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Medicina (Kaunas) 2021 May 11;57(5). Epub 2021 May 11.

Department of Oral & Maxillofacial Surgery, Beilinson Hospital, Rabin Medical Center, Petah Tikva 4941492, Israel.

Determine the contribution of coexisting factors to the risk to develop Osteoradionecrosis (ORN) of the jaws among patients who have received radiotherapy by intensity modulated radiation therapy (IMRT) for head and neck cancer (HNC) between 2013 and 2016, in a single medical center. The records of all patients treated with IMRT for HNC between 2013 and 2016 in The Davidoff Center for the treatment and Research of Cancer in Rabin Medical Center-Beilinson hospital, Petah-Tikva, Israel were screened. Patients who have received a minimum mean dose of 40 Gy to the oral cavity entered the research and their medical records were retrospectively reviewed. Read More

Oral Radiol 2021 May 11. Epub 2021 May 11.

Department of Oral and Maxillofacial Radiology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.

Objective: This study aimed to retrospectively evaluate the radiation dose and complications in soft tissue and mandible caused by Au grain brachytherapy alone or the combination with other modalities in patients with the cancer of the floor of the mouth.

Materials And Methods: Twelve patients with T1 (n = 5) and T2 (n = 7) squamous cell carcinoma of the floor of the mouth, who were treated with Au grain brachytherapy alone (n = 5) or the combination of external beam radiotherapy (EBRT) and/or chemotherapy and Au grain brachytherapy (n = 7) from January 2005 to December 2016, were included. The relationships between the radiation dose and the complications of the soft tissue or mandible were investigated. Read More

Int J Radiat Oncol Biol Phys 2021 May 6. Epub 2021 May 6.

Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.

Background And Purpose: Osteoradionecrosis (ORN) of the mandible represents a severe, debilitating complication of radiation therapy (RT) for head and neck cancer (HNC). At present, no Normal Tissue Complication Probability (NTCP) models for risk of ORN exist. The aim of this study was to develop a multivariable clinical/dose-based NTCP model for the prediction of ORN any grade (ORN) and Grade IV (ORN) following radiotherapy (± chemotherapy) in HNC patients. Read More

Arch Craniofac Surg 2021 Apr 20;22(2):105-109. Epub 2021 Apr 20.

Department of Plastic and Reconstructive Surgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

The use of a fibula osteocutaneous flap is currently the mainstay of segmental mandibular reconstruction. This type of flap is used to treat tumors, trauma, or osteoradionecrosis of the mandible. However, a fibula osteocutaneous flap may also be a good option for reconstructing the mandible to preserve oropharyngeal function and facial appearance in cases of pathological fracture requiring extensive segmental bone resection. Read More

Zhonghua Kou Qiang Yi Xue Za Zhi 2021 May 9;56(5):435-440. Epub 2021 May 9.

Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincal Key Laboratory of Stomatolagy, Guangzhou 510055, China.

To retrospectively analyze of the prevention and management of major complications in surgical treatment of osteoradionecrosis (ORN) of the mandible by using vascularized free flaps and to provide a reference for improving clinical treatments. All cases diagnosed as mandibular ORN and received surgical treatment in the Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat-sen University from August 2014 to March 2019 were included. The patients' clinical data, mainly including general information, primary tumor, interval time between radiotherapy and osteoradionecrosis, surgical methods and postoperative complications, were collected. Read More

Zhonghua Kou Qiang Yi Xue Za Zhi 2021 May 9;56(5):421-427. Epub 2021 May 9.

Department of Oral & Maxillofacial-Head & Neck Oncology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine & College of Stomatology, Shanghai Jiao Tong University & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Shanghai Key Laboratory of Stomatology, Shanghai 200011, China.

To identify risk factors associated with mandibular osteoradionecrosis (ORN) in oral and maxillofacial cancer patients following radiotherapty and to provide scientific basis for the etiological research and clinical prevention of mandibular ORN. A retrospective study was conducted in patients with oral and maxillofacial-head and neck cancer during the period from January 2013 to December 2015. Influential factors related to mandibular ORN were screened by single factor analysis, Lasso and Logistic regression analysis. Read More

Zhonghua Kou Qiang Yi Xue Za Zhi 2021 May 9;56(5):404-409. Epub 2021 May 9.

Beijing Key Laboratory of Tooth Regeneration and Function Reconstruction, Capital Medical University School of Stomatology, Beijing 100050, China.

Osteoradionecrosis of the jaw (ORNJ) and bisphosphonate-related osteonecrosis of the jaw (BRONJ) are usually caused by head and neck radio-therapy and by the usage of bisphosphonate, respectively. These diseases can lead to facial deformity and dysfunction of the mandible, and may cause severe chronic facial pain. The pathogenesis of ORNJ and BRONJ are complex, and the therapy of which is still challenged. Read More

Cancer Radiother 2021 Apr 6. Epub 2021 Apr 6.

Département d'oncologie radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand cedex 1, France. Electronic address:

The identification of the different risk factors for mandibular osteoradionecrosis (ORN) must be done before and after the management of patients with head and neck cancer. Various clinical criteria for this severe radiation-induced complication are related to the patient (intrinsic radiosensitivity, malnutrition associated with thin weight loss, active smoking intoxication, microcapillary involvement, precarious oral status, hyposalivation) and/or related to the disease (oral cavity, large tumor size, tumor mandibular invasion). Therapeutic risk factors are also associated with a higher risk of ORN (primary tumor surgery, concomitant radio-chemotherapy, post-irradiation dental avulsion, preventive non-observance with the absence of stomatological follow-up and daily installation of gutters fluoride and, non-observance curative healing treatments). Read More

Indian J Cancer 2021 Jan 27. Epub 2021 Jan 27.

Department of Radiation Oncology, University of Health Sciences, Ankara, Turkey.

Background: The aim of our study is to assess the dose enhancement from scattered radiation due to dental restorative materials used for occlusal and mesio-occlusal-distal (MOD) cavity filling during simulated head and neck radiotherapy.

Methods: We have studied the dose enhancement ratio (DER) of conventional amalgam, high-copper amalgam, and resin composite dental restorative materials at cadaver mandible teeth using 2 therapeutic photon energies of 1.25 MeV (Co-60 gamma ray) and 6 MV (Linac X-ray) for irradiation. Read More

Front Oncol 2021 22;11:630123. Epub 2021 Feb 22.

Amsterdam UMC and Academic Centre for Dentistry Amsterdam (ACTA), Vrije Universiteit Amsterdam, Department of Oral and Maxillofacial Surgery/Pathology, Amsterdam, Netherlands.

Background: Osteoradionecrosis (ORN) of the mandible is a severe complication of radiation therapy in head and neck cancer patients. Treatment of advanced stage mandibular osteoradionecrosis may consist of segmental resection and osseous reconstruction, often sacrificing the inferior alveolar nerve (IAN). New computer-assisted surgery (CAS) techniques can be used for guided IAN preservation and 3D radiotherapy isodose curve visualization for patient specific mandibular resection margins. Read More

Br J Radiol 2021 Apr 18;94(1120):20200026. Epub 2021 Mar 18.

Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.

Objectives: Mandible osteoradionecrosis (ORN) is one of the most severe toxicities in patients with head and neck cancer (HNC) undergoing radiotherapy (RT). The existing literature focuses on the correlation of mandible ORN and clinical and dosimetric factors. This study proposes the use of machine learning (ML) methods as prediction models for mandible ORN incidence. Read More

Microsurgery 2021 Mar 24;41(3):223-232. Epub 2021 Feb 24.

Department of Plastic Reconstructive and Aesthetic Surgery, China Medical University Hospital, Taichung, Taiwan.

Background: Fibula osteocutaneous flap is associated with a higher rate of reexploration in mandible reconstruction due to limited space for the fixation of various tissue components on multiple segments of the fibula flap. To maintain optimal circulation to the flap and to prevent negative outcomes because of partial or total flap loss, we shared our experiences on salvaging the free fibula flap with vascular compromise in the first reexploration and we developed an algorithm.

Methods: From 1992 to 2018, 12 patients between the ages of 48 to 63 (mean: 52. Read More

Ann Med Surg (Lond) 2021 Feb 5;62:37-42. Epub 2021 Jan 5.

Department of Medical and Surgical Sciences, Division of Plastic Surgery, University of Modena and Reggio Emilia, Policlinico of Modena, Largo Pozzo 71, 41124, Modena, Italy.

Since the introduction of fibula flap as a reconstructive technique, an evolution of indications has been observed. Our first report of a traumatic mandibular reconstruction using fibula flap was in 1992. The vast majority of indications for surgery, are: malignant tumors, benign neoplasms, osteoradionecrosis and traumas. Read More

Head Neck 2021 May 15;43(5):1428-1439. Epub 2021 Jan 15.

Department of Radiation Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.

Background: The purpose of this study was to create dental radiation maps to calculate the mean dose to individual teeth, maxilla and mandible using intensity-modulated radiation therapy (IMRT).

Methods: Eighteen common clinical settings were chosen. Radiation plans were extracted, and each tooth was contoured at its junction with the gingiva and labeled based on the Universal/American numbering system. Read More

Br J Oral Maxillofac Surg 2021 01 19;59(1):91-96. Epub 2020 Aug 19.

Department of Oral & Maxillofacial Surgery, Queen Victoria Hospital Foundation Trust, East Grinstead.

Lateral posterior segmental mandibular defects present a reconstructive challenge and an osseous flap would be the gold standard to reconstruct such a defect. However, combining a mandibular reconstruction plate (MRP) with a soft-tissue free flap (to restore mucosal integrity and provide durable coverage of the plate itself) offers an alternative option for posterior segmental mandibular defects in patients who are not suitable for osseous reconstruction, or do not choose it. We retrospectively reviewed 30 consecutive patients (19 male and 11 female) who underwent reconstruction of a segmental mandibulectomy defect using a bridging MRP and anterolateral thigh (ALT) free flap. Read More

Ear Nose Throat J 2021 Jan 6:145561320986025. Epub 2021 Jan 6.

Department of Otolaryngology-Head and Neck Surgery, 8789University of California Davis, Sacramento, CA, USA.

This case demonstrates the first successful treatment of obstructive sleep apnea with hypoglossal nerve upper airway stimulation in a patient with prior radiation for oropharynx cancer complicated by osteoradionecrosis of the mandible. Read More

Radiat Oncol 2021 Jan 5;16(1). Epub 2021 Jan 5.

Division of Radiation Oncology, Kobe University Hospital, Kobe, Hyogo, Japan.

Background: To evaluate factors associated with osteoradionecrosis of the jaw (ORNJ) in patients with head and neck squamous cell carcinoma (HNSCC), focusing on jaw-related dose-volume histogram (DVH) parameters.

Methods: We retrospectively reviewed the medical records of 616 patients with HNSCC treated with curative-intent or postoperative radiation therapy (RT) during 2008-2018. Patient-related (age, sex, history of smoking or alcohol use, diabetes mellitus, performance status, pre-RT dental evaluation, pre- or post-RT tooth extraction), tumor-related (primary tumor site, T-stage, nodal status), and treatment-related (pre-RT surgery, pre-RT mandible surgery, induction or concurrent chemotherapy, RT technique) variables and DVH parameters (relative volumes of the jaw exposed to doses of 10 Gy-70 Gy [V10-70]) were investigated and compared between patients with and without ORNJ. Read More

Eur Arch Otorhinolaryngol 2021 Jan 2. Epub 2021 Jan 2.

School of Dentistry, Chung Shan Medical University, 110, Sec. 1, Chien-Kuo N. Rd., 40201, Taichung, Taiwan.

Purpose: The association between the tumor subsites of the oral cavity and the risk of osteoradionecrosis of the jaw (ORNJ) remains unclear. We study the correlation between oral cavity tumor subsites and the risk of ORNJ in a nationwide population-based database.

Methods: We enrolled 16,701 adult patients with oral cavity cancers who were treated with radiotherapy between 2000 and 2013. Read More

Clin Oral Investig 2021 Jun 2;25(6):3739-3745. Epub 2021 Jan 2.

Department of Restorative Dentistry, Division of Dental Materials, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.

Objective: To assess whether the administration of meloxicam before head and neck radiotherapy reduces the risk of mandibular osteoradionecrosis in rats.

Material And Methods: Sixty male Wistar rats were randomly divided into 6 groups (n = 10) according to the meloxicam administration and radiation therapy: control (C), irradiated (I), single dose of meloxicam (M1), single dose of meloxicam and irradiated (M1I), triple dose of meloxicam (M3), triple dose of meloxicam and irradiated (M3I). Meloxicam was administrated (20 mg/kg per dose) 1 h before the radiation therapy (single dose of 20 Gy) and 24 h and 48 h after the radiation therapy for groups with two additional doses. Read More

Semin Plast Surg 2020 Nov 24;34(4):232-244. Epub 2020 Dec 24.

Otolaryngology and Facial Plastic Surgery Associates, Facial Plastics, Fort Worth, Texas.

Radiation therapy is an important and commonly used treatment modality for head and neck cancers. Osteoradionecrosis (ORN) is a potential debilitating complication of treatment, which most commonly affects the mandible. Management strategies are tailored to the severity of disease. Read More

J Oral Maxillofac Surg 2021 05 2;79(5):1156-1167. Epub 2020 Dec 2.

Professor, Interim Chair, Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.

Purpose: Historically, free tissue transfer has been reserved for advanced stage osteoradionecrosis (ORN) of the jaw with pathologic fracture or cutaneous fistula. The purpose of this study was to evaluate if in patients with recalcitrant intermediate stage ORN, would mandibular debridement in combination with vascularized soft tissue coverage result in durable symptom and disease resolution.

Patients And Methods: A retrospective cohort study of patients with mandibular ORN was performed comparing a mandibular preserving approach with a fasciocutaneous forearm flap for progressive treatment-resistant intermediate stage ORN to mandibulectomy and vascularized bone flap (VBF) reconstruction for advanced stage ORN. Read More

Laryngoscope 2021 06 2;131(6):1291-1296. Epub 2020 Dec 2.

Department of Otolaryngology- Head and Neck Surgery, University Hospitals Cleveland Medical Center/Case Western Reserve, Cleveland, Ohio, U.S.A.

Objectives/hypothesis: While nonunion after mandibular reconstruction for head and neck surgery is rare, literature exploring management is scarce. Our primary objective was to determine success rates of tibial bone graft (TBG) in achieving mandibular union. Secondary objectives include determining factors that contribute to failure of TBG. Read More

Oral Oncol 2021 01 5;112:105073. Epub 2020 Nov 5.

Unit of Maxillofacial Surgery, Department of Neuroscience, University of Padova, Padova, Italy. Electronic address:

Objective: We evaluated the safety of REPLICA, a CAD/CAM-designed patient-specific titanium mandible, in patients with mandibular defects not suitable for reconstruction with traditional techniques.

Patients And Methods: We performed a cohort study with a composite primary outcome assigned at the end of a 1-year follow-up. The outcome was assigned in the presence of all the following: 1) absence of intraoral or skin extrusion of REPLICA; 2) decrease or cessation of oral pain; 3) stability or increase in mouth opening; 4) resumption of oral feeding without the need of nasogastric tube; 5) absence of fracture at multidetector computer tomography (MDCT); 6) absence of displacement (MDCT); 7) absence of screw loosening (MDCT). Read More

J Clin Med 2020 Oct 30;9(11). Epub 2020 Oct 30.

Oral and Maxillo-Facial Surgery Unit, IRCCS Policlinico di Sant'Orsola, Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, 40100 Bologna, Italy.

Osteonecrosis of the jaw (ONJ) is a disease that affects the jaw. It is mainly related to radiation or bisphosphonates therapy, and the symptoms and signs consist of pain, bone exposure, inflammation of the surrounding soft tissue swelling, and secondary infection or drainage. In the case of advanced disease of the mandibular area, the treatment of choice is mandibular resection and reconstruction. Read More

J Craniofac Surg 2020 Nov/Dec;31(8):e766-e767

Department of Oral and Maxillofacial Surgery, All India Institute of Medical Sciences, New Delhi, India.

The aim of the study was to evaluate the effectiveness of sublingual gland flap in the reconstruction of surgical defect following sequestrectomy in medication induced osteonecrosis of jaws (MRONJ), osteomyelitis (OML), and osteoradionecrosis (ORN) of mandible. A total of 6 patients with MRONJ (n = 4) osteomyelitis (n = 1) and ORN (n = 1) underwent sequestrectomy and reconstruction with sublingual gland flap. There were 03 males and 03 females. Read More

Microsurgery 2021 Mar 26;41(3):263-269. Epub 2020 Oct 26.

Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Berlin, Germany.

This report focuses a defect comprising the complete mandible due to osteonecrosis, including both condyles, that required bilateral temporomandibular joint (TMJ) reconstruction with complete mandibular corpus using a computer-aided-design and computer-aided-manufacturing(CAD-CAM) planning to harvest a scapula chimeric free flap combined with plate including bilateral alloplastic TMJ prosthesis. This procedure was realized in one and the same surgery. A 73 year-old-man developed an osteoradionecrosis of the total mandible including both condyles after radiation therapy for a squamous cell carcinoma of the tongue base(cT4aN2bM0G3). Read More

Br Dent J 2020 10 23;229(8):539-543. Epub 2020 Oct 23.

University Dental Hospital of Manchester, Restorative, Higher Cambridge Street, Manchester, M15 6FH, UK.

Introduction Radiation-induced xerostomia can result in increased caries incidence, necessitating more dental extractions and a resultant increased risk of debilitating osteoradionecrosis (ORN). Patients undergoing head and neck radiotherapy are routinely treated with a topical preventative regime consisting of fluoride and CPP-ACP (Tooth Mousse). There is limited evidence specifically relating to fluoride prevention regimes in head and neck cancer patients. Read More

Indian J Surg Oncol 2020 Sep 15;11(3):469-474. Epub 2020 Jun 15.

Department of Radiotherapy, Government Medical College Thrissur, Bishop Alapatt Road, Thrissur, Kerala India.

To study the effectiveness of hyperbaric medicine in osteoradionecrosis and irradiation induced wounds. To evolve a protocol for management with combined surgical modality for irradiation induced injury. This study was carried out in the Plastic Surgery Department, from November 2011 to December 2018. Read More

Clin Nucl Med 2021 Jan;46(1):e49-e50

From the Divisions of Neuroradiology.

Osteoradionecrosis (ORN) is a well-documented complication following radiation treatment for head and neck malignancy. Facial bones, mainly the mandible, laryngeal cartilage, and skull, are frequently involved sites for ORN. A rare site for ORN is the hyoid, with very limited cases described in the literature. Read More

Stem Cells Int 2020 1;2020:8863577. Epub 2020 Sep 1.

Department of Orthodontics, School and Hospital of Stomatology, Cheeloo College of Medicine, Shandong University & Shandong Key Laboratory of Oral Tissue Regeneration & Shandong Engineering Laboratory for Dental Materials and Oral Tissue Regeneration, No. 44-1 Wenhua Road West, Jinan, Shandong Province 250012, China.

Osteoradionecrosis of the jaw (ORNJ) is an infrequent yet potentially devastating complication of head and neck radiation therapy. Low-intensity pulsed ultrasound (LIPUS) has been widely accepted as a promising method for the successful management of ORNJ, but the mechanism remains unclear. In this study, the effects of LIPUS on cytoskeletal reorganization, cell viability, and osteogenic differentiation capacity of rat mandible-derived bone marrow mesenchymal stem cells (M-BMMSCs) induced by radiation were determined by immunofluorescence staining, CCK-8 cell proliferation assay, quantification of alkaline phosphatase (ALP) activity, alizarin red staining, and real-time RT-PCR, respectively. Read More