Changing trends and the role of medical management on the outcome of patients treated for osteoradionecrosis of the mandible: experience from a regional head and neck unit.
This study is a retrospective review of treatment outcomes of osteoradionecrosis (ORN) of the mandible with specific reference to the evolving role of medical management with pentoxifylline, tocopherol, and doxycycline. We reviewed the presentation and management of 71 patients treated for ORN of the mandible at the regional head and neck unit during a 15-year period to January 2011, and categorised them into three grades using the Notani classification: grade I (n=28), grade II (n=16), and grade III (n=27). Twelve patients with grade I ORN, 3 with grade II, and 10 with grade III, were prescribed medical treatment. Of these, three with grade I, and two with grade II ORN were cured, and progression of the disease had halted and there was satisfactory control of symptoms in eight with grade I and four with grade III disease. Patients who failed to respond to conservative treatment were further analysed for the need for free flap reconstruction. Medical management was introduced as a standard treatment in January 2006. Of the 39 patients diagnosed before this, 20 (51%) required resection and free flap reconstruction compared with only 8/32 (25%) after it had been introduced.
Regional Head and Neck Unit, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK. Electronic address: dsouzaj@icloud.com.
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D'Souza
Regional Head and Neck Unit, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK; Evidence-Based Practice Research Centre (EPRC), Edge Hill University, UK.
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D
Lowe
Regional Head and Neck Unit, University Hospital Aintree, Longmoor Lane, Liverpool L9 7AL, UK; Evidence-Based Practice Research Centre (EPRC), Edge Hill University, UK.
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Rogers
D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy; D003646:Debridement / Q000379:methods; D018450:Disease Progression; D004318:Doxycycline / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000637:transplantation; D006801:Humans; D006931:Hyperbaric Oxygenation / Q000379:methods; D008297:Male; D008336:Mandibular Diseases / Q000145:classification / Q000188:drug therapy*; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D010025:Osteoradionecrosis / Q000145:classification / Q000188:drug therapy*; D010431:Pentoxifylline / Q000627:therapeutic use; D011837:Radiation-Protective Agents / Q000627:therapeutic use; D019651:Plastic Surgery Procedures / Q000379:methods; D012074:Remission Induction; D012189:Retrospective Studies; D024505:Tocopherols / Q000627:therapeutic use; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000975:Antioxidants; D011837:Radiation-Protective Agents; D004318:Doxycycline; D024505:Tocopherols; D010431:Pentoxifylline
Debridement; Hyperbaric oxygen therapy; Medical management; Osteoradionecrosis; Survival