Surgical management of extensive osteoradionecrosis in nasopharyngeal carcinoma patients with the maxillary swing approach and free muscular flaps

Choi, Na-Young; Kim, H.J.; Baek, Chung‐Hwan

doi:10.1111/coa.12866

Cited by 13 publications

(24 citation statements)

References 9 publications

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“…However, the incidence may be underestimated because the clinical signs are often not specific. Indeed, some patients present with acute signs such as massive bleeding or meningitis, but in other cases the only presenting signs are asthenia, chronic pain, or even cachexia . Such signs in a patient previously treated by radiotherapy should therefore prompt the clinician to look for ORN.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, some patients present with acute signs such as massive bleeding or meningitis, but in other cases the only presenting signs are asthenia, chronic pain, or even cachexia. 3,6,7 Such signs in a patient previously treated by radiotherapy should therefore prompt the clinician to look for ORN. These aspecific sign also explain why many patients are diagnosed at an advanced stage: four out seven patients (57%) presented with an ICA no longer covered by bone, and exposed to necrotic tissues.…”

Section: Discussionmentioning

confidence: 99%

“…An overall survival rate of 54% has been reported by Liu et al with a surgical management through an endoscopic approach . Other authors have reported on open approaches with free flaps . Huang and al.…”

Section: Discussionmentioning

confidence: 99%

“…There are relatively few studies on sphenoid ORN but it appears to be a life‐threatening condition, with reported survival rates as low as 33% . Several treatment regimen have been described, including conservative management with antibiotherapy or hyperbaric oxygen and more aggressive approaches such as surgical debridement of the necrotic tissues followed by protection of the exposed bone by local or free flaps . However, the extent of ORN may be very variable, and it seems difficult to use a single approach for the management of the various stages of the disease.…”

Section: Introductionmentioning

confidence: 99%

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Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results

Daoudi

Labeyrie

Guillerm

et al. 2020

Laryngoscope Investig Oto

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Objective Osteoradionecrosis (ORN) of the sphenoid is a rare but potentially lethal complication that can occur after irradiation of nasopharyngeal and clival malignancies. The objective of this study was to describe a multimodal treatment strategy tailored to the clinical signs and to the radiological extent of the disease, and to report on its preliminary results. Methods Retrospective monocentric study at a tertiary skull base center. Patients treated for a sphenoid ORN from January 2014 to August 2018 were identified and charts were retrospectively reviewed for demographics, histologic tumor type, previous treatments of the tumor, clinical signs at presentation, radiological data, treatment, and outcomes. Sphenoid ORN was treated by a combination of medical therapy, endovascular treatment, and/or surgery. The use of each of these therapeutic modalities was based on the extent of ORN and on the presenting signs. Results Seven patients were included: four patients underwent endovascular treatment with occlusion of the internal carotid artery, five patients underwent surgical debridement, and covering of the exposed bone by a local flap, seven patients received antibiotics (in combination with pentoxyphilline, tocopherol, and clodronate in one case). Three patients died after progression of the ORN. The global survival rate was 57% (4/7) with a mean follow‐up of 24 months. In one case, ORN was treated successfully by medical treatment only, with a combination of antibiotics, pentoxyphilline, tocopherol, and clodronate. Conclusion This retrospective study describes the results of a management strategy adapted to the extent of the disease in sphenoid ORN and based on medical therapy only, or on a combination of medical therapy, interventional radiology, and/or surgery. Level of evidence 4

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results

Daoudi

Labeyrie

Guillerm

et al. 2020

Laryngoscope Investig Oto

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“…Extensive osteoradionecrosis can be treated with a maxillary swing approach and free muscular flaps. 6 However, this technique is limited by technical difficulties, a long surgical time, and wound problems. In contrast, an nasoseptal flap (NSF) has been shown to be versatile and reliable for endoscopic skull base recon-struction.…”

mentioning

confidence: 99%

Using the Nasoseptal Flap for Reconstruction after Endoscopic Debridement of Radionecrosis in Nasopharyngeal Carcinoma

Ryu

Seo

et al. 2018

Am J Rhinol�Allergy

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Free Tissue Transfer for Skull Base Osteoradionecrosis: A Novel Approach in the Endoscopic Era

et al. 2022

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Objectives Osteoradionecrosis (ORN) of the skull base and craniovertebral junction is a challenging complication of radiation therapy (RT). Severe cases often require surgical intervention through a multi‐modal approach. With the evolution in endoscopic surgery and advances in skull base reconstruction, there is an increasing role for microvascular free tissue transfer (MFTT). We describe an endoscopic‐assisted approach for the management of ORN of the skull base using fascia lata for MFTT. Study Design Retrospective case series. Methods Between 2017 and 2021, a review of all cases in which fascia lata MFTT was utilized for skull base ORN was performed. Patient demographics, preoperative characteristics, and postoperative outcomes with long‐term follow‐up were reviewed. Results Five patients were identified. Mean duration to onset of ORN was 17 months following RT. A trial of antibiotics, hyperbaric oxygen (HBO), and/or limited debridement was attempted without success. Refractory pain and progressive osteomyelitis were unifying symptoms. All patients underwent endoscopic debridement of the affected region of ORN prior to MFTT. Vascularized fascia lata was inset through a combined endonasal and transoral corridor. There was improvement in chronic pain in the postop setting with no patients requiring continued antibiotics or HBO therapy. Mean post‐op follow‐up was 23 months. Conclusions With continued evolution in endoscopic, minimally invasive approaches, there is an expanding indication for early surgical management in refractory ORN. Fascia lata MFTT is a novel and effective strategy for the management of ORN of the skull base and upper cervical spine with excellent postoperative outcomes and limited patient morbidity. Level of Evidence 4 Laryngoscope, 133:562–568, 2023

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Surgical management of extensive osteoradionecrosis in nasopharyngeal carcinoma patients with the maxillary swing approach and free muscular flaps

Cited by 13 publications

References 9 publications

Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results

Multimodal strategy for the management of sphenoid osteoradionecrosis: Preliminary results

Using the Nasoseptal Flap for Reconstruction after Endoscopic Debridement of Radionecrosis in Nasopharyngeal Carcinoma

Free Tissue Transfer for Skull Base Osteoradionecrosis: A Novel Approach in the Endoscopic Era

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