Osseointegrated implants for prosthetic rehabilitation after treatment of cancer of the oral cavity

Factors Influencing the Survival Rate of Teeth and Implants in Patients after Tumor Therapy to the Head and Neck Region-Part 2: Implant Survival

During prosthetic rehabilitation after tumor therapy (TT) in the head and neck region, the dentist must assess whether the prognosis of the remaining teeth is sufficiently good or whether implants should be used to anchor dentures. Thus, the aim of the present study was to compare the survival rate of teeth and implants after TT and to evaluate factors potentially influencing implant survival. One hundred fifteen patients (male: 70.3%; mean age: 63.2 ± 12.4 years) having received dental treatment before and after TT at the Martin Luther University Halle-Wittenberg were enrolled in the study. Clinical examination including assessment of dental status and stimulated salivary flow rate was performed. Information about disease progression and therapy was retrieved from medical records. After TT, from a total of 1262 teeth, 27.2% had to be extracted. Of 308 implants inserted after TT, 7.0% were lost. Teeth exhibited lower 5-year survival probability (76.8%) than implants (89.9%; p = 0.001). The risk of loss (RL) of implants increased with age, nicotine use, intraoral defects, and RCT. Radiotherapy did not independently increase the RL. Thus, implants seem to be a reliable treatment option in case of progressive tooth decay after TT, particularly after RT.

Factors Influencing the Survival Rate of Teeth and Implants in Patients after Tumor Therapy to the Head and Neck Region-Part 1: Tooth Survival

We aimed to evaluate possible factors influencing the long-term survival of teeth after tumor therapy (TT) to the head and neck region with and without radiation. Between January 2019 and January 2020, patients who underwent TT for head and neck cancer and received dental treatment before and after TT at the Department of Prosthetic Dentistry of the Martin Luther University Halle-Wittenberg were enrolled in the study. Clinical examination with assessment of dental status and stimulated salivary flow rate (SFR) was performed and information about disease progression and therapy was retrieved from medical records. Of 118 patients (male: 70.3%; mean age: 63.2 ± 12.4 years), 95 received radiotherapy (RT), and 47 were administered radio-chemotherapy (RCT). The teeth of irradiated patients exhibited a lower 5-year survival probability (74.2%) than those of non-irradiated patients (89.4%). The risk of loss (RL) after RT increased with nicotine use, presence of intraoral defects, reduced SFR, RCT and regarding mandibular teeth, and decreased with crowning following TT. Lower SFR increased the RL even without RT. Consideration of patient's treatment history, individual risk profile, and clinical findings during the prosthetic planning phase could enable earlier, more targeted dental treatment after TT (e.g., timely crowning).

Image-Guided Placement of Osseointegrated Implants for Challenging Auricular, Orbital, and Rhinectomy Defects

OBJECTIVES

Prosthetic reconstruction can restore the preoperative form and function after surgery for head and neck malignancies. We demonstrate the use of preoperative planning and intraoperative image guidance for placement of osseointegrated implants to restore craniofacial defects.

METHODS

A retrospective review of patients with craniofacial defects treated with image-guided placement of osseointegrated prosthetic implants was performed.

RESULTS

Case 1: 55-year-old male who underwent total auriculectomy with anterolateral thigh reconstruction. Case 2: 64-year-old male who required orbital exenteration and total auriculectomy with latissimus dorsi reconstruction. Case 3: 74-year-old male presented after a total rhinectomy. Cases 1 and 3 received adjuvant radiation prior to implantation. Case 2 underwent simultaneous placement of osseointegrated hearing and prosthetic implants. Computed tomography scans were used to perform preoperative planning to determine the optimal implant trajectories and sites. Complications included tissue overgrowth, delayed nonunion of implant, wound infection, and dehiscence.

CONCLUSIONS

Defects following oncologic resection of head and neck malignancies can be difficult to achieve with native tissue alone. Osseointegrated implants offer an excellent means for reconstruction but can be challenging due to limited bone stock and anatomic landmarks. This can be overcome using intraoperative image guidance techniques for prosthetic reconstruction.

A systematic review of functional outcome and quality of life following reconstruction of maxillofacial defects using vascularized free fibula flaps and dental rehabilitation reveals poor data quality

BACKGROUND

Reconstruction and oral rehabilitation of segmental maxillofacial defects resulting from ablative surgery is commonly achieved by osteocutaneous vascularized free fibula (VFFF) transplantation combined with implant-supported dental prostheses. We systematically reviewed the literature regarding impact of oral rehabilitation with or without dental implants on functional outcome and quality of life (Qol) following reconstruction of such segmental maxillofacial defects with VFFF.

METHODS

This systematic review was performed according to the PRISMA guidelines. A literature search was conducted using the databases of Cochrane, MEDLINE and EMBASE. Relevant search terms for maxilla or mandible, reconstruction with VFFF, and oral rehabilitation were used. Two reviewers independently assessed the publications using eligibility and research quality criteria (MINORS).

RESULTS

In total, 554 unique publications were found. After scrutinization, 2 prospective studies and 8 retrospective case-series without comparison were left for ultimate analysis. Quality ranged from 44% to 88% of the maximum score. Overall survival rate of the VFFF was 99% and the survival rate of dental implants was 95%. Speech intelligibility and overall aesthetic outcome were 'good' to 'excellent'. No statistically significant changes in QoL were found. Methods to measure functional outcome varied strongly, making pooling impossible.

CONCLUSIONS

Oral rehabilitation with implant-supported dental prostheses after reconstruction of segmental maxillofacial defects with VFFF results in good to excellent speech intelligibility and aesthetics. Results are probably positively biased by the retrospective nature of the studies. In future prospective research, functional outcome measures should be addressed using standardized questionnaires and validated objective tests with adequate follow-up.

Dental implants in irradiated versus nonirradiated patients: A meta-analysis

The purpose of the present meta-analysis was to test the null hypothesis of no difference in dental implant failure rates, postoperative infection, and marginal bone loss for patients being rehabilitated by dental implants and being previously irradiated in the head and neck region versus nonirradiated patients against the alternative hypothesis of a difference. The study suggests that irradiation negatively affects the survival of implants, as well as the difference in implant location (maxilla vs mandible), but there is no statistically significant difference in survival when implants are inserted before or after 12 months after radiotherapy. The study failed to support the effectiveness of hyperbaric oxygen therapy in irradiated patients. It was observed that there was a tendency of lower survival rates of implants inserted in the patients submitted to higher irradiation doses. The results should be interpreted with caution because of the presence of uncontrolled confounding factors in the included studies.

Oral rehabilitation of segmental mandibulectomy patient with osseointegrated dental implant

Surgical management of oral cancer lesions results in explicit aesthetic and functional disfigurement, including facial deformity, loss of hard and soft tissue, impaired speech, swallowing and mastication, which modify the patient's self-image and quality-of-life. Recent advances in head and neck reconstruction techniques and dental implant based prosthetic rehabilitation may significantly improve the quality-of-life and self-esteem for such post-surgery patients. This clinical report describes rehabilitation of oral cancer patient having segmental mandibulectomy with implant-supported fixed partial denture.

Systematic survey of the dose enhancement in tissue-equivalent materials facing medium- and high-Z backscatterers exposed to X-rays with energies from 5 to 250 keV

The present study has been inspired by the results of earlier dose measurements in tissue-equivalent materials adjacent to thin foils of aluminum, copper, tin, gold, and lead. Large dose enhancements have been observed in low-Z materials near the interface when this ensemble was irradiated with X-rays of qualities known from diagnostic radiology. The excess doses have been attributed to photo-, Compton, and Auger electrons released from the metal surfaces. Correspondingly, high enhancements of biological effects have been observed in single cell layers arranged close to gold surfaces. The objective of the present work is to systematically survey, by calculation, the values of the dose enhancement in low-Z media facing backscattering materials with a variety of atomic numbers and over a large range of photon energies. Further parameters to be varied are the distance of the point of interest from the interface and the kind of the low-Z material. The voluminous calculations have been performed using the PHOTCOEF algorithm, a proven set of interpolation functions fitted to long-established Monte Carlo results, for primary photon energies between 5 and 250 keV and for atomic numbers varying over the periodic system up to Z = 100. The calculated results correlate well with our previous experimental results. It is shown that the values of the dose enhancement (a) vary strongly in dependence upon Z and photon energy; (b) have maxima in the energy region from 40 to 60 keV, determined by the K and L edges of the backscattering materials; and (c) are valued up to about 130 for "International Commission on Radiological Protection (ICRP) soft tissue" (soft tissue composition recommended by the ICRP) as the adjacent low-Z material. Maximum dose enhancement associated with the L edge occurs for materials with atomic numbers between 50 and 60, e.g., barium (Z = 56) and iodine (Z = 53). Such materials typically serve as contrast media in medical X-ray diagnostics. The gradual reduction in the dose enhancement with increasing distance from the material interface, owed to the limited ranges of the emitted secondary electrons, has been documented in detail. The discussion is devoted to practical radiological aspects of the dose enhancement phenomenon. Cytogenetic effects in cell layers closely proximate to surfaces of medium-Z materials might vary over two orders of magnitude, because the dose enhancement is accompanied by the earlier observed about twofold increase in the low-dose RBEM at a tissue-to-gold interface.

The influence of radiation therapy on dental implantology

Patients with a history of head and neck cancer resection require extensive prosthodontic rehabilitation following cancer treatment. The oral anatomy drastically changes from ablative therapy, and the oral tissue response becomes altered as a consequence of radiation and chemotherapy. Successful restoration of oral function in this specific patient population was increasingly difficult before the widespread use of dental implants. Implant-borne prosthetics are now often used. However, surgical guidelines remain unclear with regard to oncology-related parameters. In this article, guidelines are introduced for implant therapy in the cancer patients according to radiation dosage and timing. Indications for hyperbaric oxygen treatment are highlighted along with risk assessment associated with implant placement. These guidelines are intended to augment knowledge obtained through oncology consultation; moreover, provide a rationale for implant therapy within the course of cancer treatment.

Five-year follow-up of oral functioning and quality of life in patients with oral cancer with implant-retained mandibular overdentures

BACKGROUND

The purpose of this prospective study was to assess the quality of life (QOL) and oral functioning of patients with oral cancer up to 5 years after prosthodontic rehabilitation with mandibular implant-retained overdentures.

METHODS

Fifty patients who had received implants during ablative surgery were evaluated by standardized questionnaires before and after oncological and prosthetic treatment.

RESULTS

In 20 of 24 surviving patients, the dentures were functional after 5 years. In these survivors, oral function remained unchanged during this period. In the 6 patients with concurrent comorbidity, global health and QOL had deteriorated, while in the patients without comorbidity, global health and QOL were very high. Five-year survivors had a higher global health and better oral functioning at the 1-year evaluation than nonsurvivors.

CONCLUSION

Oral function and denture satisfaction were high and did not change over time for survivors. Deterioration in overall global health and QOL was associated with concurrent comorbidity.

Benefits of dental implants installed during ablative tumour surgery in oral cancer patients: a prospective 5-year clinical trial

OBJECTIVE

This prospective study assessed treatment outcome and patient satisfaction of oral cancer patients with a mandibular overdenture on implants up to 5 years after treatment.

MATERIALS AND METHODS

At baseline, 50 consecutive edentulous oral cancer patients, in whom prosthetic problems were expected after oncological treatment, were evaluated by standardized questionnaires and clinical assessments. All implants were installed during ablative tumour surgery in native bone in the interforaminal area. About two-thirds of the patients (n=31) had radiotherapy post-surgery (dose >40 Gy in the interforaminal area).

RESULTS

At the 5-year evaluation, 26 patients had passed away and four patients had to be excluded from the analyses, because superstructures were not present, due to persistent local irritation (n=2), loss of three implants (n=1) and the impossibility of making an overdenture related to tumour and oncological surgery-driven anatomical limitations (n=1). In the remaining 20 patients, the prosthesis was still in function (76 implants). During the 5-year follow-up, total 14 implants were lost, 13 in irradiated bone (survival rate 89.4%, dose >40 Gy) and one in non-irradiated bone (survival rate 98.6%). Peri-implant tissues had a healthy appearance and remained healthy over time. Patients were satisfied with their dentures.

CONCLUSIONS

It was concluded that oral cancer patients can benefit from implants installed during ablative surgery, with a high survival rate of the implants, a high percentage of rehabilitated patients and a high denture satisfaction up to 5 years after treatment.

Implant survival rate after oral cancer therapy: a review

The overall impression regarding the success of dental implants (DI) in patients having undergone oral cancer therapy remains unclear. The aim of the present review study was to assess the implant survival rate after oral cancer therapy. Databases were explored from 1986 up to and including September 2010 using the following keywords in various combinations: "cancer", "chemotherapy", "dental implant", "oral", "osseointegration", "radiotherapy", "surgery" and "treatment". The eligibility criteria were: (1) original research articles; (2) clinical studies; (3) reference list of pertinent original and review studies; (4) intervention: patients having undergone radio- and chemotherapy following oral cancer surgery; and (5) articles published only in English. Twenty-one clinical studies were included. Results from 16 studies reported that DI can osseointegrate and remain functionally stable in patients having undergone radiotherapy following oral cancer surgery; whereas three studies showed irradiation to have negative effects on the survival of DI. Two studies reported that DI can osseointegrate and remain functionally stable in patients having undergone chemotherapy. It is concluded that DI can osseointegrate and remain functionally stable in patients having undergone oral cancer treatment.

Prosthodontic rehabilitation of oral function in head-neck cancer patients with dental implants placed simultaneously during ablative tumour surgery: an assessment of treatment outcomes and quality of life

The aim of this prospective study was to assess treatment outcome and impact on quality of life of prosthodontic rehabilitation with implant-retained prostheses in head-neck cancer patients. Fifty patients were evaluated by standardized questionnaires and clinical assessment. All received the implants during ablative tumour surgery in native bone in the interforaminal area. About two-thirds of the patients (n=31) needed radiotherapy post-surgery. Both in irradiated and non-irradiated bone two implants were lost 18-24 months after installation. Peri-implant tissues had a healthy appearance. No cases of osteoradionecrosis occurred. In 15 patients no functional implant-retained lower dentures could be made for various reasons. The other 35 patients all functioned well, with an improvement in quality of life. Major improvement was observed in the non-irradiated patients. In the irradiated patients, less improvement in many functional items was observed, while items related to the oral sequelae of radiotherapy did not improve. Similar to the quality-of-life assessments, denture satisfaction was improved and tended to be higher in non-irradiated than irradiated patients. Implant-retained lower dentures can substantially improve the quality of life related to oral functioning and denture satisfaction in head-neck cancer patients. This effect is greater in non-irradiated than irradiated cancer patients.

Rehabilitation of oral function in head and neck cancer patients after radiotherapy with implant-retained dentures: effects of hyperbaric oxygen therapy

Surgical treatment of malignancies in the oral cavity and subsequent radiotherapy often result in an anatomic and physiological oral condition unfavorable for prosthodontic rehabilitation. The objective of this prospective study was to assess the effect of hyperbaric oxygen therapy on treatment outcome (condition of peri-implant tissues, implant survival, oral functioning and quality of life) of prosthodontic rehabilitation with implant-retained lower dentures in radiated head and neck cancer patients 6 weeks and 1 year after placing the new dentures. The treatment outcome was assessed in a group of 26 head neck cancer patients who were subjected to radiotherapy after tumour surgery. Standardized questionnaires were completed and clinical and radiographic assessments were performed. After randomization, endosseous Brånemark implants were placed in the anterior part of the mandible either under antibiotic prophylaxis (13 patients) or under antibiotic prophylaxis combined with pre and postsurgery hyperbaric oxygen (HBO) treatment (13 patients). In the HBO and non-HBO group eight implants (implant survival 85.2%) and three implants (implant survival 93.9%) were lost, respectively. Peri-implant tissues had a healthy appearance in both groups. Osteoradionecrosis developed in one patient in the HBO group. All patients functioned well with their implant-retained lower denture. The quality of life related to oral functioning and denture satisfaction were improved to a comparable extent in the HBO and non-HBO group. Implant-retained lower dentures can improve the quality of life related to oral functioning and denture satisfaction in head and neck cancer patients. Adjuvant hyperbaric oxygen therapy could not be shown to enhance implant survival in radiated mandibular jaw bone.

Oral rehabilitation after treatment for head and neck malignancy

BACKGROUND

Advances in the management of oral malignancy have resulted in significant improvements in survival and functional outcome. Ablation of oral tissues and radiotherapy render many patients unable to wear conventional prostheses, and these patients are, thus, candidates for oral rehabilitation with osseointegrated implants. We aim to present outcomes and complications of such treatment over a 14-year period in a single unit.

METHODS

Data were collected for 81 consecutive patients, most of whom had received microvascular free flap reconstruction after surgical ablation of oral squamous cell carcinoma. Three hundred eighty-six implants were placed after a delay of 12 months after surgery. Sixty-five percent of implants were placed in the anterior mandible. Radiotherapy was used in 47% of the patients, and hyperbaric oxygen treatment was routinely used in irradiated subjects during the latter half of the series. Retrospective analysis of implants and prostheses was made by use of case notes, radiographs, and a computerized database.

RESULTS

Data are presented for 364 of the 386 implants in 77 of the 81 patients after a median follow-up of 4 years. Two hundred sixty-five (73%) of the implants were in function supporting prostheses, 56 (15%) had been lost, and 43 (12%) were present but not loaded (ie, "sleepers"). Implant loss seemed patient specific and was also correlated with host bone type. Thirteen percent of patients in whom implants were placed in the mandible lost at least one implant, and the equivalent values for the maxilla was 40%. Thirty-six percent of patients in whom implants were placed in bone graft or flap lost at least one implant. The effects of implant manufacture, dimensions, radiotherapy, and hyperbaric oxygen did not reach statistical significance in this series. Cases of a second primary malignancy were noteworthy; however, the impact of recurrence was minimized by the delay between resection and rehabilitation. Of the 42 fixed and 29 removable prostheses fitted, 12 (17%) failed.

CONCLUSIONS

Implants placed in mandible were reliable, but failure rates in vascularized bone graft and maxilla were higher. Radiotherapy did not seem to prejudice implant survival, and hyperbaric oxygen had no demonstrable benefit in this series. Despite some persistent soft tissue problems and implant loss, most patients reached a successful prosthetic and functional outcome.

Osseointegration in Irradiated Cancer Patients: An Analysis With Respect to Implant Failures

PURPOSE

This study retrospectively evaluated implant survival of 631 osseointegrated implants installed in irradiated cancer patients over a 25-year period.

PATIENTS AND METHODS

The files of 107 patients followed since 1979 were evaluated. Factors influencing implant survival as oncologic treatment, radiotherapy protocols, patient and implant related elements were analyzed.

RESULTS

Compared with a control group of non-irradiated patients, implant failures were higher after previous radiotherapy. High implant failures were seen after high dose radiotherapy and a long time after irradiation. All craniofacial regions were affected, but the highest implant failures were seen in frontal bone, zygoma, mandible, and nasal maxilla. Lowest implant failures were seen in oral maxilla. The use of long fixtures, fixed retention, and adjuvant hyperbaric oxygen therapy decreased implant failures. Noncontributing factors to implant survival were gender, age, smoking habits, tumor type and size, surgical oncologic treatment, and osseointegration (OI) surgery experience.

CONCLUSION

Survival after cancer therapy is so high, and outcome from OI therapy so favorable that OI in the irradiated patient can be recommended. However, the OI clinician should be aware of the risks and pitfalls of treating such patients.

The use of implant retained mandibular prostheses in the oral rehabilitation of head and neck cancer patients. A review and rationale for treatment planning

Surgical treatment of malignancies in the oral cavity (tongue, floor of the mouth, alveolus, buccal sulcus, oropharynx) often results in an unfavourable anatomic situation for prosthodontic rehabilitation. The outcome is a severe disturbance of oral functioning despite the improved surgical techniques for reconstruction that are currently available. Radiotherapy, which often is applied postsurgically, worsens oral functioning in many cases. Main problems that may hamper proper prosthodontic rehabilitation of these patients include a severe reduction of the neutral zone, an impaired function of the tongue, and a very poor load-bearing capacity of the remaining soft tissues and mandibular bone. Many of these problems can, at least in part, be diminished by the use of endosseous oral implants. These implants can contribute to the stabilisation of the prostheses and intercept the main part of the occlusal loading. Surgical interventions after radiotherapy are preferably avoided because of compromised healing, which may lead to development of radionecrosis of soft tissues and bone as well as to increased implant loss. If surgical treatment after radiotherapy is indicated, measures to prevent implant loss and development of radionecrosis have to be considered e.g. antibiotic prophylaxis and/or pre-treatment with hyperbaric oxygen (HBO). To avoid this problem, implant insertion during ablative surgery has to be taken into consideration if postoperative radiotherapy is scheduled or possibly will be applied. This approach is in need of a thorough pre-surgical examination and multidisciplinary consultation for a well-established treatment planning. The primary curative intent of the oncological treatment and the prognosis for later prosthodontic rehabilitation have to be taken into account too.

Hyperbaric oxygen therapy in the treatment of radio-induced lesions in normal tissues: a literature review

Late complications are one of the major factors limiting radiotherapy treatment, and their treatment is not codified. Hyperbaric oxygen (HBO) has been used in combination with radiotherapy for over half a century, either to maximise its effectiveness or in an attempt to treat late complications. In this latter case, retrospective trials and case reports are prevailing in literature. This prompted European Society for Therapeutic Radiotherapy and Oncology and European Committee for Hyperbaric Medicine to organise a consensus conference in October 2001, dealing with the HBO indications on radiotherapy for the treatment and prevention of late complications. This updated literature review is part of the documents the jury based its opinion on. A systematic search was done on literature from 1960 to 2004, by only taking into account the articles that appeared in peer review journals. Hyperbaric oxygen treatment involving complications to the head and neck, pelvis and nervous system, and the prevention of complications after surgery in irradiated tissues have been studied. Despite the small number of controlled trials, it may be indicated for the treatment of mandibular osteoradionecrosis in combination with surgery, haemorrhagic cystitis resistant to conventional treatments and the prevention of osteoradionecrosis after dental extraction, whose level of evidence seems to be the most significant though randomised trials are still necessary. The other treatment methods are also outlined for each location.

Clinical complications with implants and implant prostheses

The purpose of this article is to identify the types of complications that have been reported in conjunction with endosseous root form implants and associated implant prostheses. A Medline and an extensive hand search were performed on English-language publications beginning in 1981. The searches focused on publications that contained clinical data regarding success/failure/complications. The complications were divided into the following 6 categories: surgical, implant loss, bone loss, peri-implant soft tissue, mechanical, and esthetic/phonetic. The raw data were combined from multiple studies and means calculated to identify trends noted in the incidences of complications. The most common implant complications (those with a greater than a 15% incidence) were loosening of the overdenture retentive mechanism (33%), implant loss in irradiated maxillae (25%), hemorrhage-related complications (24%), resin veneer fracture with fixed partial dentures (22%), implant loss with maxillary overdentures (21%), overdentures needing to be relined (19%), implant loss in type IV bone (16%), and overdenture clip/attachment fracture (16%). It was not possible to calculate an overall complications incidence for implant prostheses because there were not multiple clinical studies that simultaneously evaluated all or most of the categories of complications. Although the implant data had to be obtained from different studies, they do indicate a trend toward a greater incidence of complications with implant prostheses than single crowns, fixed partial dentures, all-ceramic crowns, resin-bonded prostheses, and posts and cores.

A clinical evaluation of implants in irradiated oral cancer patients

In this prospective study, we determined the effects of the time interval between irradiation and implant therapy, implant location, bone-resection surgery, and irradiation dose on implant survival. We analyzed the survival of 446 implants inserted after radiotherapy over a period of up to 14 years in 130 consecutive patients treated for oral cancer. The 10-year overall Kaplan-Meier implant survival percentage is 78%. The difference in survival percentages of implants inserted < 1 year and >/= 1 year after irradiation (76% and 81%, respectively) is not significant. We concluded that implant survival is significantly influenced by the location (maxilla or mandible, 59% and 85%, respectively; p = 0.001), by the incidence of bone-resection surgery in the jaw where the implant was installed (p = 0.04), and by the irradiation dose at the implant site (< 50 Gray or >/= 50 Gray, p = 0.05).

Treatment of mandibular osteoradionecrosis by cancellous bone grafting

PURPOSE

This study was undertaken to evaluate a new method in the treatment of mandibular osteoradionecrosis.

PATIENTS AND METHODS

Eight patients, seven male and one female, with a mean age of 64 years (range, 43 to 67 years), suffering from osteoradionecrosis of the mandible, two bilaterally and six unilaterally, were treated. Five initially had hyperbaric oxygen (HBO) followed by sequestrectomy, and three had sequestrectomy alone. Because healing failed to occur, all patients were treated by removal of the necrotic bone in the affected part of the mandible and filling the defect with compressed particulated cancellous bone and marrow from the tibia. The patients were observed for an average period of 39 months (range, 20 to 93 months).

RESULTS

Primary healing was achieved in two patients with unilateral osteoradionecrosis and HBO treatment. In another patient treated with HBO primary healing occurred on one side while the other healed secondarily. In the remaining five patients, complete secondary healing took place, but it was complicated in three patients by fistulas, two of which were associated with fractures of the mandibular body. The fistulas were excised, and complete healing of the soft tissues occurred, but the fractures resulted in pseudarthrosis.

CONCLUSIONS

The technique presented in this study can be useful in the treatment of osteoradionecrosis as an alternative to continuity resection and reconstruction with free osteocutaneous flaps, but, whenever possible, it should be proceeded by HBO treatment.