Osteoradionecrosis in Patients With Head and Neck Cancer
Key Points
Key Points
- Osteoradionecrosis (ORN) of the mandible and maxilla is a mechanistically complex, clinically impactful risk of head and neck radiation therapy (RT) characterized by non-healing exposed oral bone.
- The reported two-year incidence of exposed bone was 6.1%, with an incidence of confirmed ORN of 3.1%.
- Prevention of oral complications in these patients, including prevention of ORN, would reduce costs associated with utilization of health care resources.
Diagnosis
...gnosis...
...1. Descriptions of Complete, Partial, an...
Table 2. Risk Factors for Development of O...
...ure 1. Fistula Present in Edentulous Anter...
Management
Managem...
...ry of Recommendation...
...mmendation
...Question 1:How should ORN be characterized,...
...ORN of the jaw (mandible, maxilla) sho...
...th radiation dose to the jaw of 50 Gy or...
...ans evaluating ORN should utilize the ClinRad stag...
...ssment should have a defined formal char...
...e reporting and diagnosis should include...
...mended initial evaluation of ORN should include o...
...ed serial characterization or surveillance of...
...on 2:What are the recommended best...
...erage of tumor should not be compromised to avoid...
...dvanced radiation planning techniques (e.g.,...
...d effort should be made to reduce the mea...
...dental assessment by a dentist (with a dental spe...
...Dental extraction, if clinically indicat...
...5.1.(General dentists and dental specialists)...
....(Radiation oncologists) Oral asse...
...ealing period between time of dental extraction a...
...7.Patients at risk of radiation-induc...
....8.Modifiable risk factors that place pati...
...Question 3:What are the recommended be...
...rior to finalizing dental treatment plans in p...
...in areas at high risk for ORN, altern...
...recommended that patients considered to...
...at risk for ORN who have delayed healing...
...recommended that pentoxifylline (400 mg t...
...of prophylactic hyperbaric oxygen (HBO) therapy...
...recommendation. Due to limited, low-quality...
...nical Question 4:How should ORN be managed non-sur...
...Pentoxifylline may be used in cancer-fre...
...O therapy in conjunction with surgical...
...stion 5:How should ORN be managed surgically?...
...1.In partial thickness ORN (ClinRad Stage I or...
...Small defects...
...l thickness ORN (ClinRad selected Stag...
...3.In full thickness ORN or extensive partial thic...
....4.1.Maxillectomy defects that extend into...
...4.2.Osteomyocutaneous free flap reconstruct...
...aps are recommended over pedicle f...
...erative radiographic interpretation of ex...
...hen patients are unfit to undergo definitive surg...
....7.2.Removal of superficial bony sequestra...
...linical Question 6:When, how, and by whom s...
...Patients should be assessed by their hea...
...ack of data specific to management of adv...