[Mandibular osteoradionecrosis: part I: severity factors]

Rev Stomatol Chir Maxillofac. 2007 Dec;108(6):513-25. doi: 10.1016/j.stomax.2007.05.003. Epub 2007 Nov 26.
[Article in French]

Abstract

Introduction: The severe evolution for some patient presenting with osteoradionecrosis, even if classified in the same stages as other patients, suggests that there are aggravating factors.

Material and method: A retrospective study was made between 1992 and 2002 on all patient operated for mandibular osteoradionecrosis. Fifty-nine patients were included and the mandibular defects were reconstructed with a bone or a composite free flap (fibula 21%, iliac crest 49%, scapula 6%, antebrachial 3%), and with a periosteal free flap (13%).

Results: The study included severe cases (87% of stage II or III) operated on several times without success. Free flap reconstruction was successful in 90% of the cases. However, complications were present in 60% of cases (24% minor complications, 48% major complications), and were more frequent with a higher stage. The analysis allowed identifying morbidity factors.

Discussion: Studying the morbidity allowed identifying severity factors of osteoradionecrosis; spontaneous onset, important irradiation (important dose, bone proximity of the tumor, bilateral damage), vascular damage (symphyseal localization, lack of sequestrum, facial artery ligature, active tobacco addiction), actinomycosis colonization, non-observance of medical treatment. Understanding aggravating factors should allow us to offer more efficient surgery on an early osteoradionecrosis stage, also decreasing the morbidity linked to reconstructive surgery.

Publication types

  • English Abstract

MeSH terms

  • Adult
  • Aged
  • Bone Transplantation
  • Female
  • Follow-Up Studies
  • Graft Survival
  • Humans
  • Male
  • Mandibular Diseases / classification*
  • Mandibular Diseases / surgery
  • Microsurgery
  • Middle Aged
  • Mouth Neoplasms / radiotherapy
  • Neoplasm Recurrence, Local / pathology
  • Osteoradionecrosis / classification*
  • Osteoradionecrosis / surgery
  • Periosteum / transplantation
  • Plastic Surgery Procedures / methods
  • Postoperative Complications
  • Radiotherapy Dosage
  • Reoperation
  • Retrospective Studies
  • Risk Factors
  • Surgical Flaps
  • Tooth Extraction / adverse effects
  • Treatment Outcome