Chinese expert group consensus on diagnosis and clinical management of osteoradionecrosis of the mandible

He, Yue; Ma, Chunyue; Hou, Jinsong; Li, X.; Peng, Xin; Wang, Hailong; Wang, S.; Liu, L.; Liu, Boming; Tian, Li; Liu, Zeliang; Liu, X.; Xu, Xin; Zhang, Defei; Jiang, Chunxiang; Wang, J.; Yao, Yao; Zhu, Guopei; Bai, Yongrui; Sun, Changfu; Li, J.; He, Shaokun; Wang, C.; Zhang, Z.; Qiu, Weimin

doi:10.1016/j.ijom.2019.06.015

Cited by 23 publications

(22 citation statements)

References 63 publications

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“…Despite the recent change in the definition for additional soft tissue considerations, most studies regarding ORN evaluations still focus on the simple elements of osseous injuries ( 5 , 6 ). Based on the classic theory of pathogenesis, radio-induced fibrosis can also occur in soft tissues due to “hypoxia, hypovascularization, and hypocellularity” in the surrounding cellular matrix ( 7 ). As proof of such theory, radiation-induced symptoms, such as swelling, dysphagia and trismus, were also frequently observed in advanced ORN cases ( 8 ).…”

Section: Introductionmentioning

confidence: 99%

Radiation-Induced Soft Tissue Injuries in Patients With Advanced Mandibular Osteoradionecrosis: A Preliminary Evaluation and Management of Various Soft Tissue Problems Around Radiation-Induced Osteonecrosis Lesions

Gao

Liu

et al. 2021

Front. Oncol.

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ObjectivesRadiation-induced soft-tissue injuries (STIs) in mandibular osteoradionecrosis (ORN) are not well studied regarding their correlations with nearby bone lesions. The aim of this study is to investigate the severity of radiation-induced STIs in advanced mandibular ORN and its relationship with hard-tissue damage and postoperative outcomes.MethodsA retrospective study was performed in our institution from January 2017 to December 2019. Aside from demographic factors, the associations between the triad ORN variables (irradiation doses, ORN stages, ORN sizes) and radiation-related STI factors, vascular characteristics, and postoperative functional recovery were assessed. In addition, the severity of STI was also compared with treatment outcomes. Such correlations were established via both univariate and multivariable analyses.ResultsA total number of 47 patients were included. The median follow-up reached 27 months. Nasopharyngeal cancer was the histology type among most patients (n = 21, 44.7%). The median irradiation doses reached 62 Gy (range, 40–110 Gy). For STI, the symptom scoring equaled an average of 5.4 (range from 1 to 12), indicative of the severity of STI problems. During preoperative MRI examinations, signs of hypertrophy or edema (n = 41, 87.2%) were frequently discerned. Most patients (n = 23, 48.9%) also had extensive muscular fibrosis and infection, which required further debridement and scar release. Surprisingly, most STI factors, except cervical fibrosis (p = 0.02), were not in parallel with the ORN levels. Even the intraoperative soft-tissue defect changes could not be extrapolated by the extent of ORN damage (p = 0.096). Regarding the outcomes, a low recurrence rate (n = 3, 6.9%) was reported. In terms of soft tissue-related factors, we found a strong correlation (p = 0.004) between symptom scores and recurrence. In addition, when taking trismus into consideration, both improvements in mouth-opening distance (p < 0.001) and facial contour changes (p = 0.004) were adversely affected. Correlations were also observed between the intraoperative soft-tissue defect changes and complications (p = 0.024), indicative of the importance of STI evaluation and management.ConclusionsThe coexistence of hard- and soft-tissue damage in radiation-induced advanced mandibular ORN patients reminds surgeons of the significance in assessing both aspects. It is necessary to take the same active measures to evaluate and repair both severe STIs and ORN bone lesions.

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Section: Introductionmentioning

confidence: 99%

Radiation-Induced Soft Tissue Injuries in Patients With Advanced Mandibular Osteoradionecrosis: A Preliminary Evaluation and Management of Various Soft Tissue Problems Around Radiation-Induced Osteonecrosis Lesions

Gao

Liu

et al. 2021

Front. Oncol.

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“…It was reported that 5%–15% of patients with HNC suffer from ORNJ [[4], [5], [6]]. ORNJ is defined as an area of exposed devitalized irradiated bone that fails to heal over a period of 3–6 months in the absence of local neoplastic disease [7,8]. ORNJ can also be characterized by bone tissue necrosis and failure of healing; ORNJ either stabilizes or gradually worsens and is notoriously difficult to manage [[7], [8], [9]].…”

Section: Introductionmentioning

confidence: 99%

Symptom distress and interference among cancer patients with osteoradionecrosis of jaw: A cross-sectional study

Yang

Feng²,

et al. 2019

International Journal of Nursing Sciences

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Objective Osteoradionecrosis of the jaws (ORNJ) is among the most serious oral complications of head and neck cancer treatment with radiation therapy. This study aimed to examine the level of symptom distress and interference of ORNJ in head and neck cancer patients in China. Methods A cross-sectional study was conducted to profile patient reported symptom severity. Ninety-five hospitalized ORNJ patients were recruited. Participants completed the MD Anderson Symptom Inventory–Head and Neck Module-Chinese version. Results The percentage of participants who reported that they experienced at least one type of symptom was 97.9%, and 85.2% patients reported interference. The 10 most severe symptoms were as follows: limited mouth opening, problem with teeth/gums, difficulty swallowing/chewing, dry mouth, oral malodor, difficulty with voice/speech, dental ulcer, tinnitus/ear obstruction, skin pain/burning/rash, and difficulty hearing. The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy. The interference of patients positively correlated with core symptoms ( r = 0.612), head and neck symptoms ( r = 0.709), and ORNJ symptoms ( r = 0.440) ( P < 0.01). The longer time to the onset of ORNJ after radiotherapy was positively and significantly correlated with symptom distress ( r = 0.479, P < 0.001), and mouth opening correlated negatively with symptom distress ( r = −0.298, P = 0.003). Conclusions ORNJ patients suffered mainly from limited mouth opening and other maxillofacial symptoms. The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy. ORNJ patients commonly had symptom distress, which influenced their quality of life.

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“…Based on the degree of bone and soft tissue damage, ORN consists of four stages (stage 0, stage I, stage II, and stage III) [ 60 ]. Different stages of ORN require distinct treatment protocols [ 85 ].…”

Section: Traditional Treatments Of Ornsmentioning

confidence: 99%

The Potential Therapeutic Role of Mesenchymal Stem Cells-Derived Exosomes in Osteoradionecrosis

Wang

Pang

et al. 2021

Journal of Oncology

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As one of the most serious complications of radiotherapy, osteoradionecrosis (ORN) seriously affects the quality of life of patients and even leads to death. Vascular injury and immune disorders are the main causes of bone lesions. The traditional conservative treatment of ORN has a low cure rate and high recurrent. Exosomes are a type of extracellular bilayer lipid vesicles secreted by almost all cell types. It contains cytokines, proteins, mRNA, miRNA, and other bioactive cargos, which contribute to several distinct processes. The favorable biological functions of mesenchymal stem cells-derived exosomes (MSC exosomes) include angiogenesis, immunomodulation, bone regeneration, and ferroptosis regulation. Exploring the characteristic of ORN and MSC exosomes can promote bone regeneration therapies. In this review, we summarized the current knowledge of ORN and MSC exosomes and highlighted the potential application of MSC exosomes in ORN treatment.

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Chinese expert group consensus on diagnosis and clinical management of osteoradionecrosis of the mandible

Cited by 23 publications

References 63 publications

Radiation-Induced Soft Tissue Injuries in Patients With Advanced Mandibular Osteoradionecrosis: A Preliminary Evaluation and Management of Various Soft Tissue Problems Around Radiation-Induced Osteonecrosis Lesions

Radiation-Induced Soft Tissue Injuries in Patients With Advanced Mandibular Osteoradionecrosis: A Preliminary Evaluation and Management of Various Soft Tissue Problems Around Radiation-Induced Osteonecrosis Lesions

Symptom distress and interference among cancer patients with osteoradionecrosis of jaw: A cross-sectional study

The Potential Therapeutic Role of Mesenchymal Stem Cells-Derived Exosomes in Osteoradionecrosis

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