenerative techniques have been suggested to minimize the aesthetic and functional effects caused by intraoral bone defects, enabling the installation of dental implants. Among them, porous three-dimensional structures (scaffolds) composed mainly of bioabsorbable ceramics, such as hydroxyapatite (HAp) and β-tricalcium phosphate (β-TCP) stand out for reducing the use of autogenous, homogeneous, and xenogenous bone grafts and their unwanted effects. In order to stimulate bone formation, biodegradable polymers such as cellulose, collagen, glycosaminoglycans, polylactic acid (PLA), polyvinyl alcohol (PVA), poly-ε-caprolactone (PCL), polyglycolic acid (PGA), polyhydroxylbutyrate (PHB), polypropylenofumarate (PPF), polylactic-co-glycolic acid (PLGA), and poly L-co-D, L lactic acid (PLDLA) have also been studied. More recently, hybrid scaffolds can combine the tunable macro/microporosity and osteoinductive properties of ceramic materials with the chemical/physical properties of biodegradable polymers. Various methods are suggested for the manufacture of scaffolds with adequate porosity, such as conventional and additive manufacturing techniques and, more recently, 3D and 4D printing. The purpose of this manuscript is to review features concerning biomaterials, scaffolds macro and microstructure, fabrication techniques, as well as the potential interaction of the scaffolds with the human body.
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