[Mandibular osteoradionecrosis: part I: severity factors].
BACKGROUND
The severe evolution for some patient presenting with osteoradionecrosis, even if classified in the same stages as other patients, suggests that there are aggravating factors.


METHODS
A retrospective study was made between 1992 and 2002 on all patient operated for mandibular osteoradionecrosis. Fifty-nine patients were included and the mandibular defects were reconstructed with a bone or a composite free flap (fibula 21%, iliac crest 49%, scapula 6%, antebrachial 3%), and with a periosteal free flap (13%).


RESULTS
The study included severe cases (87% of stage II or III) operated on several times without success. Free flap reconstruction was successful in 90% of the cases. However, complications were present in 60% of cases (24% minor complications, 48% major complications), and were more frequent with a higher stage. The analysis allowed identifying morbidity factors.


CONCLUSIONS
Studying the morbidity allowed identifying severity factors of osteoradionecrosis; spontaneous onset, important irradiation (important dose, bone proximity of the tumor, bilateral damage), vascular damage (symphyseal localization, lack of sequestrum, facial artery ligature, active tobacco addiction), actinomycosis colonization, non-observance of medical treatment. Understanding aggravating factors should allow us to offer more efficient surgery on an early osteoradionecrosis stage, also decreasing the morbidity linked to reconstructive surgery.
d'Hauthuille
C
C
Service de chirurgie maxillofaciale et stomatologie, CHU de Nantes, place Alexis-Ricordeau, 44000 Nantes, France. Cedric@dhauthuille.net
Testelin
S
S
Taha
F
F
Bitar
G
G
Devauchelle
B
B
D000328:Adult; D000368:Aged; D016025:Bone Transplantation; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006801:Humans; D008297:Male; D008336:Mandibular Diseases / Q000145:classification* / Q000601:surgery; D008866:Microsurgery; D008875:Middle Aged; D009062:Mouth Neoplasms / Q000532:radiotherapy; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D010025:Osteoradionecrosis / Q000145:classification* / Q000601:surgery; D010521:Periosteum / Q000637:transplantation; D011183:Postoperative Complications; D011879:Radiotherapy Dosage; D019651:Plastic Surgery Procedures / Q000379:methods; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013524:Surgical Flaps; D014081:Tooth Extraction / Q000009:adverse effects; D016896:Treatment Outcome