Abstract
Osteoradionecrosis of the jaw can be treated using both conservative treatment and
surgery. External fixation may be used to bridge large resection defects after sequestrectomy
for stabilisation and before secondary mandibular reconstruction. We designed a retrospective
analysis of 70 patients with osteoradionecrosis treated between the years 2014 and
2018, and found that the use of external fixation greatly improves their outcomes.
Patients were grouped according to Notani’s classification: those who had Notani I
disease were treated surgically but without external fixation; and those with Notani
II and Notani III disease were eligible for external fixation. In those with Notani
II disease, there was a significant reduction in the number of pathological fractures
that occurred with external fixation. In those with Notani III disease, the success
rate of primary sequestrectomy was only 1:14; however, those treated with external
fixation all successfully healed after their first operation. It was hypothesised
that although external fixation would improve outcome, it would come at a detriment
to their quality of life (QoL). However, in a subset of these patients, we showed
that in addition to increasing successful healing, patients’ QoL with the external
fixator was no worse than when they had an active osteonecrotic lesion. The treatment
of osteoradionecrosis is cumbersome and advanced stages are associated with more complications.
The use of an external fixator significantly reduces the probability of pathological
fractures and increases the rate of successful healing in patients after mandibular
resection. It does this without greatly interfering with patients’ lives, while improving
their condition sufficiently to allow for subsequent mandibular reconstruction.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to British Journal of Oral and Maxillofacial SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Osteoradionecrosis of the jaws: definition, epidemiology, staging and clinical and radiological findings. A concise review.Int Dent J. 2018; 68: 22-30
- External pin fixation for stabilization of the mandible—comeback of a method: historical review and first experiences with the ‘mandible external fixator’.Oral Maxillofac Surg. 2009; 13: 1-14
- Case report of maxillofacial fracture in a patient under bisphosphonates in the absence of ONJ disease: Guidelines?.Int J Surg Case Rep. 2018; 51: 318-322
- Mandibular condylar fractures in children:morphological results after treatment with external fixation.J Craniofac Surg. 2017; 28: 1742-1745
- Definitions of quality of life: what has happened and how to move on.Top Spinal Cord Inj Rehabil. 2014; 20: 167-180
- Head and Neck database listing evidence on QoL.2012 (Available from URL: http://www.handle-on-qol.com/Index.aspx Last accessed 21 May 2020)
- Assessing quality of life using the Oral Health Impact Profile (OHIP-14) in subjects with and without orthodontic treatment need in Chennai, Tamil Nadu, India.J Clin Diagn Res. 2017; : ZC78-81
- Standards for validating health measures: Definition and content.J Chron Dis. 1987; B40: 473-480
- Potential risk factors for jaw osteoradionecrosis after radiotherapy for head and neck cancer.Radiat Oncol. 2016; 11: 101
- Osteoradionecrosis: a new concept of its pathophysiology.J Oral Maxillofac Surg. 1983; 41: 283-288
- Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment.Br J Oral Maxillofac Surg. 2008; 46: 653-660
- Management of mandibular osteoradionecrosis corresponding to the severity of osteoradionecrosis and the method of radiotherapy.Head Neck. 2003; 25: 181-186
- Hyperbaric oxygen in the management of late radiation injury to the head and neck. Part I: treatment.Br J Oral Maxillofac Surg. 2011; 49: 2-8
- Etiology and treatment of osteonecrosis of the mandble.Contemp Oncol (Pozn). 2013; 3: 281-285
- Clinico-therapeutic management of osteoradionecrosis: a literature review and update.Med Oral Patol Oral y Cir Bucal. 2011; 16: e900-4
- HOPON (Hyperbaric Oxygen for the Prevention of Osteoradionecrosis): a randomised controlled trial of hyperbaric oxygen to prevent osteoradionecrosis of the irradiated mandible: study protocol for a randomised controlled trial.Trials. 2018; 19: 22
- The use of hyperbaric oxygen for the prevention and management of osteoradionecrosis of the jaw: a Dana‐Farber/Brigham and Womens Cancer Center Multidisciplinary Guideline.Oncologist. 2017; 22: 343-350
- Medical treatment of osteoradionecrosis of the mandible by PENTOCLO: Preliminary results.Eur Ann Otorhinolaryngol Head Neck Dis. 2014; 131: 333-338
- Pentoxifylline, tocopherol, and clodronate for the treatment of mandibular osteoradionecrosis: a systematic review.Oral Surg Oral Med Oral Pathol Oral Radiol. 2018; 125: 431-439
- Management of pathologic fractures of the mandible secondary to osteoradionecrosis.Otolaryngol Head Neck Surg. 2013; 148: 54-58
Article info
Publication history
Published online: June 18, 2020
Accepted:
May 22,
2020
Identification
Copyright
© 2020 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.
