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Chinese expert group consensus on diagnosis and clinical management of osteoradionecrosis of the mandible
Affiliation:1. Department of Oral & Maxillofacial – Head & Neck Oncology, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China;2. Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-Sen University, Guangzhou, China;3. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology, Beijing, China;4. Stomatology Hospital Affiliated to School of Medicine, Zhejiang University, Zhejiang, China;5. Salivary Gland Disease Center and Molecular Laboratory for Gene Therapy and Tooth Regeneration, School of Stomatology, Capital Medical University, Beijing, China;6. Department of Oral and Maxillofacial Surgery, West China Hospital of Stomatology, Sichuan University, Chengdu, China;7. The State Key Laboratory Breeding Base of Basic Science of Stomatology and Key Laboratory of Oral Biomedicine Ministry of Education, School and Hospital of Stomatology, Wuhan University, Wuhan, Hubei, China;8. Department of Cranio-facial Trauma and Orthognathic Surgery, School of Stomatology, Fourth Military Medical University, Xi''an, China;9. The State Key Laboratory of Military Stomatology, School of Stomatology, Fourth Military Medical University, Xi''an, China;10. Department of Oral and Maxillofacial Surgery, The Second Affiliated Hospital Zhejiang University School of Medicine, Zhejiang, Hangzhou, China;11. Department of Oral and Maxillofacial Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China;12. Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central South University, Changsha, China;13. Department of Head and Neck Surgery, Gansu Province Tumor Hospital, Lanzhou, China;14. Department of Radiotherapy, 9th People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;15. Department of Radiotherapy, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China;16. Department of Radiation Oncology, Eye & ENT Hospital, Fudan University, Shanghai, China;17. Department of Oromaxillofacial – Head and Neck Surgery, Department of Oral and Maxillofacial Surgery, School of Stomatology, China Medical University, Liaoning, China;18. Department of Oral and Maxillofacial Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China;1. Department of Veteran Affairs, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA;2. Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA;3. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;4. Department of Oral and Maxillofacial Surgery, Medical University of South Carolina, Charleston, SC, USA;5. University of Michigan School of Dentistry, Ann Arbor, MI, USA;6. Private Practice, Burlington, MA;7. Dow International Medical College, Dow University of Health Sciences;8. Private Practice, Olympia, Washington;9. Department of Orofacial Pain, College of Dentistry, University of Kentucky, Lexington, KY, USA;10. Ralph H. Johnson VA Medical Center, Charleston, SC, USA;1. State Key Laboratory of Military Stomatology and National Clinical Research Centre for Oral Diseases and Shaanxi Clinical Research Centre for Oral Diseases, Department of Oral Surgery, School of Stomatology, The Fourth Military Medical University, Xi’an, China;2. Department of Stomatology, Xi’an Medical University, Xi’an, China;3. Department of Endodontics and Restorative Dentistry, School of Stomatology, Tianjin Medical University, Tianjin, China;4. Department of Health Statistics, School of Preventive Medicine, The Fourth Military, Medical University, Xi’an, China;1. Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands;2. Department of Radiation Oncology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands;1. Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China;2. Department of Intensive Care Unit, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510120, China;1. Department of Maxillo-Facial Surgery, University Hospital of Amiens, Avenue Laennec, 80000 Amiens, France;2. EA CHIMERE, Picardie Jules Verne University, Avenue Laennec, 80000 Amiens, France;3. Department of Plastic and Reconstructive Surgery, Université Catholique de Louvain-Clinique Universitaire, St-Luc Avenue Hippocrate, 1200 Bruxelles, Belgium
Abstract:Osteoradionecrosis of the mandible (MORN) is one of the most devastating complications caused by radiation therapy in the head and neck region. It is characterized by infection and chronic necrosis of the mandible as the main manifestation. Clinically, MORN-related symptoms include swelling, pain, dysphagia, trismus, masticatory or speech disorders, refractory orocutaneous fistula, bone exposure, and even pathological fracture. MORN has become a challenging clinical problem for oral and maxillofacial surgeons to deal with, but thus far, this problem has not been solved due to the lack of widely accepted treatment algorithms or guidelines.Because of the nonexistence of standardized treatment criteria, most clinical treatment against MORN nowadays is largely based on controversial empirical understandings, while recommendations on post-therapeutic evaluations are scarce. Therefore, to further unify and standardize the diagnosis and treatment of MORN, to decrease the huge waste of medical resources, and ultimately, to improve the wellbeing of the patients, the Chinese Society of Oral and Maxillofacial Surgery (CSOMS) convened an expert panel specialized in MORN from 16 domestic medical colleges and affiliated hospitals to discuss the spectrum of diagnosis and and formulate treatment. In addition, consensus recommendations were also revised with a comprehensive literature review of the previous treatment experiences and research pearls. This ‘expert consensus statement on diagnosis and clinical management of MORN’ is for clinical reference.
Keywords:mandible  osteoradionecrosis  treatment  expert consensus
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