Dental extractions in the irradiated head and neck patient: a retrospective analysis of Memorial Sloan-Kettering Cancer Center protocols, criteria, and end results.
BACKGROUND
This study was designed to use our institutional experience with irradiated head and neck patients to evaluate 1) dental extraction incidence and sequelae; 2) those patients who developed osteoradionecrosis via extraction and the efficacy of hyperbaric oxygen therapy; and 3) guidelines for extraction protocols in this population. Materials and methods A group of 1,194 patients with a history of radiation to the head and neck, who were evaluated and treated in the Dental Service at Memorial Sloan-Kettering Cancer Center, were reviewed. The 187 who required dental extractions were analyzed using patient demographics, tumor location, staging, histopathology, radiation dosage, field, and timing, dental extraction indications, location, surgical methods, and sequelae.


RESULTS
Almost 85% of the patients reviewed did not require extraction. Only 4 of those who underwent extractions at Memorial Sloan-Kettering Cancer Center developed osteoradionecrosis.


CONCLUSIONS
The use of multidisciplinary team communications and careful extraction selection by prognosis and symptomatology regardless of preexisting dental pathologies, atraumatic extraction procedures, and meticulous follow-up can lower both extraction and osteoradionecrosis rates.
Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10021, USA.
Frankie
F
Sulaiman
Joseph M
JM
Huryn
Ian M
IM
Zlotolow
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002173:Cancer Care Facilities / Q000706:statistics & numerical data; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D002648:Child; D002985:Clinical Protocols; D016371:Cranial Irradiation / Q000009:adverse effects*; D003796:Dental Service, Hospital / Q000706:statistics & numerical data; D006258:Head and Neck Neoplasms / Q000532:radiotherapy; D006801:Humans; D006931:Hyperbaric Oxygenation; D007571:Jaw Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D009519:New York City; D010025:Osteoradionecrosis / Q000209:etiology* / Q000628:therapy; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D014081:Tooth Extraction / Q000009:adverse effects*