Patterns of treatment of osteoradionecrosis with hyperbaric oxygen therapy in the United Kingdom

We aimed to find out the number of patients with osteoradionecrosis (ORN) being treated by hyperbaric chambers in the UK during 2006-07, and the protocols that were being used. We did a telephone survey of 76 chambers to find out whether they treated patients with ORN, how many patients they treated in 2006-07, what chamber pressure they used, the duration of each session, and the total number of sessions/patient. A total of 25 chambers treated 273 patients with ORN in 2006-07; 10 were listed by the British Hyperbaric Association (BHA) and 15 were at multiple sclerosis (MS) centres. MS centres treated 23 (8%) of patients with ORN with a variable number of sessions of shorter duration and lower pressures than the chambers listed by the BHA. Most BHA chambers treated patients at 2.2 ATA for 90 min/session with 30 preoperative and 10 postoperative sessions/patient.     

颌骨放射性骨坏死93例治疗分析

目的 分析颌骨放射性骨坏死的临床特点及治疗方法,为临床诊治该疾病提供参考.方法 对2000-2010年北京大学口腔医院口腔颌面外科收治的93例颌骨放射性骨坏死患者病历资料进行回顾性分析.66例患者接受1个疗程放疗,放疗剂量34～90Gy,平均64.6 Gy,其中22例在骨坏死症状暴露前有拔牙或牙槽外科手术等创伤刺激.末次放疗与症状暴露间隔时间为放疗后2周至33年,平均间隔54个月.病变发生于下颌骨79例,上颌骨13例,上下颌骨均有累及1例.结果 56例患者行颌骨切除术并行游离组织瓣修复,49例手术成功,7例术后出现血管危象,其中3例进行血管危象探查,并重新吻合血管皮瓣成活,2例去除皮岛及血管蒂改行游离骨移植并成活,2例行皮瓣摘除直接拉拢缝合.56例患者术后1例坏死复发,53例术后咀嚼、吞咽等功能恢复良好,2例颌骨切除患者仅行钛板修复,术后均出现钛板外露.20例行刮治术,9例术后坏死复发.15例行颌骨切除术后未作修复,2例坏死复发,余术后咀嚼、吞咽等功能均较差.结论 颌骨放射性骨坏死一般发生于下颌骨,手术治疗主张颌骨切除并行游离组织瓣修复,应慎行刮治术及单纯钛板修复.     

Osteoradionecrosis of the mandible and mastoiditis after radiotherapy for parotid mucoepidermoid carcinoma

Osteoradionecrosis of the mandible in conjunction with mastoiditis is an extremely rare occurrence following irradiation of salivary gland malignancy in the orofacial region. We report one such case of a patient who presented to us with trismus, jaw pain, and ear discharge. Imaging of the jaws revealed classical features of osteoradionecrosis and mastoiditis. This case is important because presenting features like trismus and dental infection led us to investigative procedures that revealed extensive bone involvement including mastoiditis. Trismus progressively increased over a period of 8 years. In this case, we would like to emphasize the importance of good oral hygiene in the postradiotherapy stage for head and neck cancer.     

Management of osteoradionecrosis of the jaws: An analysis of evidence

Aim

To review and discuss the management of jaw bone osteoradionecrosis (JORN) based on levels of evidence.

Methods

The Medline/PUBMED and Cochrane search was performed to identify all studies on the management of JORN, published in English, French, and German during January 1975–October 2007. Only clinical researches were identified and classified into four levels of evidence before being examined. All references of the retrieved articles were analysed.

Findings

Seventy three articles and their additional 45 citations were evaluated. Most of the eligible literature provided observational evidence. Hyperbaric oxygen therapy (HBOT) is an adjunct; however, its clinical usefulness remains controversial. A conservative approach should be limited to early-onset JORN, while radical surgery is indicated for an advanced or refractory lesion. Free tissue transfer is the reconstruction of choice for large defects without the need of HBOT. Some new technologies have also been studied, including ultrasound, biological molecules, distraction osteogenesis and antioxidant agents.

Conclusions

Most of the reports on the treatment of JORN offer weak evidence. Current information seems insufficient for establishing the definite treatment guideline; thus, well-designed studies with long-term clinical data are encouraged.     

颌骨放射性骨坏死的危险因素分析

目的 :研究放射性颌骨骨坏死 (ORNJ)的危险因素。方法 :对 1976年～ 1997年间四川大学华西口腔医学院收治的 5 6例ORNJ患者的临床资料进行回顾性分析 ,评估ORNJ的发生、发展和治疗效果。结果 :创伤和感染、高剂量照射是重要致病因素 ,下颌骨是易发部位。结论 :为尽量减少创伤因素的影响 ,放疗和手术时间间隔以 3周为宜。临床上可将 6 80 0cGy作为高能线照射的临床阈值     

Hyperbaric oxygen in the management of late radiation injury to the head and neck. Part I: treatment

Osteoradionecrosis (ORN) is a serious condition following treatment for head and neck cancer with serious associated morbidity and mortality. While the use of hyperbaric oxygen (HBO) in treating established osteoradionecrosis has been standard practice in many units for years, the evidence base for this remains remarkably weak. The published evidence has been made even more controversial by trial protocols that do not use HBO as it is generally advocated. This review describes the classification, incidence, and treatment of ORN, and explores the available published evidence with particular emphasis on randomised trials of treatment with HBO.