Osteoradionecrosis of the mandible: through a radiologist's eyes

Bosmans

Semin Musculoskelet Radiol

et al. 2020

Radiopaque lesions and lesions of mixed density are less frequent than radiolucent lesions of the jawbones. They comprise a spectrum of odontogenic and non-odontogenic lesions. The latter group includes inherited and developmental disorders, osteomyelitis, and benign and malignant primary bone tumors and metastases. Most odontogenic radiopaque or mixed lesions are either related to the apex or more rarely to the crown of the tooth, although there are exceptions to this rule. Some lesions, such as a torus mandibularis and torus palatinus, have a characteristic location, whereas others show no relationship to the dentition. This article describes the most characteristic and prevalent radiopaque and mixed lesions of the jaws and their imaging characteristics. Paget's disease, fibrous dysplasia, and rare sclerotic bone diseases of the maxillofacial bones are discussed elsewhere in this issue. Careful correlation of clinical presentation, panoramic radiographs, cone beam computed tomography, and histopathology are the cornerstones for appropriate lesion characterization.

Section: Osteoradionecrosismentioning

confidence: 99%

Imaging of Mixed and Radiopaque Jaw Lesions

Bosmans

Semin Musculoskelet Radiol

et al. 2020

“… Stage 0: mucosal defects only; bone exposed  Stage I: radiological evidence of necrotic bone, dento-alveolar only  Stage II: positive radiographic findings above ID canal with denuded bone intraorally  Stage III: clinically exposed radionecrotic bone, verified by imaging techniques, along with skin fistulas and infection with addition of potential or actual pathological fracture. Radiological evidence of bone necrosis within the radiation field, where tumour recurrence has been excluded (Dhanda et al, 2016) (Deshpande et al, 2015 (Karagozoglu, et al. 2014) (Shaw and Dhanda, 2011) (Notani, et al.…”

Section: Osteoradionecrosismentioning

confidence: 99%

The oral management of oncology patients requiring radiotherapy, chemotherapy and/or bone marrow transplantation

Kumar

Brooke

Burke

et al. 2013

FDJ

Patients undergoing cancer therapy may experience unwanted side-effects involving the oral cavity and more evidence is emerging regarding the management of these complications. These oral effects have both short and long-term implications. Dentists need to be aware of these implications and liaise closely with the oncology teams to establish pathways of oral care. This enables patients to have appropriate dental support in place before, during and after cancer therapy. This article is an executive summary of a review undertaken for a national clinical guideline, The Oral Management of Oncology Patients following Radiotherapy, Chemotherapy and/or Bone Marrow Transplanation. The full text is available on the FDS website: www.rcseng.ac.uk/fds/publications-clinical-guidelines/clinical_guidelines/

BMC Musculoskelet Disord

“…Deshpande found that TI-201 SPECT clarified 75% (three of the four) of the false-positive PET to be ORN. Thus, SPECT may be used to reduce false-positive rates and improve specificity [18]. Owing to the lack of specificity of imaging studies in the differential diagnosis from recurrent tumors, bone biopsies may be invasive in special cases but can be useful for making a definite diagnosis of ORN.…”

Section: Discussionmentioning

confidence: 99%

Lumbar vertebral osteoradionecrosis: a rare case report with 10-year follow-up and brief literature review

Cong

Xie

Liang

et al. 2020

Background: Osteoradionecrosis (ORN) is a complication that occurs after radiotherapy for head or neck malignancies. ORN of the spine is rare, with only few cases affecting the cervical spine reported to date. To our knowledge, no case of lumbar ORN has been reported. We report a rare case of ORN in the lumbar spine that occurred 2 years after radiotherapy and perform a literature review. Case presentation: We present a case of lumbar ORN that occurred 2 years after radiotherapy for gallbladder carcinoma. The patient was successfully treated conservatively and followed up for > 10 years. Conclusions: ORN of the spine is a rare complication of radiotherapy. Spinal ORN is clinically described as a chronic disease with a slow onset. The most common presenting symptom of spinal ORN is pain. However, as ORN progresses, spinal kyphosis and instability can lead to neurological compression and thus to induced myelopathy or radiculopathy. Treatment of spinal ORN is comprehensive, including orthosis, medication, hyperbaric oxygen therapy, surgery, and new treatment combinations of pentoxifylline and tocopherol. The surgical rate for spinal ORN is relatively high.