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
...iagnosis
...ble 1. Descriptions of Complete, Partial, and Min...
...ble 2. Risk Factors for Development of O...
...1. Fistula Present in Edentulous Anterior Left...
Management
...agement...
...ry of Recommendations
...ecommendat...
...estion 1:How should ORN be character...
...1.ORN of the jaw (mandible, maxilla)...
...2.A patient with radiation dose to the jaw of 50...
...valuating ORN should utilize the ClinRad...
...assessment should have a defined fo...
...se reporting and diagnosis should include formal...
...ended initial evaluation of ORN shoul...
...serial characterization or surveillance o...
...ion 2:What are the recommended best practic...
...rget coverage of tumor should not be...
...ed radiation planning techniques (e...
2.3.Focused effort should be made to redu...
...dental assessment by a dentist (with a dental...
...extraction, if clinically indicated, shou...
...entists and dental specialists) Teeth with poor p...
....5.2.(Radiation oncologists) Oral a...
...wo week healing period between time of dental...
...atients at risk of radiation-induce...
...difiable risk factors that place patients at...
...Question 3:What are the recommended best...
...ior to finalizing dental treatment plans i...
...teeth in areas at high risk for ORN, alternatives...
...mended that patients considered to be...
...ents at risk for ORN who have delayed he...
...is recommended that pentoxifylline (400 mg t...
...Routine use of prophylactic hyperbaric oxygen (H...
...ecommendation. Due to limited, low-quality availab...
...al Question 4:How should ORN be manag...
...ine may be used in cancer-free patients...
...2.HBO therapy in conjunction with surgical in...
...Question 5:How should ORN be managed surgica...
...ial thickness ORN (ClinRad Stage I o...
...Small defects...
...n full thickness ORN (ClinRad selected S...
...thickness ORN or extensive partial thickness...
...Maxillectomy defects that extend into the...
...taneous free flap reconstructions are recom...
...5.Free flaps are recommended over pedicle flap...
...6.Pre-operative radiographic interpr...
...nts are unfit to undergo definitive surgical tr...
...superficial bony sequestra should...
...on 6:When, how, and by whom should patients...
...atients should be assessed by their health...
...of data specific to management of adverse events a...