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Appl Spectrosc 2022 Jun 24:37028221109244. Epub 2022 Jun 24.

Institute of Dentistry, University of Eastern Finland, Kuopio, Finland.

Understanding the biochemical changes in irradiated human mandible after radiotherapy of cancer patients is critical for oral rehabilitation. The underlying mechanism for radiation-associated changes in the bone at the molecular level could lead to implant failure and osteoradionecrosis. The study aimed to assess the chemical composition and bone quality in irradiated human mandibular bone using Raman spectroscopy. Read More

J Oral Maxillofac Surg 2022 May 16. Epub 2022 May 16.

Assistant Professor, Department of Otolaryngology Head and Neck Surgery, Baylor College of Medicine, Houston, TX.

We describe a method for performing mandibular resection and vascularized tissue transfer via an intraoral and contralateral submandibular approach to minimize the risk of wound complications in a radiated field. Surgery on radiated tissue associated with osteoradionecrosis of the mandible can present with oral cutaneous fistulas, dense fibrotic skin, and altered tissue planes to make dissection through this tissue tedious and can place the marginal mandibular nerve at increased risk of injury. The use of custom plates allows surgeons to minimize incisions and depend less on anatomic/visual cues during surgery to obtain an accurate result. Read More

J Pers Med 2022 May 20;12(5). Epub 2022 May 20.

Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, 9713GZ Groningen, The Netherlands.

Background: Pre-operative margin planning for the segmental resection of affected bone in mandibular osteoradionecrosis (ORN) is difficult. The aim of this study was to identify a possible relation between the received RT dose, exposed bone volume and the progression of ORN after segmental mandibular resection.

Method: Patients diagnosed with grade 3-4 ORN for which a segmental resection was performed were included in the study. Read More

Microsurgery 2022 May 12. Epub 2022 May 12.

Division of Plastic and Reconstructive Surgery, Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.

Background: Plate-related complications are major long-term complications in mandible reconstruction. There are controversies regarding the use of a reconstruction plate versus miniplates and a bone flap versus a soft tissue flap with a bridging plate. Direct comparisons of a fibula flap and an anterolateral thigh flap, the applicability between a reconstruction plate and miniplate, and the correlation between plate-related complications and quality of life remain unclarified. Read More

Oral Oncol 2022 Jul 6;130:105878. Epub 2022 May 6.

Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, United States. Electronic address:

Objectives: Radiation (ORNJ) and bisphosphonate-related (BRONJ) osteonecrosis of the jaw represent challenging entities to treat, with many patients requiring segmental resection and reconstruction with microvascular free tissue transfer (MFTT) in the setting of failed conservative therapy. Microvascular reconstruction is associated with higher post-operative complication rates when performed for advanced osteonecrosis versus oncologic defects. We hypothesize that basing antibiotic therapy on cultures obtained from the healthy bone marrow following resection during MFTT for ORNJ or BRONJ reduces rates of post-operative wound and surgical complications. Read More

J Plast Reconstr Aesthet Surg 2022 Mar 14. Epub 2022 Mar 14.

Plastic Surgery, Chang Gung Memorial Hospital and University, Taiwan.

Real-time intraoperative computed tomography created the accuracy of less than 1 mm deviation in virtual surgical planning double barrel fibular flap for mandibular reconstruction-the symbiosis of intelligent technology in a digital OR.

Background: With the intelligent technology of virtual surgical planning, CAD/CAM, and intraoperative CT(iCT) in a digital OR, the secondary mandibular defect or primary amelobalstoma mandibulectomy can be restored using double barrel fibula and be achieved precision medicine purpose.

Material And Method: A series of 7 patients underwent free flap for oral cancers who sustained 5 osteoradionecrosis, 2 segmental mandibular defect, and 2 ameloblastoma. Read More

J Oral Implantol 2022 Apr 21. Epub 2022 Apr 21.

Resident, Post-Graduate Prosthodontics, Nova Southeastern University College of Dental Medicine.

Adenoid cystic carcinoma of the submandibular gland is a relatively rare malignancy of the oral and maxillofacial region.  It is an insidious disease characterized by regional spread, perineural invasion, and potential distant metastases.  Because of the aggressive nature of this lesion, it is often impossible to completely excise the tumor, necessitating combination therapy of surgery and radiation. Read More

Front Oncol 2022 3;12:843175. Epub 2022 Mar 3.

Department of Radiation Oncology, Mayo Clinic Arizona, Phoenix, AZ, United States.

Purpose: To retrospectively investigate empirical relative biological effectiveness (RBE) for mandible osteoradionecrosis (ORN) in head and neck (H&N) cancer patients treated with pencil-beam-scanning proton therapy (PBSPT).

Methods: We included 1,266 H&N cancer patients, of which, 931 patients were treated with volumetric-modulated arc therapy (VMAT) and 335 were treated with PBSPT. Among them, 26 VMAT and 9 PBSPT patients experienced mandible ORN (ORN group), while all others were included in the control group. Read More

J Craniomaxillofac Surg 2022 May 7;50(5):393-399. Epub 2022 Mar 7.

Burdenko Main Military Clinical Hospital, 3 Gospitalnaya Poloschad, Moscow, 105229, Russian Federation.

This prospective study aimed to evaluate neurosensory disturbance and quality of life in patients who underwent mandibular resection for benign tumors and whose inferior alveolar nerve (IAN) was either preserved or sacrificed. Mandibular resection was indicated owing to the presence of osteoradionecrosis in 25 patients and ameloblastoma in 15 patients. Resection was unilateral in 24 patients and bilateral in 16 patients. Read More

Head Neck 2022 06 3;44(6):1313-1323. Epub 2022 Mar 3.

Department of Head and Neck Surgery, The University of Texas, MD Anderson Cancer Center, Houston, Texas, USA.

Objectives: To analyze charges, complications, survival, and functional outcomes for definitive surgery of mandibular osteoradionecrosis (ORN).

Materials And Methods: Retrospective analysis of 76 patients who underwent segmental mandibulectomy with reconstruction from 2000 to 2009.

Results: Complications occurred in 49 (65%) patients and were associated with preoperative drainage (odds ratio [OR] 4. Read More

Oral Maxillofac Surg 2022 Jan 24. Epub 2022 Jan 24.

Department for Oral and Maxillofacial Surgery, University Hospital Erlangen, Glueckstrasse 11, 91054, Erlangen, Germany.

Background: Intraoral soft tissue deficiency and impaired wound beds are common problems after cleft and tumour surgery or after dental trauma. Frequently, limited defects are overtreated with extensive microvascular reconstruction procedures, but pedicled flaps remain useful, as they are simple to harvest, and they provide a reliable outcome. The buccal flap, first described in the 1970s, has been used for palatine lengthening in cleft patients over decades. Read More

Acta Otolaryngol 2022 Jan 13;142(1):78-83. Epub 2022 Jan 13.

Otolaryngology and Head and Neck surgery, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.

Background: The treatment of head and neck cancer is an intensive multimodal treatment that has a great impact on the individual patient.

Aims/objectives: This study aimed to evaluate acute and long-term complications associated with mandibular resections and reconstructions.

Material And Methods: We retrospectively retrieved data on complications and recurrences among patients that underwent mandibular resections and reconstructions for treating oral cavity cancer ( = 190 patients) and osteoradionecrosis (ORN,  = 72). Read More

Brachytherapy 2022 Mar-Apr;21(2):224-228. Epub 2021 Dec 6.

Department of Radiation Oncology, Basavatarakam Indo American, Cancer Hospital and Research Institute, Hyderabad, Telangana, India.

Purpose: To analyze the long-term local control, overall survival and toxicity in Carcinoma Buccal Mucosa patients treated with interstitial brachytherapy.

Methods And Materials: This analysis included patients diagnosed as Carcinoma Buccal Mucosa on biopsy and treated with radical brachytherapy or External Beam Radiotherapy (EBRT) followed by brachytherapy boost. All patients received High dose rate (HDR) interstitial brachytherapy. Read More

Radiother Oncol 2022 01 26;166:137-144. Epub 2021 Nov 26.

Department of Anaesthesia, Center of Head and Orthopedics, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.

Purpose: Osteoradionecrosis (ORN) of the mandible is a serious complication of head and neck radiotherapy. This study aims to investigate the effect of hyperbaric oxygen (HBO) treatment on ORN in two randomized, controlled multicentre trials.

Methods And Materials: Patients with ORN with indication for surgical treatment were randomised to either group 1: surgical removal of necrotic mandibular bone supplemented by 30 pre- and 10 postoperative HBO exposures at 243 kPa for 90 min each, or group 2: surgical removal of necrotic bone only. Read More

Cancers (Basel) 2021 Nov 18;13(22). Epub 2021 Nov 18.

Department of Clinical and Experimental Medicine, University of Foggia, Via Rovelli 50, 71122 Foggia, Italy.

Teeth extractions before or after radiotherapy (RT) could be procedures at high risk for osteoradionecrosis (ORN) onset. This systematic review was performed to investigate the ORN incidence following teeth extractions during and after RT for head and neck (H&N) cancer and to evaluate any other possible risk factor.

Methods: This systematic review was conducted according to PRISMA protocol, and the PROSPERO registration number was CRD42018079986. Read More

Sci Rep 2021 11 15;11(1):22241. Epub 2021 Nov 15.

Human Health Department, IRSN, Institute for Radioprotection and Nuclear Safety, PSE-SANTE, SERAMED, LRMed, 92 262, Fontenay-aux-Roses, France.

Osteoradionecrosis (ORN) is one of the most feared side effects of radiotherapy following cancers of the upper aero-digestive tract and leading to severe functional defects in patients. Today, our lack of knowledge about the physiopathology restricts the development of new treatments. In this study, we refined the ORN rat model and quantitatively studied the progression of the disease. Read More

Oral Oncol 2021 12 11;123:105604. Epub 2021 Nov 11.

Princess Margaret Cancer Centre, University Health Network, 610 University Ave. Toronto, Room 2-933 - Dental Oncology and Maxillofacial Prosthetics Clinic, ON M5G 2C1, Canada; Faculty of Dentistry, Univeristy of Toronto, 124 Edward Street, room 463, Toronto, ON M5G 1G6, Canada. Electronic address:

Purpose: Limited evidence exists linking the specific preventative dental care provided prior to radiation therapy (RT) for head and neck cancer to outcomes like osteoradionecrosis (ORN). This study utilized expert consensus to develop tooth-specific dental treatment pathways for head and neck cancer patients prior to radiation.

Materials And Methods: Dental oncologists from across a single nation were engaged in a Modified Delphi process. Read More

Curr Treat Options Oncol 2021 11 13;22(12):115. Epub 2021 Nov 13.

Cleveland Clinic, 9500 Euclid Ave, A71, Cleveland, OH, 44195, USA.

Opinion Statement: Osteoradionecrosis (ORN) of the mandible is a rare but devastating complication which occurs following radiation therapy for head and neck malignancies. Left untreated, ORN often results in pathologic fracture of the mandible leading to pain, trismus, difficulty eating, and overall poor quality of life. Historically, early intervention relied on hyperbaric oxygen and local debridement. Read More

Oral Surg Oral Med Oral Pathol Oral Radiol 2022 Jul 3;134(1):e8-e13. Epub 2021 Sep 3.

Professor of Clinical Dentistry, UCLA School of Dentistry, Los Angeles, CA, USA.

Objective: The objective of this study was to assess characteristics of patients with mandibular osteoradionecrosis (ORN) of severity necessitating segmental mandibulectomy and osteocutaneous free flap reconstruction.

Study Design: This study is a retrospective review of patients who underwent free flap reconstruction of the mandible at the UCLA Medical Center between January 2016 and February 2020 secondary to ORN.

Results: Twenty-nine charts with detailed dental and medical records were identified. Read More

Radiother Oncol 2021 12 30;165:87-93. Epub 2021 Oct 30.

Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, University of Liverpool Cancer Research Centre, University of Liverpool, United Kingdom; Head and Neck Unit, Liverpool University Hospital NHS Foundation Trust, Aintree University Hospital, United Kingdom.

Background/aim: Utilising radiotherapy in the management of head and neck cancer (HNC) often results in long term toxicities. Mandibular osteoradionecrosis (ORN) represents a late toxicity associated with significant morbidity. We aim to identify a panel of common genetic variants which can predict ORN to aid development of personalised radiotherapy protocols. Read More

Pract Radiat Oncol 2022 Mar-Apr;12(2):90-94. Epub 2021 Oct 24.

Department of Radiation Oncology, New York University Grossman School of Medicine, New York, New York. Electronic address:

Cancer 2022 02 19;128(3):487-496. Epub 2021 Oct 19.

Section of Oral Medicine, University of Connecticut Health, Farmington, Connecticut.

Background: Patients with head and neck cancer (HNC) treated with radiation therapy (RT) are at risk for jaw osteoradionecrosis (ORN), which is largely characterized by the presence of exposed necrotic bone. This report describes the incidence and clinical course of and risk factors for exposed intraoral bone in the multicenter Observational Study of Dental Outcomes in Head and Neck Cancer Patients (OraRad) cohort.

Methods: Participants were evaluated before RT and at 6, 12, 18, and 24 months after RT. Read More

Dysphagia 2021 Oct 13. Epub 2021 Oct 13.

Therapies Department, The Royal Marsden NHS Foundation Trust, London, U.K.

Despite recent advances in the radiation techniques used for the treatment of head and neck cancer (HNC) including intensity-modulated radiotherapy (IMRT), mandibular osteoradionecrosis (ORN) remains a significant complication. Advanced stage ORN is managed surgically with resection and immediate free tissue transfer reconstruction. An evaluation of the functional speech and swallowing outcomes was undertaken for patients undergoing surgical management of advanced ORN. Read More

Hua Xi Kou Qiang Yi Xue Za Zhi 2021 Oct;39(5):524-530

Dept. of Stomatology, Daping Hospital, Army Medical University, Chongqing 400042, China.

Objectives: To compare the effects of different irradiators on the establishment of osteoradionecrosis of jaw model (ORNJ) to explore an ideal modeling method.

Methods: A total of 33 adult SD rats were included and randomly divided into three groups according to the radiation equipment, namely, the blank control (CN, 3 rats), group A (linear accelerator irradiation, 15 rats), and group B (small-animal irradiator irradiation, 15 rats). Groups A and B were irradiated with daily fractions of 7, 8, and 9 Gy for 5 days and further divided into three subgroups as follows: group A/B, 35 Gy; group A/B, 40 Gy; and group A/B, 45 Gy. Read More

BMJ Case Rep 2021 Sep 20;14(9). Epub 2021 Sep 20.

Department Oral and Maxillofacial Surgery, University Hospitals Leuven, Leuven, Flanders, Belgium.

A 55-year-old man initially presented with an undifferentiated, HPV-p16-negative squamous cell carcinoma (SCC) in the left tonsillar region (cT4a N0 M0), which was treated with a combination of radiotherapy and chemotherapy. Several months later, the patient developed osteoradionecrosis on the left side of the mandible as well as a second primary lesion at the left base of the tongue. Surgical resection and mandibular reconstruction with a free vascularised fibula flap was performed. Read More

Int J Oral Maxillofac Surg 2022 Jun 14;51(6):724-731. Epub 2021 Sep 14.

Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan; Center for Tissue Engineering, Chang Gung Memorial Hospital, Taoyuan, Taiwan. Electronic address:

Midline and paramedian mandibulotomies both have distinct anatomical and surgical strengths. A retrospective study was performed at Chang Gung Memorial Hospital, Linkou Branch between 2014 and 2019 to investigate how the osteotomy site (midline (n = 221) or paramedian (n = 44)) and type (straight, notched, or stair-stepped) affect postoperative and post-radiotherapy complications in patients undergoing wide excision of tongue cancer with flap reconstruction. Midline mandibulotomies were predominantly of the straight osteotomy type, while paramedian mandibulotomies were mostly notched type (P < 0. Read More

Br J Oral Maxillofac Surg 2021 11 2;59(9):1031-1035. Epub 2020 Dec 2.

Liverpool Head & Neck Centre, Liverpool University Hospitals NHS Foundation Trust Aintree Hospital, Lower Lane, Liverpool L9 7AL; Liverpool Head & Neck Centre, University of Liverpool Cancer Research Centre, 200 London Road Liverpool L3 9TA.

The aim of this retrospective study was to compare outcomes and reconstruction-related complications in patients receiving a composite free flap reconstruction of the mandible for ORN with those reconstructed for other indications. The records of all patients who underwent composite reconstruction of a mandibular defect at Aintree University Hospital, Liverpool, were reviewed and analysed. Based on radiotherapy exposure and ORN history, the study cohort was divided into three separate case-matched groups. Read More

Microsurgery 2022 Jan 17;42(1):80-83. Epub 2021 Aug 17.

Department of Otolaryngology - Head and Neck Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA.

Near-total mandibular reconstruction poses many challenges to reconstructive surgeons. The purpose of this article is to present a challenging case in a patient with osteoradionecrosis of the mandible requiring a near-total mandibular reconstruction using bilateral scapula tip free tissue reconstruction. A 68-year-old African-American male with a history of T2N0M0 squamous cell carcinoma of the tonsil presented with advanced stage osteoradionecrosis of the mandible. Read More

Ann Plast Surg 2021 09;87(3):291-297

From the Division of Plastic Surgery, Department of Surgery.

Background: Small recalcitrant defects of the mandible and maxilla may be secondary to tumor, trauma, infection, and congenital origin. Vascularized bone grafting has been shown to effectively manage these defects; however, donor sites are limited. The vascularized medial femoral condyle (MFC) provides adequate cortical cancellous bone with the option of a skin island, consistent anatomy, and minimal donor site morbidity. Read More

Laryngoscope 2021 12 6;131(12):2688-2693. Epub 2021 Aug 6.

Facial Plastic and Microvascular Surgery, Cleveland Clinic, Cleveland, Ohio, U.S.A.

Objectives: To demonstrate that the anterolateral thigh fascia lata (ALTFL) rescue flap may be effectively used for management of osteoradionecrosis (ORN) in selected patients.

Study Design: Retrospective case review.

Methods: Retrospective chart review was performed on patients who underwent ALTFL free flap repair to various sites of ORN in the head and neck between 2011 and 2018. Read More