Temporal Bone Osteoradionecrosis After Surgery and Radiotherapy for Malignant Parotid Tumors

Diffuse Osteoradionecrosis of Temporal Bone as a Late Complication of Adjuvant Radiotherapy to Parotid Bed: A Case Report

“…The local type is confined to the external auditory canal, whereas the diffuse type is wide spread and it can involve the skull base and adjacent structures.The rarer diffuse type is usually seen in patients who have received higher doses of external irradiation to the temporal bone. The incidence of temporal bone osteoradionecrosis is also higher when amastoidectomy or temporal bone resection is done for surgical clearance, followed by post-operative radiotherapy [6]. Diffuse type is associated with various complications such as suppurative labyrinthitis, meningitis, cerebrospinal fluid leakage, and internal carotid aneurysms [7].…”

“…Studies have shown that patients with advanced disease do not benefit from hyperbaric oxygen therapy [9]. Surgical management of osteoradionecrosis sometimes ends up in failure, because of the difficulty which is faced in accurately assessing the viability of nonnecrotic bone [6].…”

“…Leonetti et al, reported that patients with parotid malignancies who underwent over sew of the external auditory meatus, subtotal petro sectomy, and temporal bone defect obliteration, did not develop temporal bone osteoradionecrosis [6]. Highly precise conformal therapies help in delivering adequate doses to diseased sites and minimized doses to normal tissues, thus reducing the incidence of such complications [10][11][12].…”

Osteoradionecrosis of the Mandible and Mastoiditis after Radiotherapy for Parotid Mucoepidermoid Carcinoma

“…6 The management of osteoradionecrosis in the temporal bone is controversial. In the localized type, conservative treatment with frequent aural cleansing and topical antibiotics is often administered.…”

“…7 Oversew of the ear canal with mastoid obliteration should be considered in this subgroup of patients to avoid this long-term complication of radiotherapy used in the treatment of malignant parotid tumors. 6 The risk for osteoradionecrosis and infection can be minimized by removing all poorly supported teeth, allowing sufficient time for the extraction wounds to heal before beginning radiation therapy, and adjusting dentures to minimize the risk for denture sores. 4 Before beginning radiation therapy, all patients should undergo a thorough dental evaluation, including full mouth radiographs, dental and periodontal diagnosis, and prognosis for each tooth.…”