Mandibular osteoradionecrosis as a consequence of radiotherapy

Authors

  • Dania Rodríguez Herrera Hospital Universitario Clínico-Quirúrgico “Comandante Faustino Pérez Hernández”. Matanzas, Cuba.
  • María Isabel Garay Crespo Universidad Ciencias Médicas de Matanzas.
  • María Teresa Lima Reyna Hospital Clínico Quirúrgico Comandante Faustino Pérez. Matanzas
  • Ana María Rodríguez Rodríguez Universidad de Ciencias Médicas de Matanzas

Abstract

Introduction: Radiotherapy is used for the treatment of head and neck cancer. Mandibular osteoradionecrosis is a typical complication of irradiated patients. This growing use of radiotherapy requires that dentists are aware of the prevention, diagnosis and treatment of its complications.

Objective: Present a clinical case of mandibular osteoradionecrosis.

Clinical case: A case is presented of a white male 68-year-old inveterate smoker and drinker patient with a diagnosis of epidermoid nasopharyngeal carcinoma (Stage II). After discharge from the dental services, the patient received radiotherapy on the primary site and ganglion regions of the neck, achieving complete response from the primary tumor and its ganglion metastases. At ten months from treatment he started with tooth mobility of the 48, periodontal abscesses at repetition, pain, impossibility to chew and trismus. Intraoral exploration found bone exposure in the right mandibular body. Mandibular radiography revealed osteolysis. A diagnosis was achieved of mandibular osteoradionecrosis. Analysis in head and neck multidisciplinary consultation advised radical surgical treatment: segmental mandibulectomy and reconstruction with a resistance plate. The patient had a favorable evolution and reports satisfaction with the functional improvement achieved.

Conclusions: In this case mandibular osteoradionecrosis was associated to periodontitis of the 48 and toxic habits. The goal of treatment should be prevention, and the role of dentists is vital. Complex as it is, the procedure achieved eradication preserving the esthetic and functional characteristics.

Key words: osteoradionecrosis, radiotherapy, prevention, control.

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References

1. Siré A, Albornoz C, Fuentes LE, Queipo G. Consecuencias de la radioterapia de cabeza y cuello. AMC. 1998; 2(1): 13-7.

2. Chronopoulos A, Zarra T, Ehrenfeld M, Sven O. Osteoradionecrosis of the jaws: definition, epidemiology, staging and clinical and radiological findings. A concise review. Int. Dent. J. 2018; 68 (1): 22-30.

3. Epstein J, Wong F, SMP. Osteoradionecrosis: clinical experience and a proposal for classification. J Oral Maxillofac Surg. 1987; 45(2):104-10.

4. Aarup-Kristensen S, Hansen C, Forner L, Brink C, Eriksen J, Johansen Y. Osteorradionecrosis de la mandíbula después de la radioterapia para el cáncer de cabeza y cuello: factores de riesgo y correlaciones dosis-volumen. Acta Oncol. 2019; 58(10): 1373-77.

5. Kuhnt T, Stang A, Wienke A, Vordermark D, Schweyen R, Hey J. Factores de riesgo potenciales para la osteorradionecrosis de la mandíbula después de la radioterapia para el cáncer de cabeza y cuello. Radiat. Oncol. 2016; 11(101).

6. Kojima Y, Yanamoto S, Umeda M, Kawashita Y, Saito I, Hasegawa T, et al. Relationship between dental status and development of osteoradionecrosis of the jaw: a multicenter retrospective study. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2017; 1248(2): 139-45.

7. Caparrotti F, Huang SH, Lin L, Bratman SV, Ringash J, Bayley A. Osteorradionecrosis de la mandíbula en pacientes con carcinoma de orofaringe tratados con radioterapia de intensidad modulada. CANCER. 2017; 123(19).

8. Kraeima J, Steenbakkers RJHM, Spijkervet FKL, Roodenburg JLN, Witjes MJH. Secondary surgical management of osteoradionecrosis using three-dimensional isodose curve visualization: a report of three cases. Int. J. Oral and Maxillofac.Surg. 2018; 47(2): 214-19.

9. Rivero JA, Shamji O, Kolokythas A. Osteoradionecrosis: a review of pathophysiology, prevention and pharmacologic management using pentoxifylline, α-tocopherol, and clodronate. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2017; 124( 5).

10. Sultan A, Glenn H, Margalit D, Chau N, Goguen LA, M. Marty F, et al. El uso de oxígeno hiperbárico para la prevención y el tratamiento de la osteorradionecrosis de la mandíbula: una guía multidisciplinaria. Oncologist. 2017; 22(3): 343-350.

11. Figueiredo Pereira I, Targino Firmino R, Côrtes Meira H, Do Egito Vasconcelos BC, Reimar-Augusto-de Souza Noronha V, Rodrigues Santos V. Osteoradionecrosis prevalence and associated factors: A ten years retrospective study. Med Oral Patol Oral Cir Bucal. 2018; 23(6): 633–38.

12. Raggio B, Winters R. Modern management of osteoradionecrosis. Otolaryngol. Head Neck Surg. 2018; 26(4): 254-59.

13. Duchnay M, El‐Rabbany M, Reza RazieeMaria H, Zych M, Tenenbaum H, S ShahAmir P, et al. Osteoradionecrosis of mandible: Case report with review of literature. Cochrane Database Syst Rev .2019.

Published

2021-08-27

How to Cite

1.
Rodríguez Herrera D, Garay Crespo MI, Lima Reyna MT, Rodríguez Rodríguez AM. Mandibular osteoradionecrosis as a consequence of radiotherapy. Rev Cub Oncol [Internet]. 2021 Aug. 27 [cited 2025 Jul. 2];19(2). Available from: https://revoncologia.sld.cu/index.php/onc/article/view/122

Issue

Section

Reportes de casos