Osteoradionecrosis

What is osteoradionecrosis?

Osteoradionecrosis is an irradiated bone (undergo radiotherapy) that becomes devitalized(dead) and exposed through the overlying skin or mucosa, without healing for 3 months. It is more common in mandible (your lower jaw) compared to your maxilla (the upper jaw)  due to its compact structure and it receives less blood supply compared to the maxilla.

What are the risk factors of osteoradionecrosis

1)      Characteristics of tumor(the size and stage of tumor can increase your risk to develop osteoradionecrosis)The  greater the size and the more advanced the tumor is, the greater probability to develop osteoradionecrosis.

2)      Dental status of the patient who had radiotherapy

Patients who have poor oral hygiene and severe periodontal problems have higher risk to develop osteoradionecrosis.

3)      Usage of alcohol and tobacco has been implicated as a cause of osteoradionecrosis.

 

Diagnosis of osteoradionecrosis

Osteoradionecrosis is diagnosed when there is:

1)      Presence of pain

2)      Trismus (when there is limitation of your mouth opening)

3)      Infection

4)      Radiographic evidence of bone necrosis

In the early stages of osteoradionecrosis, there might be just an exposure of bone. This is an exposed devitalized bone and it is usually asymptomatic. As the lesion progresses, the pain might start kicking in and can be quite disturbing. You might also have other symptoms such as halitosis, or food impaction at the exposed area.  Fracture of jaw bone can occur in advanced case of osteoradionecrosis.

Stages of osteoradionecrosis

1)      Stage 1: Alveolar bone exposure without any radiologic signs of bone necrosis.  Stage I osteoradionecrosis is normally treated with conservative management.

2)      Stage 2 : Alveolar bone is exposed with the evidence of necrosis of the exposed superficial bone.  Stage 2 osteoradionecrosis is normally treated conservatively and does not require any surgical treatment.

3)      Stage 3: Alveolar bone necrosis with diffuse involvement and is normally treated with resection/removal of the mandible (involved)

 

How to treat osteoradionecrosis ?

For the non surgical management of osteoradionecrosis,

• The dental practitioner will  irrigate (clean) the necrotic area with saline and prescribe the patients with orally and parentally antibiotics.

 

For the surgical management of osteoradionecrosis,

• 1. Local and regional resection of necrotic bone will be done.
• 2. Bone is removed until bleeding margins are obtained
•  3. Pre-op and post-op hyperbaric oxygen therapy(HBO)

HYPERBARIC OXYGEN THERAPY

What is it?

Hyperbaric oxygen therapy is the medical usage of oxygen at a higher than atmospheric pressure. (100 percent oxygen)

What is the use of hyberbaric oxygen therapy?

• To increase the available amount of oxygen to the tissues
• To increase the process of  angiogenesis (Angiogenesis is the growth of new blood vessels in the body)
• To Promote the function of  osteoblasts and fibroblasts (osteoblasts are cells that are responsible for bone formation )

 

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