Osteoradionecrosis

Osteoradionecrosis (ORN) is a serious complication of radiation therapy in cancer treatment where radiated bone becomes necrotic and exposed.[1] ORN occurs most commonly in the mouth during the treatment of head and neck cancer, and can arise over 5 years after radiation.[2] Common signs and symptoms include pain, difficulty chewing, trismus, mouth-to-skin fistulas and non-healing ulcers.

The pathophysiology of ORN is fairly complex and involves drastic changes to bone tissue as a result of DNA damage and cell death caused by radiation treatment.[3] Radiation therapy targeting tumor cells can affect normal cells as well,[4][5] which can result in the death of bone tissue. Advances in radiation therapy have decreased the incidence of ORN, estimated at around 2%.[6] Certain risk factors including the size and location of tumor,[7][8] history of smoking[2] or diabetes,[7] and presence of dental disease[3][9] can affect the chances of developing ORN.

Osteoradionecrosis is difficult to prevent and treat. Current prevention strategies are aimed at avoiding excess doses of radiation as well as maintaining excellent dental hygiene.[7] Treatments are variable depending on the provider and disease severity, and can range from medical treatment with antibiotics to hyperbaric oxygen therapy (HBO) to surgical debridement or reconstruction.[3]

  1. ^ Beacher NG, Sweeney MP (November 2018). "The dental management of a mouth cancer patient". British Dental Journal. 225 (9): 855–864. doi:10.1038/sj.bdj.2018.932. PMID 30412520. S2CID 53247776.
  2. ^ a b Caparrotti F, Huang SH, Lu L, Bratman SV, Ringash J, Bayley A, et al. (October 2017). "Osteoradionecrosis of the mandible in patients with oropharyngeal carcinoma treated with intensity-modulated radiotherapy". Cancer. 123 (19): 3691–3700. doi:10.1002/cncr.30803. PMID 28608925.
  3. ^ a b c Lyons A, Ghazali N (December 2008). "Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment". The British Journal of Oral & Maxillofacial Surgery. 46 (8): 653–60. doi:10.1016/j.bjoms.2008.04.006. PMID 18562055.
  4. ^ Revell SH (1983). "Relationships between chromosome damage and cell death.". In Ishihara T, Sasaki MS (eds.). Radiation-induced chromosome damage in man. New York City: Liss. pp. 215–33.
  5. ^ Holcomb III GW, Murphy JP, St Peter SD, Gatti JM, Ashcraft KW (2019-04-14). Holcomb and Ashcraft's pediatric surgery (Seventh ed.). Edinburgh: Elsevier. pp. 968–985. ISBN 9780323549769. OCLC 1107667324.
  6. ^ Nabil S, Samman N (March 2011). "Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review". International Journal of Oral and Maxillofacial Surgery. 40 (3): 229–43. doi:10.1016/j.ijom.2010.10.005. PMID 21115324.
  7. ^ a b c Sathasivam HP, Davies GR, Boyd NM (January 2018). "Predictive factors for osteoradionecrosis of the jaws: A retrospective study". Head & Neck. 40 (1): 46–54. doi:10.1002/hed.24907. PMID 29149496. S2CID 26965826.
  8. ^ Mendenhall WM (December 2004). "Mandibular osteoradionecrosis". Journal of Clinical Oncology. 22 (24): 4867–8. doi:10.1200/JCO.2004.09.959. PMID 15520050.
  9. ^ Katsura K, Sasai K, Sato K, Saito M, Hoshina H, Hayashi T (June 2008). "Relationship between oral health status and development of osteoradionecrosis of the mandible: a retrospective longitudinal study". Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontics. 105 (6): 731–8. doi:10.1016/j.tripleo.2007.10.011. PMID 18329913.
This article is issued from Wikipedia. The text is available under Creative Commons Attribution-Share Alike 4.0 unless otherwise noted. Additional terms may apply for the media files.