Infected osteoradionecrosis of the mandible: follow-up study suggests deterioration in outcome for patients with Actinomyces-positive bone biopsies.
Infected osteoradionecrosis (IORN) is one of the major complications of oral cancer radiotherapy. Recent studies showed a high prevalence of Actinomyces in IORN. In this study, the clinical follow up of IORN patients (n=25; 20 male, 5 female) with regard to Actinomyces detection in the mandible was analyzed. Within 1.6-119 months of follow up, disease control was achieved in almost 90% of the patients with Actinomyces-negative bone biopsies, but only in 25% of the Actinomyces-positive group. The presence of Actinomyces was associated with a significantly higher risk of treatment failure (P=0.004; Fisher's exact test). This held true when the data were controlled for 'extent of bone destruction', 'type of surgery' and 'soft-tissue closure' in a logistic regression analysis (P=0.018; Wald test). Since Actinomyces was detected in a significant number of patients with non-healing mucosal defects, this microbe may promote the persistence of chronic non-healing inflammatory processes. Actinomyces positivity defines a subpopulation with a clinically deteriorated course of mandibular IORN.
Hansen
T
T
Institute of Pathology, Johannes Gutenberg-University of Mainz, Langenbeckstr. 1, D-55101 Mainz, Germany. hansen@pathologie.klinik.uni-mainz.de
Wagner
W
W
Kirkpatrick
C J
CJ
Kunkel
M
M
D000190:Actinomyces / Q000302:isolation & purification*; D000196:Actinomycosis / Q000150:complications / Q000382:microbiology*; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008297:Male; D008334:Mandible / Q000382:microbiology* / Q000601:surgery; D008336:Mandibular Diseases / Q000382:microbiology* / Q000601:surgery; D008875:Middle Aged; D010025:Osteoradionecrosis / Q000382:microbiology* / Q000601:surgery; D016896:Treatment Outcome