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
Diagno...
...ble 1. Descriptions of Complete, Partial, an...
...k Factors for Development of ORNHavi...
Figure 1. Fistula Present in Edentulou...
Management
Management
...ummary of Recommendation...
...mmendation...
...uestion 1:How should ORN be characte...
...jaw (mandible, maxilla) should be charac...
....2.A patient with radiation dose to the jaw...
...evaluating ORN should utilize the Cl...
...ssessment should have a defined formal character...
1.5.ORN case reporting and diagnosi...
...ecommended initial evaluation of ORN should i...
...ed serial characterization or surve...
...on 2:What are the recommended best practices for...
...coverage of tumor should not be compromised to...
...radiation planning techniques (e.g., IMRT, i...
...ocused effort should be made to reduce...
...ental assessment by a dentist (with a dental...
...ental extraction, if clinically indic...
2.5.1.(General dentists and dental spec...
...Radiation oncologists) Oral assessment, including...
...6.A two week healing period between...
...risk of radiation-induced salivary hypofunction sh...
...Modifiable risk factors that place patients...
...inical Question 3:What are the recommended best...
...to finalizing dental treatment plans in patients...
...n areas at high risk for ORN, alternativ...
...ommended that patients considered to...
...at risk for ORN who have delayed healing after de...
...ommended that pentoxifylline (400 mg t...
...e use of prophylactic hyperbaric oxygen (...
...commendation. Due to limited, low-quality availab...
...on 4:How should ORN be managed non-surgically...
...entoxifylline may be used in cancer-fre...
...py in conjunction with surgical intervention may...
...Question 5:How should ORN be managed surgical...
...partial thickness ORN (ClinRad Stage...
....1.2.Small defects
...full thickness ORN (ClinRad selected Stage II...
...3.In full thickness ORN or extensive partial...
...ctomy defects that extend into the sinus (ClinRad...
...teomyocutaneous free flap reconstructions are reco...
...Free flaps are recommended over pedic...
...erative radiographic interpretation o...
...patients are unfit to undergo definitive surgical...
...val of superficial bony sequestra shoul...
...ical Question 6:When, how, and by w...
...atients should be assessed by their healthcar...
...lack of data specific to management of adverse ev...