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...
...Descriptions of Complete, Partial, and Min...
...Factors for Development of ORNHaving troub...
...ula Present in Edentulous Anterior Le...
Management
...anagemen...
...y of Recommendations...
...ecommendat...
...n 1:How should ORN be characterized, g...
...of the jaw (mandible, maxilla) shoul...
...tient with radiation dose to the jaw of 50...
...s evaluating ORN should utilize the Cl...
1.4.ORN assessment should have a defined forma...
...orting and diagnosis should include f...
....Recommended initial evaluation of ORN...
...mended serial characterization or surveillance o...
...ion 2:What are the recommended best pr...
...1.Target coverage of tumor should not be comprom...
....2.Advanced radiation planning techniques (...
...used effort should be made to reduce...
....A dental assessment by a dentist (with a dental s...
...raction, if clinically indicated, should oc...
...General dentists and dental specialists) Teeth...
...iation oncologists) Oral assessment, in...
...healing period between time of dental extracti...
...tients at risk of radiation-induced salivary hypof...
...8.Modifiable risk factors that pla...
...Question 3:What are the recommended best prac...
...finalizing dental treatment plans in pa...
...teeth in areas at high risk for ORN, a...
...t is recommended that patients considered to be...
...ents at risk for ORN who have delayed healing af...
...ommended that pentoxifylline (400 mg twice d...
...of prophylactic hyperbaric oxygen...
...tion. Due to limited, low-quality...
...uestion 4:How should ORN be managed non-...
...toxifylline may be used in cancer-free pat...
...therapy in conjunction with surgical interventio...
...nical Question 5:How should ORN be manag...
....1.1.In partial thickness ORN (ClinRad Stage...
....1.2.Small defects
...thickness ORN (ClinRad selected Stage...
...ickness ORN or extensive partial thickness...
...ctomy defects that extend into the sinus (C...
...omyocutaneous free flap reconstructions are recom...
...are recommended over pedicle flaps. Fre...
...re-operative radiographic interpretation of e...
...patients are unfit to undergo definitive surgical...
...val of superficial bony sequestra should be per...
...cal Question 6:When, how, and by whom should...
...ents should be assessed by their healthcare p...
...of data specific to management of...