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

Abstract

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.

Osteoradionecrosis of the Jaw—Comparison between Bone and Soft Tissue Injury and Their Influence on Surgical Outcomes—A Retrospective Cohort Study

“…In our view, this healthy tissue enables a tension-free wound healing and therefore leads to increased therapeutic success. This goes in line with Ma et al, whose retrospective study of 47 patients with advanced ORN suggests that bone alteration alone appears to be a poor predictor of therapeutic success [12]. Their data show that soft tissue injury especially has a predictive value for surgical success.…”

“…Interestingly, it has been shown that the extent of bone loss is not directly related to the extent of soft tissue injury and vice versa [12]. It is therefore not surprising that more and more groups are starting to consider both bone loss and soft tissue damage in their therapeutic algorithms for the treatment of ORN.…”

ATG7‐mediated autophagy protects human gingival myofibroblasts from irradiation‐induced apoptosis

“…Persistent activation and apoptosis resistance of myofibroblasts result in continuously accumulated myofibroblasts, excess extracellular matrix remodeling, and ultimately irradiation‐induced fibrosis 18,19 . Fibrosis induced by irradiation was reported to be the main reason for ORNJ 2,20 . In the present study, we found that irradiation lead to significantly decreased viability and increased apoptosis of normal fibroblasts, while no statistical difference was observed in ORNJ fibroblasts, these results firstly demonstrate the apoptosis resistance of human gingival myofibroblasts to irradiation.…”

Modified Gap Arthroplasty for Temporomandibular Joint Ankylosis Following Radiotherapy for Rhabdomyosarcoma: Report of an Unusual Case and Brief Literature Review

“…Osteoradionecrosis (ORN) is defined as non-healing, exposed bone in a previously radiated area of the body (12). ORN occurs when a bone in an irradiated field undergoes necrosis and eventually becomes exposed through the overlying soft tissues (13). Of all bones in the head and neck area, the mandible is the most common site of ORN due to its superficial location and lower blood supply.…”