Osteoradionecrosis in Patients With Head and Neck Cancer

Publication Date: May 1, 2024

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

Diagnosi...

...Descriptions of Complete, Partial,...


...Factors for Development of ORNHav...


...stula Present in Edentulous Anterior Left Mandible...


Management

...anagemen...

...ummary of Recommendations

Recommenda...

...al Question 1:How should ORN be characterized,...

...the jaw (mandible, maxilla) shoul...

...ient with radiation dose to the jaw of 50 Gy or...

...valuating ORN should utilize the ClinRad s...

1.4.ORN assessment should have a defined formal...

....ORN case reporting and diagnosis should in...

...ended initial evaluation of ORN sh...

...mended serial characterization or surveillance of...

...ical Question 2:What are the recommended bes...

...Target coverage of tumor should not be compro...

...vanced radiation planning techniques (e...

...rt should be made to reduce the mean dos...

....1.A dental assessment by a dentist (with a dental...

...xtraction, if clinically indicated...

...1.(General dentists and dental specialis...

...iation oncologists) Oral assessment, including a...

...ek healing period between time of den...

...t risk of radiation-induced salivary h...

...iable risk factors that place patie...

...l Question 3:What are the recommended best prac...

3.1.Prior to finalizing dental treatm...

...areas at high risk for ORN, alternatives to d...

...mended that patients considered to be at higher...

...s at risk for ORN who have delayed...

...is recommended that pentoxifylline...

...e of prophylactic hyperbaric oxygen (H...

...endation. Due to limited, low-quality availab...

...stion 4:How should ORN be managed non...

...xifylline may be used in cancer-free pa...

...rapy in conjunction with surgical intervention m...

...on 5:How should ORN be managed surgically?...

...ial thickness ORN (ClinRad Stage I or II), s...

....1.2.Small defects...

...full thickness ORN (ClinRad selected Stage II a...

....3.In full thickness ORN or extens...

...tomy defects that extend into the sinus (Cl...

...omyocutaneous free flap reconstructions are recomm...

....Free flaps are recommended over pedi...

...tive radiographic interpretation of extent...

...ents are unfit to undergo definitive s...

...f superficial bony sequestra should be performed...

...linical Question 6:When, how, and by w...

...Patients should be assessed by their healthc...

....2.Given lack of data specific to manageme...