Osteoradionecrosis

Excerpt

Treatment of malignancies with ionizing radiation has saved countless lives in the past 50 years. However, a small percentage of patients treated with radiation for head and neck cancers will develop osteoradionecrosis (ORN) of the jaw. Patients treated with more than 6000 centigrays (cGy) of radiation have an approximately 9% incidence of developing mandibular osteoradionecrosis. A newer radiation technique called intensity-modulated radiation therapy (IMRT) has been reported to have a lower incidence of mandibular osteoradionecrosis. Some of these patients will develop exposed intraoral mandibular bone. Many of these patients will go on to heal spontaneously and without complications, but some will develop osteomyelitis and even fractures of the mandible leading to eventual soft tissue necrosis.

Hyperbaric oxygen treatment has become a mainstay treatment for osteoradionecrosis. An interprofessional team consisting of oral maxillofacial surgeons, dentists, undersea and hyperbaric medicine specialists, infectious disease specialists, and radiation oncologists can optimize treatment for patients who develop osteoradionecrosis as a complication of radiation treatment. Hyperbaric treatments should be given adjunctively with surgical debridement and appropriate culture-directed antibiotic therapy to provide the most optimal outcome.