title: Recurrent Malignancy in Osteoradionecrosis Specimen.
abstract: OBJECTIVE
  Osteoradionecrosis (ORN) is a well-known complication of head and neck radiation therapy. Statistically, the mandible is the most commonly affected site. The incidental finding of malignancy in the resection specimen has been documented but is somewhat rare. The aim of this review is to investigate the presence of recurrent carcinoma and sarcoma or new primary malignancies in resection specimens previously diagnosed and treated as ORN.
  
  
  METHODS
  This study is a retrospective case series. We conducted a chart review of all cases managed at the University of Miami Miller School of Medicine/Jackson Memorial Hospital. The inclusion criteria included a history of head and neck carcinoma treated with radiation of at least 6,000 cGy; clinical diagnosis of ORN; and surgical intervention with osseous resection for treatment of ORN. The study endpoint measured included microscopic evidence of malignancy in the resected ORN specimen. Additional data collected included gender, age, and type of primary pathology.
  
  
  RESULTS
  A total of 564 patients met the inclusion criteria. Of these patients, 14 had microscopic evidence of cancer in the specimen (2.48%) and 5 had a proven second primary malignancy in the foregut (1 in the lung, 0.18%, and 4 in the oropharynx, 0.70%). In 1 of the 14 patients, a high-grade sarcoma was diagnosed and the patient died within 1 year of diagnosis. In the treatment of our ORN patient population, a total of 19 malignancies were found collectively (3.37%). Of the 564 patients, 352 were men and 212 were women. The median age was 46 years (range, 33 to 97 years). Head and neck squamous cell carcinoma represented 531 cases in our sample, followed by 28 cases of salivary gland carcinoma and only 5 cases of sarcoma.
  
  
  CONCLUSIONS
  Although the finding of malignancy in ORN patients is relatively rare (3.37% in this study), oral and maxillofacial surgeons should be cognizant of its potential presence. The treatment of malignant disease is different than that of ORN, and a multidisciplinary treatment approach is recommended if a malignancy is diagnosed in an ORN patient.
authors.affiliation: Chief Resident, Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Hisham
authors.initials: H
authors.lastname: Marwan
authors.affiliation: Previous Fellow in Facial Plastic Surgery, Maxillofacial Oncology, and Reconstructive Surgery, Miller School of Medicine, University of Miami, Miami, FL; Staff Surgeon, Naval Medical Center Portsmouth, Portsmouth, VA; Assistant Professor of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD. Electronic address: DrG@JMGIII.com.
authors.forename: J Marshall
authors.initials: JM
authors.lastname: Green
authors.affiliation: Assistant Professor of Surgery, Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Ramzey
authors.initials: R
authors.lastname: Tursun
authors.affiliation: Professor of Surgery and Chief, Division of Oral and Maxillofacial Surgery, Miller School of Medicine, University of Miami, Miami, FL.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Marx
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000532:radiotherapy / Q000556:secondary* / Q000601:surgery; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008336:Mandibular Diseases / Q000209:etiology / Q000601:surgery*; D008339:Mandibular Neoplasms / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D016609:Neoplasms, Second Primary / Q000175:diagnosis*; D010025:Osteoradionecrosis / Q000209:etiology / Q000601:surgery*; D018714:Radiotherapy, Adjuvant / Q000009:adverse effects; D012189:Retrospective Studies; D012509:Sarcoma / Q000175:diagnosis / Q000556:secondary* / Q000601:surgery; D000077195:Squamous Cell Carcinoma of Head and Neck