Osteoradionecrosis: Experience from the Oral and Maxillofacial Surgery Unit at Christchurch Hospital, New Zealand

Abstract

Background and objectives: Osteoradionecrosis of the jaws (ORN) is a debilitating complication of radiotherapy among head and neck cancer patients. Dentists are critical to the management of patients at risk and may be the first clinicians to encounter new onset ORN. Oral and Maxillofacial Surgical teams are commonly involved in the surgical management of such patients. To the best of our knowledge there have been no studies examining the referral pathways of patients with ORN to Oral and Maxillofacial Surgical Services in New Zealand. Methods: A retrospective study was conducted and included all patients with ORN referred to the Oral and Maxillofacial Surgical Service at Christchurch Hospital, New Zealand in the 3-year period 1st January 2018 to 31st December 2020. Clinical records were accessed to collect data endpoints. To illustrate the potential severity of ORN we also present a case report of a patient with mandibular ORN and pathologic fracture that was managed. Results: Thirteen patients with ORN were referred to the Oral and Maxillofacial Surgical Service at Christchurch Hospital over the study period. The majority of patients were referred by internal Christchurch Hospital colleagues (Otorhinolaryngology and Hospital Dentists). A wide range of presenting signs/symptoms were found. All patients presented with exposed necrotic bone however no other symptoms were found to be of high sensitivity for ORN. Patients required a range of treatment modalities, from conservative management to resection and fibula free-flap reconstruction. Conclusions: Most patients at risk of ORN are being maintained on long-term Hospital based recall lists for clinical review. Given the wide range of presenting signs/symptoms of ORN, oral health practitioners must exercise a high degree of clinical suspicion when encountering these in irradiated patients.