Osteoradionecrosis of the Mandible

Rankow, Robin M.; Weissman, Bruce

doi:10.1177/000348947108000426

Cited by 57 publications

(33 citation statements)

References 5 publications

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“…In early and localized cases, an initial trial of conservative management with improvement in oral hygiene and treatment with antibiotics may be sufficient. [1][2][3][4] Hyperbaric oxygen (HBO) therapy in conjuction with sequestrectomy have also been advocated. [5][6][7][8][9][10][11] However, in advanced cases, such as when the patient has pathological fracture, the results of conservative treatment may be inadequate.…”

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confidence: 99%

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Management of advanced mandibular osteoradionecrosis with free flap reconstruction

et al. 2001

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confidence: 99%

“…[1][2][3][4]7,[12][13][14][15][16][17][18] Grafting of non-vascularized bone into irradiated tissue has achieved limited success. 19,20 The survival rate of bone grafts, particularly in irradiated wounds, is extremely low, with complication rates approaching 80% in some reports.…”

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confidence: 99%

Management of advanced mandibular osteoradionecrosis with free flap reconstruction

et al. 2001

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“…15 Hyposalivation results in a number of disturbances to the oral physiology such as impaired lubrication, buffering capacity, cleansing activity, antimicrobial activity, agglutination, pellicle formation, digestion, and loss of the ion reservoir necessary for remineralization of teeth, leading to massively increased rates of dental caries, 16,17 increased rate of oral candidiasis, 13 increased mucosal irritation, increase in gingivitis 18 and reduced taste sensation. 7 The sequelae of these events may be catastrophic to the patient resulting in loss of teeth 17 or severe mucosal attrition leading to osteoradionecrosis 18 of the underlying bone. Such problems exist in addition to acute radiation mucositis 8 at the time of radiotherapy.…”

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An Investigation into the Use of Pilocarpine as a Sialagogue in Patients With Radiation Induced Xerostomia

Frydrych

Davies

Slack‐Smith

et al. 2002

Australian Dental Journal

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Background: Radiation therapy to the head and neck region can be an effective form of treatment for malignancies. Unfortunately damage to salivary glands may occur. Treatment of resultant dry mouth is at present very poor. The purpose of this pilot study was to investigate whether pilocarpine dissolved in artificial saliva and administered in a mouth spray would be effective in relieving such symptoms. Methods: Twenty-three patients with radiation induced hyposalivation were recruited for this randomized, double-blind investigation. Subjects were randomly allocated to placebo or control medicaments used for eight weeks. All subjects were evaluated for the severity of their xerostomia associated symptoms prior to administration of the spray and again eight weeks later. Results: The questionnaire and the visual analogue scale did not reveal any improvements in the dry mouth symptoms between cases and controls. Sideeffects were reported among cases, mostly mild and tolerable. All patients taking pilocarpine (with base salivary flow rates > 0ml/min) demonstrated improvement in stimulated and unstimulated salivary flow rates. Candida counts decreased among the cases and controls although decrease among the cases was much greater. Conclusions:The results obtained indicate that provided residual functioning salivary tissue exists, pilocarpine used as formulated is effective and warrants further investigation.

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“…If healing does not occur after the patient has followed this regimen for a period of time, a number of superficial sequestrectomies are performed to remove the necrotic tissue. According to the literature, the resolution rate after the first four steps of this therapy ranges from 8% (5) to 75% (6), with a number of other authors reporting different rates within this range (3,7). If the patient does not heal after the first four steps, reconstructive surgery is required.…”

Section: Treatment Options Conservative Therapymentioning

confidence: 99%

“…Along with this concept of the pathophysiology of osteoradionecrosis, it has been suggested that seven factors contribute to its development. These factors include the size of the tumour, combined interstitial and external beam radiation, energy of the radiation source, field size and number of treatment fields, oral hygiene, dental trauma and/or dental extractions and, finally, postradiotherapy radical neck dissection (3). Marx (5) proposed an alternative pathogenesis in which microorganisms play a very minor role.…”

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confidence: 99%