Systematic Management of Osteoradionecrosis in the Head and Neck

Hao, Sheng‐Po; Chen, Hung-Chi; Wei, Fu‐Chan; Chen, Chao‐Yu; Yeh, Albert Re‐Ming; Su, Jen‐Liang

doi:10.1097/00005537-199908000-00027

“…4 The reported advantage of microvascular reconstruction is that it allows extensive excision of all necrotic and scarred tissue, without concern for the size of the defect. This improves the likelihood that resection of tissue back to healthy, bleeding native bone will be achieved.…”

Section: Commentmentioning

confidence: 99%

Influence of Prior Hyperbaric Oxygen Therapy in Complications Following Microvascular Reconstruction for Advanced Osteoradionecrosis

Gal¹,

Yueh²,

Futran³

2003

Arch Otolaryngol Head Neck Surg

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Microvascular reconstruction is effective in the treatment of patients with mandibular ORN. Management of mandibular ORN can be successfully achieved without the use of perioperative HBO therapy. Because only 3 patients received perioperative HBO therapy, we are unable to comment on its potential benefit. Patients in whom prior HBO therapy has failed are significantly more likely to have surgical complications than are other patients with Marx stage III disease, and further study is required to improve outcomes in this subgroup of patients.

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“…Many authors of articles on ORN either failed to mention antibiotics at all, or made only a brief comment about their general application. 1,5,8,11,12,[28][29][30] The purpose of this investigation was to determine prescribing for exodontia and minor oral surgery following radiotherapy by surveying current opinion amongst consultant oral and maxillofacial surgeons.…”

Section: N B R I E Fmentioning

confidence: 99%

A survey of antibiotic prescribing by maxillofacial consultants for dental extractions following radiotherapy to the oral cavity

Kanatas¹,

Rogers

²

,

Martín

³

2002

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Objectives To analyse the antibiotic prescribing trends for exodontia and minor oral surgery in patients with a history of radiotherapy. Also, to evaluate the use of hyperbaric oxygen as a separate modality in the prevention of osteoradionecrosis. Design A survey of antibiotic prescribing involving the analysis of a questionnaire which included the management of three patients with a history of head and neck malignancy. Method The heads of the departments in each unit in the UK were sent a closed-response questionnaire. Antibiotic prescribing was assessed in three case scenarios. Case one referred to a patient that had surgery alone as part of the management of head and neck cancer, who needed the surgical removal of second molar roots. Case two referred to a patient that had surgery and adjuvant radiotherapy as part of the management of head and neck cancer, and needed the same procedure as in case one. Case three included a patient with a history of surgery and adjuvant radiotherapy, who required the extraction of three mobile and periodontally-involved lower incisors. Consultants were also asked about the use of hyperbaric oxygen in the patients who had radiotherapy as part of their treatment strategy. Results A total of 109 questionnaires were sent to all the Maxillofacial Units in the UK. The response rate was 73%. In patients with a history of radical surgery alone for the management of head and neck cancer, 20% of the surgeons advocated pre-operative antibiotics for the surgical removal of lower posterior teeth. In contrast, in the patient with a history of adjuvant radiotherapy 86% supported pre-operative antimicrobial use for the surgical removal of the same teeth. In the extraction of mobile and periodontally involved lower incisors in the previously irradiated patient, 63% of the clinicians supported pre-extraction antibiotics. Postoperative antibiotics were advocated in 52% in the first case, 89% in the second case and 71% in the third case. 34% of the clinicians advocated hyperbaric oxygen for surgical removal of posterior teeth and 15% for the extraction of mobile anterior teeth.

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“…Traditionally ORN has been defined as the exposed irradiated bone that fails to heal over a period of 3 months. 5 It is a chronic condition, it is not the same as a dry socket, and the risk of developing it does not diminish with time. 6,7 The accepted cause is a progressive endarteritis with a decrease in the microcirculation.…”

mentioning

confidence: 99%

A survey of antibiotic prescribing by maxillofacial consultants for dental extractions following radiotherapy to the oral cavity

Kanatas¹,

Rogers

²

,

Martin

³

2002

View full text Add to dashboard Cite

Objectives To analyse the antibiotic prescribing trends for exodontia and minor oral surgery in patients with a history of radiotherapy. Also, to evaluate the use of hyperbaric oxygen as a separate modality in the prevention of osteoradionecrosis. Design A survey of antibiotic prescribing involving the analysis of a questionnaire which included the management of three patients with a history of head and neck malignancy. Method The heads of the departments in each unit in the UK were sent a closed-response questionnaire. Antibiotic prescribing was assessed in three case scenarios. Case one referred to a patient that had surgery alone as part of the management of head and neck cancer, who needed the surgical removal of second molar roots. Case two referred to a patient that had surgery and adjuvant radiotherapy as part of the management of head and neck cancer, and needed the same procedure as in case one. Case three included a patient with a history of surgery and adjuvant radiotherapy, who required the extraction of three mobile and periodontally-involved lower incisors. Consultants were also asked about the use of hyperbaric oxygen in the patients who had radiotherapy as part of their treatment strategy. Results A total of 109 questionnaires were sent to all the Maxillofacial Units in the UK. The response rate was 73%. In patients with a history of radical surgery alone for the management of head and neck cancer, 20% of the surgeons advocated pre-operative antibiotics for the surgical removal of lower posterior teeth. In contrast, in the patient with a history of adjuvant radiotherapy 86% supported pre-operative antimicrobial use for the surgical removal of the same teeth. In the extraction of mobile and periodontally involved lower incisors in the previously irradiated patient, 63% of the clinicians supported pre-extraction antibiotics. Postoperative antibiotics were advocated in 52% in the first case, 89% in the second case and 71% in the third case. 34% of the clinicians advocated hyperbaric oxygen for surgical removal of posterior teeth and 15% for the extraction of mobile anterior teeth.

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Systematic Management of Osteoradionecrosis in the Head and Neck

Cited by 115 publications

References 8 publications

Influence of Prior Hyperbaric Oxygen Therapy in Complications Following Microvascular Reconstruction for Advanced Osteoradionecrosis

Influence of Prior Hyperbaric Oxygen Therapy in Complications Following Microvascular Reconstruction for Advanced Osteoradionecrosis

A survey of antibiotic prescribing by maxillofacial consultants for dental extractions following radiotherapy to the oral cavity

A survey of antibiotic prescribing by maxillofacial consultants for dental extractions following radiotherapy to the oral cavity

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