title: Is simultaneous surgical management of advanced craniofacial osteoradionecrosis cost-effective?
abstract: BACKGROUND
  Osteoradionecrosis is a serious complication of head and neck radiotherapy. Advanced cases are not amenable to periodic debridement, systemic antibiotics, or hyperbaric oxygen therapy. The authors sought to describe a cost-effective approach for patients with advanced craniofacial osteoradionecrosis.
  
  
  METHODS
  Fifteen consecutive patients with craniofacial osteoradionecrosis were treated with radical resection and immediate microvascular free flap reconstruction at Johns Hopkins Hospital or R Adams Cowley Shock Trauma Center from 2002 to 2008. Demographic data were reviewed, and procedure costs were used to compare treatment options.
  
  
  RESULTS
  All patients presented with intractable osteoradionecrosis, and most failed conservative therapy. Most cases (60 percent) involved the mandible, and the fibula was the flap of choice (73 percent). The median follow-up was 14 months, with 13 percent complications. Relative cost analysis for hyperbaric oxygen, surgical debridement, and a hospital stay was $25,010; simultaneous resection-microvascular free flap reconstruction and 7-day hospital stay were $30,030. The majority of patients, however, had prior attempts at conservative therapy followed by simultaneous resection and reconstruction; therefore, the average total relative cost per patient was $55,040 ($25,010 + $30,030).
  
  
  CONCLUSIONS
  Definitive treatment of advanced or intractable osteoradionecrosis with simultaneous resection and microvascular composite flap reconstruction is not only definitive but financially sound.
authors.affiliation: Baltimore, Md. From the Division of Plastic, Reconstructive, and Maxillofacial Surgery, R Adams Cowley Shock Trauma Center, University of Maryland School of Medicine, and Johns Hopkins School of Medicine.
authors.forename: Shahrooz S
authors.initials: SS
authors.lastname: Kelishadi
authors.forename: Hugo
authors.initials: H
authors.lastname: St-Hilaire
authors.forename: Eduardo D
authors.initials: ED
authors.lastname: Rodriguez