[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.
Service de chirurgie maxillofaciale et stomatologie, CHU de Nantes, place Alexis-Ricordeau, 44000 Nantes, France. Cedric@dhauthuille.net
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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