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
Diagnosis
...1. Descriptions of Complete, Partial, and...
...Risk Factors for Development of ORNHaving tro...
...e 1. Fistula Present in Edentulous Anterior Le...
Management
...nagement
...ummary of Recommendations...
Recommendat...
...tion 1:How should ORN be characteri...
...jaw (mandible, maxilla) should be cha...
...A patient with radiation dose to the jaw of...
...ians evaluating ORN should utilize the Clin...
....ORN assessment should have a defin...
1.5.ORN case reporting and diagnosis shoul...
...d initial evaluation of ORN should include one...
1.7.Recommended serial characterization or survei...
Clinical Question 2:What are the recommended b...
...erage of tumor should not be compromised to avoid...
...vanced radiation planning techniques (e.g...
...ed effort should be made to reduce the mean...
...assessment by a dentist (with a dental specialis...
...xtraction, if clinically indicated,...
...General dentists and dental specialists...
...iation oncologists) Oral assessment, including a...
...healing period between time of dental extraction...
...7.Patients at risk of radiation-induced sa...
...iable risk factors that place patient...
...inical Question 3:What are the recomme...
...to finalizing dental treatment plans in patients...
...in areas at high risk for ORN, alternatives t...
...s recommended that patients considered...
3.4.Patients at risk for ORN who have delayed hea...
...ommended that pentoxifylline (400 mg twice...
...of prophylactic hyperbaric oxygen (HBO) therapy...
...on. Due to limited, low-quality available evide...
...Question 4:How should ORN be managed non-...
...lline may be used in cancer-free pa...
....HBO therapy in conjunction with surgical inter...
...stion 5:How should ORN be managed surgically...
...partial thickness ORN (ClinRad Stage I or II...
5.1.2.Small de...
...thickness ORN (ClinRad selected Stage II and all...
...3.In full thickness ORN or extensiv...
...illectomy defects that extend into...
...taneous free flap reconstructions are...
...flaps are recommended over pedicle...
...e-operative radiographic interpretation o...
....When patients are unfit to undergo definitive sur...
...emoval of superficial bony sequestra shoul...
...linical Question 6:When, how, and by whom shou...
...ts should be assessed by their healthcare...
...lack of data specific to management of adver...