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Osteoradionecrosis and orn and hbo

Sameep Kadakia, Arvind Badhey, Jared Inman, Moustafa Mourad, Yadranko Ducic
PURPOSE: To report the outcomes of 47 patients with temporal bone osteoradionecrosis treated primarily with surgical resection in order to analyze whether flap type and hyperbaric oxygen use affect wound breakdown. MATERIALS AND METHODS: Between January 1998 and January 2016, 47 patients were treated for temporal bone osteoradionecrosis with surgery. Some patients were also treated with hyperbaric oxygen. Resection of grossly necrotic temporal bone was followed by immediate reconstruction with local, regional, or free flaps...
July 23, 2017: American Journal of Otolaryngology
Anne-Frédérique Chouinard, Luc Giasson, Michel Fortin
Although radiation therapy is a common treatment for head and neck cancer, osteoradionecrosis (ORN) represents a major complication during or after treatment. Hyperbaric oxygen is often mentioned as a prophylactic and therapeutic treatment for ORN. In this article, we review the literature on hyperbaric oxygen therapy in head and neck irradiated patients. The widespread use of such therapy for the prevention and treatment of ORN appears to be based mainly on personal beliefs and experience, as no consensus exists in the scientific literature about its efficacy...
September 2016: Journal—Canadian Dental Association, Journal de L'Association Dentaire Canadienne
Ahmed Sultan, Glenn J Hanna, Danielle N Margalit, Nicole Chau, Laura A Goguen, Francisco M Marty, Guilherme Rabinowits, Jonathan D Schoenfeld, Stephen T Sonis, Tom Thomas, Roy B Tishler, Nathaniel S Treister, Alessandro Villa, Sook-Bin Woo, Robert Haddad, Hani Mawardi
BACKGROUND: Osteoradionecrosis of the jaw (ORN) is an infrequent yet potentially devastating complication of radiation therapy to the head and neck region. Treatment options include antimicrobial therapy, local sequestrectomy, resection, and the use of hyperbaric oxygen (HBO). Published data on ORN are difficult to compare because of the lack of a universally accepted classification and staging system, and the literature on the use of HBO to either prevent or successfully manage ORN is controversial and inconclusive...
March 2017: Oncologist
F J Dieleman, T T T Phan, F J A van den Hoogen, J H A M Kaanders, M A W Merkx
This study aimed to evaluate the success of hyperbaric oxygen therapy (HBOT) and surgery in the treatment of mandibular osteoradionecrosis (ORN) in relation to the extent of the ORN. Twenty-seven patients with ORN were identified from a total of 509 patients with a history of primary oral or base of the tongue cancer; these patients had been treated with radiation therapy with curative intent between 1992 and 2006, with a radiation dose to the mandible of ≥50Gy. The ORN was staged according to the classification of Notani et al...
April 2017: International Journal of Oral and Maxillofacial Surgery
Richard Shaw, Binyam Tesfaye, Matt Bickerstaff, Paul Silcocks, Christopher Butterworth
INTRODUCTION: Mandibular osteoradionecrosis (ORN) is a common and serious complication of head and neck radiotherapy for which there is little reliable evidence for prevention or treatment. The diagnosis and classification of ORN have been inconsistently and imprecisely defined, even in clinical trials. METHODS: A systematic review of diagnosis and classifications of ORN with specific focus on clinical trials is presented. The most suitable classification was evaluated for consistency using blinded independent review of outcome data (clinical photographs and radiographs) in the HOPON trial...
January 2017: Oral Oncology
Marcos Martins Curi, Camila Lopes Cardoso, Anthony Froy Condezo Benites, Patrícia Martins Bueno
We present a rare case of massive tongue necrosis occurring simultaneously with bilateral osteoradionecrosis (ORN) of the jaw in a patient with a history of treatment, including surgery and postoperative radiotherapy, for a retromolar trigone carcinoma 8 years earlier. There is a distinct possibility that the extractions and administration of local anesthesia with a vasoconstrictor contributed to the onset of ORN; together, these events may have influenced the blood supply to the tongue. A glossectomy was performed after hyperbaric oxygen therapy...
February 2017: Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Haim Gavriel, Ephraim Eviatar, Rani Abu Eta
BACKGROUND: Although hyperbaric oxygen therapy (HBOT) is used to treat chronic radiation tissue injury, clinical evidence supporting its use in maxillary bone osteoradionecrosis (ORN) is lacking. Therefore, the purpose of this study was to report our results of collected patient outcomes from a single center's large experience using HBOT to treat maxillary bone ORN. METHODS: From 1999 to 2015, 21 patients received treatment for maxillary bone ORN at our center. The medical records were retrospectively reviewed for the following variables: age, sex, comorbidities, tumor stage and site, previous surgery, previous radiotherapy or chemoradiation therapy, HBOT data, response to treatment and further management...
February 2017: Head & Neck
Diogo Alpuim Costa, Tiago Porfírio Costa, Eduardo Carlinhos Netto, Natércia Joaquim, Isabel Ventura, Ana Cristina Pratas, Patrícia Winckler, Inês Pires Silva, Ana Catarina Pinho, Isabel Goulão Sargento, Francisco Gamito Guerreiro, António Rita Moreira
Over the last decades, several therapeutic options were considered in the treatment of the osteoradionecrosis (ORN) of the mandible, including supportive measures, ultrasound therapy, corticosteroids, hyperbaric oxygen, surgical resection with reconstruction, and, more recently, drugs capable of reversing the fibroatrophic process. Once established, the ORN does not spontaneously disappear and a standard treatment has not yet been defined. The clear clinical effectiveness of hyperbaric oxygen therapy (HBOT) varies according to the literature and there are some economic/logistic issues to be considered; the triplet tocopherol/pentoxifylline/clodronate demands greater evidence from randomized clinical trials and also resilience from the patient, given the long treatment duration and its possible side effects...
November 2016: Head & Neck
J Rhet Tucker, Li Xu, Erich M Sturgis, Abdallah S R Mohamed, Theresa M Hofstede, Mark S Chambers, Stephen Y Lai, Clifton David Fuller, Beth Beadle, G Brandon Gunn, Katherine A Hutcheson
PURPOSE: The present study was undertaken to evaluate osteoradionecrosis (ORN) in patients with salivary gland malignancies (SGM) after treatment with radiation therapy. MATERIALS AND METHODS: The medical records of 172 patients treated with radiation therapy for SGM during a 12-year period (August 2001 to November 2013) were reviewed. Incidence, time to event, staging and management of ORN were analyzed. RESULTS: Of the 172 patients, 7 patients (4%) developed ORN (median latency: 19months, range: 4-72months)...
June 2016: Oral Oncology
Michael H Bennett, John Feldmeier, Neil B Hampson, Robert Smee, Christopher Milross
BACKGROUND: Cancer is a significant global health problem. Radiotherapy is a treatment for many cancers and about 50% of people having radiotherapy will be long-term survivors. Some will experience late radiation tissue injury (LRTI) developing months or years later. Hyperbaric oxygen therapy (HBOT) has been suggested as a treatment for LRTI based upon the ability to improve the blood supply to these tissues. It is postulated that HBOT may result in both healing of tissues and the prevention of problems following surgery...
April 28, 2016: Cochrane Database of Systematic Reviews
J Dhanda, D Pasquier, L Newman, R Shaw
Osteoradionecrosis (ORN) of the jaws is a feared complication of head and neck radiotherapy. ORN causes significant morbidity for patients and controversy among clinicians. This overview considers the variations in definition and classification of the condition that affect estimates of incidence and also the interpretation of evidence. The influence of newer radiotherapy techniques in reducing ORN through reduced dose and xerostomia is balanced against a probable increase in a vulnerable population through a rising head and neck cancer incidence...
July 2016: Clinical Oncology: a Journal of the Royal College of Radiologists
Vinod Patel, Yusuf Gadiwalla, Isabel Sassoon, Chris Sproat, Jerry Kwok, Mark McGurk
Osteoradionecrosis (ORN) is a complication of radiotherapy, and is difficult to manage once established. However, its pathogenesis has been reinvestigated, and it is now thought to be potentially amenable to treatment with pentoxifylline and tocopherol (vitamin E). We made a retrospective analysis of 62 patients with established ORN who were treated in this way. When only pentoxifylline and vitamin E was used ORN resolved in 14/25 (56%) but paradoxically, when it was combined with antibiotics, only 6/22 resolved (27%)...
April 2016: British Journal of Oral & Maxillofacial Surgery
Christopher Sames, Desmond F Gorman, Peter Sandiford, Lifeng Zhou
AIM: To compare Australian and New Zealand (NZ) rates of referral to hyperbaric units for patients with, or at risk of developing mandibular or maxillary osteoradionecrosis (ORN) due to a history of radiotherapy for oro-pharyngeal cancer. METHOD: Relevant patient treatment data from all hyperbaric units in Australia and NZ were collated and analysed. RESULTS: The rate of referral to hyperbaric units in Australia for treatment or prophylaxis of patients with, or at risk of oro-facial ORN, was 1...
December 2015: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
Luke Nicholls, Peter Gorayski, Jennifer Harvey
INTRODUCTION: Osteoradionecrosis (ORN) of the chest wall is a rare complication after whole-breast radiotherapy (RT). Herein, we report a case of ORN involving the underlying ribs following adjuvant whole-breast RT using standard fractionation and conduct a review of the literature. CASE REPORT: A previously well 43-year-old female with right-sided, early-stage, node-negative breast cancer was treated with breast-conserving surgery. She subsequently underwent adjuvant whole-breast RT receiving 50 Gy in 25 fractions over 5 weeks using standard tangential photon fields with 6 MV photons followed by an electron boost of 10 Gy in 5 fractions according to International Commission on Radiation Units (ICRU) requirements...
May 2015: Case Reports in Oncology
Huan Fan, Soung Min Kim, Yun Ju Cho, Mi Young Eo, Suk Keun Lee, Kyung Mi Woo
Osteoradionecrosis (ORN) of the jaw is a significant complication of radiotherapy for oral cavity cancer. In addition to antibiotic medication, treatment options such as hyperbaric oxygen therapy, surgical approaches, and combined therapy with pentoxifylline and tocopherol have been recently introduced. In this review article, we will discuss the definition and classifications of osteoradionecrosis, its etiology and pathophysiology, previous treatment options, oral and maxillofacial complications of radiotherapy, basic information on pentoxifylline and tocopherol, recent reports of pentoxifylline and tocopherol combined therapy, and, finally, ORN-induced animal models and future approaches...
2014: Biomaterials Research
Marc Hayashi, Monica Pellecer, Evelyn Chung, Eric Sung
BACKGROUND: Osteoradionecrosis (ORN) is an unfortunate complication of radiation therapy to the head and neck. Treatment has historically centered around hyperbaric oxygen therapy and surgical removal of necrotic bone. Recently, a new theory on the pathogenesis of ORN has proposed treatment with pentoxifylline (PTX) and tocopherol/vitamin E. The aim of this retrospective analysis was to evaluate the effectiveness of pentoxifylline and tocopherol in the management of patients with ORN...
November 2015: Special Care in Dentistry
Jordan T Glicksman, Sammy Khalili, Kevin Fung, Lorne S Parnes, Sumit K Agrawal
BACKGROUND: Osteoradionecrosis (ORN) of the temporal bone is a complication of radiation therapy that is extremely challenging to manage. METHODS: We report the case of a patient treated at our institution and present a review of the literature. RESULTS: A 52-year-old woman presented with ORN of the temporal bone 20 years after radiation therapy for an ipsilateral parotid tumor. She failed conservative management, including serial debridements, oral and topical antibiotics/antifungals, and aural lavage...
December 2015: Head & Neck
Linda Spiegelberg, Joanna A M Braks, Lisanne C Groeneveldt, Urville M Djasim, Karel G H van der Wal, Eppo B Wolvius
BACKGROUND: Radiation therapy (RT) as part head and neck cancer treatment often leads to irradiation of surrounding normal tissue, such as mandibular bone. A reduced reparative capacity of the bone can lead to osteoradionecrosis (ORN). Hyperbaric oxygen therapy (HBOT) is used to treat ORN, based on its potential to raise the oxygen tension in tissues. However, prevention of radiation-induced damage is of great interest. Our purpose was to investigate whether HBOT could prevent radiation-induced damage to murine mandibles...
March 2015: Journal of Cranio-maxillo-facial Surgery
Jyun-An Chen, Chen-Chi Wang, Yong-Kie Wong, Ching-Ping Wang, Rong-San Jiang, Jin-Ching Lin, Chien-Chih Chen, Shih-An Liu
BACKGROUND: The purpose of this study was to investigate factors associated with osteoradionecrosis (ORN) of the mandible bone in a large cohort of patients with oral cancer. METHODS: We reviewed the medical records of patients with oral cancer and identified those with ORN of the mandible bone. Variables of patients with and without ORN were compared and associated factors were investigated by logistic regression model. RESULTS: A total of 1692 patients were included in the final analysis and 105 patients (6...
May 2016: Head & Neck
Lone Forner, Anne Lee, Erik Christian Jansen
In head and neck cancer patients with late radiation injury, hyperbaric oxygen (HBO) is used for therapeutic or prophylactic reasons against soft-tissue and osteoradionecrosis (ORN). Twenty-nine departments of oncology, ENT, oral and maxillofacial (OMF) surgery were surveyed using the Enalyzer tool (, of whom 21 responded. Data were incomplete in four returns. Within the previous year, 14 departments had referred at least one patient for hyperbaric oxygen therapy (HBOT). There appears to be a generally positive attitude in Danish OMF, ENT and oncology departments towards referral of patients with ORN for HBOT...
September 2014: Diving and Hyperbaric Medicine: the Journal of the South Pacific Underwater Medicine Society
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