A review of advanced head and neck osteoradionecrosis

Abstract

Osteoradionecrosis (ORN) of the head and neck can be a devastating complication following radiation therapy. ORN is associated with pain, chronic infection, and non-healing wounds. Radiation fibrosis, chronic infection, fistula formation, and necrotic tissues can make treatment challenging. The following review article is a narrative on the management of advanced head and ORN.

Keywords

Head and neck reconstruction / free flap / osteoradionecrosis

References

[1] Trotti A,Epstein JB.Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systematic literature review.Radiother Oncol2003;66:253-62

[2] Marx RE.Osteoradionecrosis: a new concept of its pathophysiology.J Oral Maxillofac Surg1983;41:283-8

[3] Danielsson D,Haghdoost S,Halle M.Osteoradionecrosis, an increasing indication for microvascular head and neck reconstruction.Int J Oral Maxillofac Surg2020;49:1-6

[4] Thorn JJ,Specht L.Osteoradionecrosis of the jaws: clinical characteristics and relation to the field of irradiation.J Oral Maxillofac Surg2000;58:1088-93; discussion 1093-5

[5] Aarup-Kristensen S,Forner L,Eriksen JG.Osteoradionecrosis of the mandible after radiotherapy for head and neck cancer: risk factors and dose-volume correlations.Acta Oncol2019;58:1373-7

[6] Moon DH,Wang K.Incidence of, and risk factors for, mandibular osteoradionecrosis in patients with oral cavity and oropharynx cancers.Oral Oncol2017;72:98-103

[7] Reuther T,Mende U.Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients--a report of a thirty year retrospective review.Int J Oral Maxillofac Surg2003;32:289-95

[8] AlDhalaan NA,Al-Omar A.Medication-related osteonecrosis of the jaw: a review.Cureus2020;12:e6944 PMCID:PMC7067354

[9] Jereczek-Fossa BA.Radiotherapy-induced mandibular bone complications.Cancer Treat Rev2002;28:65-74

[10] Ren W,Li S.Virtual Planning and 3D printing modeling for mandibular reconstruction with fibula free flap.Med Oral Patol Oral Cir Bucal2018;23:e359-66 PMCID:PMC5945234

[11] Oh HK,Martin JW,Park HJ.Osteoradionecrosis of the mandible: treatment outcomes and factors influencing the progress of osteoradionecrosis.J Oral Maxillofac Surg2009;67:1378-86

[12] Khan AA,Hanley DA.International Task Force on Osteonecrosis of the JawDiagnosis and management of osteonecrosis of the jaw: a systematic review and international consensus.J Bone Miner Res2015;30:3-23

[13] Marx RE.A new concept in the treatment of osteoradionecrosis.J Oral Maxillofac Surg1983;41:351-7

[14] Shaw RJ,Silcocks P.HOPON (hyperbaric oxygen for the prevention of osteoradionecrosis): a randomized controlled trial of hyperbaric oxygen to prevent osteoradionecrosis of the irradiated mandible after dentoalveolar surgery.Int J Radiat Oncol Biol Phys2019;104:530-9

[15] Sultan A,Margalit DN.The use of hyperbaric oxygen for the prevention and management of osteoradionecrosis of the jaw: a Dana-Farber/Brigham and Women's Cancer Center Multidisciplinary Guideline.Oncologist2017;22:343-50 PMCID:PMC5344641

[16] Hirsch DL,Dierks EJ,Potter BE.Analysis of microvascular free flaps for reconstruction of advanced mandibular osteoradionecrosis: a retrospective cohort study.J Oral Maxillofac Surg2008;66:2545-56

[17] Alam DS,Christian J.Analysis of outcomes of vascularized flap reconstruction in patients with advanced mandibular osteoradionecrosis.Otolaryngol Head Neck Surg2009;141:196-201

[18] Delanian S,Lefaix JL.Major healing of refractory mandible osteoradionecrosis after treatment combining pentoxifylline and tocopherol: a phase II trial.Head Neck2005;27:114-23

[19] Delanian S,Porcher R,Lefaix JL.Complete restoration of refractory mandibular osteoradionecrosis by prolonged treatment with a pentoxifylline-tocopherol-clodronate combination (PENTOCLO): a phase II trial.Int J Radiat Oncol Biol Phys2011;80:832-9

[20] Patel V,Sassoon I,Kwok J.Prophylactic use of pentoxifylline and tocopherol in patients who require dental extractions after radiotherapy for cancer of the head and neck.Br J Oral Maxillofac Surg2016;54:547-50

[21] Dissard A,Barthelemy I.Efficacy of pentoxifylline-tocopherol-clodronate in mandibular osteoradionecrosis.Laryngoscope2020;130:E559-66

[22] Sweeny L,Swendseid BP.Microvascular reconstruction of osteonecrosis: assessment of long-term quality of life.Otolaryngol Head Neck Surg2021;

[23] Rogers SN,Lowe D.Longitudinal evaluation of health-related quality of life after osteoradionecrosis of the mandible.Br J Oral Maxillofac Surg2015;53:854-7

[24] Wang L,Liao GQ.Quality of life in osteoradionecrosis patients after mandible primary reconstruction with free fibula flap.Oral Surg Oral Med Oral Pathol Oral Radiol Endod2009;108:162-8

[25] Shaha AR,Hidalgo DA.Resection and immediate microvascular reconstruction in the management of osteoradionecrosis of the mandible.Head Neck1997;19:406-11

[26] Lofstrand J,Karlsson T.Quality of life after free fibula flap reconstruction of segmental mandibular defects.J Reconstr Microsurg2018;34:108-20

[27] Kim JW,Ahn KM.Fibular flap for mandible reconstruction in osteoradionecrosis of the jaw: selection criteria of fibula flap.Maxillofac Plast Reconstr Surg2016;38:46 PMCID:PMC5122601

[28] Blumberg JM,Johnson S.Mandibular reconstruction with the scapula tip free flap.Head Neck2019;41:2353-8

[29] Yeh DH,Sahovaler A.Shouldering the load of mandible reconstruction: 81 cases of oromandibular reconstruction with the scapular tip free flap.Head Neck2019;41:30-6

[30] Dowthwaite SA,Belzile M.Comparison of fibular and scapular osseous free flaps for oromandibular reconstruction: a patient-centered approach to flap selection.JAMA Otolaryngol Head Neck Surg2013;139:285-92

[31] Bigcas JLM. Osteocutaneous radial forearm flap. Treasure Island (FL): StatPearls Publishing; 2021. Available from: https://www.ncbi.nlm.nih.gov/books/NBK564384/ [Last accessed on 30 Nov 2021]

[32] Kim JH,Ellis T.Radial forearm osteocutaneous free flap in maxillofacial and oromandibular reconstructions.Laryngoscope2005;115:1697-701

[33] Chapchay K,Eliashar R.Anterior skull base reconstruction following ablative surgery for osteoradionecrosis: case report and review of literature.Ann Otol Rhinol Laryngol2019;128:1134-40

[34] Sharaf B,Hirsch DL,Schiff BA.Importance of computer-aided design and manufacturing technology in the multidisciplinary approach to head and neck reconstruction.J Craniofac Surg2010;21:1277-80

[35] Largo RD.Updates in head and neck reconstruction.Plast Reconstr Surg2018;141:271e-85e

[36] Avraham T,Brecht LE.Functional outcomes of virtually planned free fibula flap reconstruction of the mandible.Plast Reconstr Surg2014;134:628e-34e

[37] Chang EI.Long-term operative outcomes of preoperative computed tomography-guided virtual surgical planning for osteocutaneous free flap mandible reconstruction.Plast Reconstr Surg2016;138:559e-60e

[38] Patel H,Ho AS.Virtual surgical planning for bisphosphonate-related osteonecrosis of the jaw: a valuable application in advanced cases.Cureus2020;12:e9696 PMCID:PMC7486086

[39] Vieira L,Dimovska EOF.Four lessons learned from complications in head and neck microvascular reconstructions and prevention strategies.Plast Reconstr Surg Glob Open2021;9:e3329 PMCID:PMC7858199

[40] Mayland EJ SB,Wax MK. Management and and outcomes of advanced head and neck osteonecrosis. Forthcoming 2021. Available from: https://journals.lww.com/cancerjournal/Fulltext/2016/12020/Antibiotic_protocol_for_the_prevention_of.22.aspx [Last accessed on 30 Nov 2021]

[41] Menapace DC,Jackson RS.Primary vs secondary endosseous implantation after fibular free tissue reconstruction of the mandible for osteoradionecrosis.JAMA Facial Plast Surg2018;20:401-8 PMCID:PMC6233614

[42] Wilkman T,Lassus P.Clinical comparison of scapular, fibular, and iliac crest osseal free flaps in maxillofacial reconstructions.Scand J Surg2019;108:76-82

[43] Danielsson D,Hagel E.Quality of life after microvascular mandibular reconstruction for osteoradionecrosis-a prospective study.Head Neck2019;41:2225-30

[44] Baumann DP,Hanasono MM.Free flap reconstruction of osteoradionecrosis of the mandible: a 10-year review and defect classification.Head Neck2011;33:800-7

[45] Jacobson AS,Smith M.Quality of life after management of advanced osteoradionecrosis of the mandible.Int J Oral Maxillofac Surg2013;42:1121-8

[46] Chang EI,Hoffman WY.Quality of life for patients requiring surgical resection and reconstruction for mandibular osteoradionecrosis: 10-year experience at the University of California San Francisco.Head Neck2012;34:207-12

[47] Rogers SN,Lowe D,Yueh B.The addition of mood and anxiety domains to the University of Washington quality of life scale.Head Neck2002;24:521-9

[48] Derek Lowe SR. University of Washington Quality of Life Questionnaire (UW-QOL v4) Guidance for scoring and presentation. Available from: https://www.entnet.org/wp-content/uploads/files/uw_qol_r_v4.pdf [Last accessed on 1 Nov 2021]

[49] Sweeny L,Light T.Effect of overlapping operations on outcomes in microvascular reconstructions of the head and neck.Otolaryngol Head Neck Surg2017;156:627-35

[50] Cannady SB,Kroeker A,Rosenthal EL.Free flap reconstruction for osteoradionecrosis of the jaws--outcomes and predictive factors for success.Head Neck2011;33:424-8

[51] Lee M,Eslick GD,Paramaesvaran S.Outcomes of microvascular free flap reconstruction for mandibular osteoradionecrosis: a systematic review.J Craniomaxillofac Surg2015;43:2026-33

[52] Park L,Addison B.Cost analysis of osteoradionecrosis.J Laryngol Otol2017;131:303-8

[53] Kelishadi SS,Rodriguez ED.Is simultaneous surgical management of advanced craniofacial osteoradionecrosis cost-effective?.Plast Reconstr Surg2009;123:1010-7

[54] Li H,Alexander S,Ramakrishnan A.Comparative osteoradionecrosis rates in bony reconstructions for head and neck malignancy.J Plast Reconstr Aesthet Surg2019;72:1478-83

[55] Sandhu S,Sankar V,Villa A.Osteonecrosis of the jaw and dental extractions: a single-center experience.Oral Surg Oral Med Oral Pathol Oral Radiol2020;130:515-21

[56] Al-Bazie SA,Al-Ghazi M,Ramalingam S.Antibiotic protocol for the prevention of osteoradionecrosis following dental extractions in irradiated head and neck cancer patients: a 10 years prospective study.J Cancer Res Ther2016;12:565-70

[57] Marx RE,Kline SN.Prevention of osteoradionecrosis: a randomized prospective clinical trial of hyperbaric oxygen versus penicillin.J Am Dent Assoc1985;111:49-54

[58] Bennett MH,Hampson NB,Milross C.Hyperbaric oxygen therapy for late radiation tissue injury.Cochrane Database Syst Rev2016;4:CD005005 PMCID:PMC6457778

[59] Teguh DN,Noever I.Early hyperbaric oxygen therapy for reducing radiotherapy side effects: early results of a randomized trial in oropharyngeal and nasopharyngeal cancer.Int J Radiat Oncol Biol Phys2009;75:711-6

[60] D'Souza J,Goru S,Vaughan ED.The influence of hyperbaric oxygen on the outcome of patients treated for osteoradionecrosis: 8 year study.Int J Oral Maxillofac Surg2007;36:783-7

[61] Bessereau J.Treatment of osteoradionecrosis of the jaw: the case against the use of hyperbaric oxygen.J Oral Maxillofac Surg2010;68:1907-10