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KMID : 0361020000430101109
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Korean Journal of Otolaryngology - Head and Neck Surgery
2000 Volume.43 No. 10 p.1109 ~ p.1115
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Management of Osteoradionecrosis of the Mandible in Patients with Oral and Oropharyngeal Cancers
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1정연훈/1Yun Hoon choung
2이한국/3강성석/3최은창/4김귀언/5변성규/5차인호/2Han Kook Lee/3Eun Chang Choi/3Seong Seok kang/4Gwi Eon Kim/5In Ho Cha/5Seong Kyn Byun
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Abstract
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Background and Objectives : Osteoradionecrosis (ORN) of the mandible is one of the most serious
complications following radiotherapy for oral and oropharyngeal cancer. However, the predisposing
factors and clinical course of ORN are variable and its proper management is currently
undetermined. The objective of this study is to review our ORN cases and evaluate the treatment
methods.
Patients and methods : We retrospectively reviewed 57 cases of oral and orpharyngeal cancers,
where patients received combined surgery and radiotherapy from 1990 to 1998. Osteoradionecrosis
occurred in 5 cases, and we evaluated the predisposing factors, clinical course and results of
treatments. Four patients were treated with radical sequestrectomy and open reduction of
mandible., Of these four patients, three received the combined treatment with hyperbaric
oxygen(HBO) therapy, and one received the conservative treatment.
Results : four ORN cases occurred at the lateral mandibulotomy site and one case arose at the
opposite mandibular body unrelated to osteotomy. The interval between ORN and radiotherapy was
so variable as 3 to 140 months. Four patients were successfully treated with the combined
surgical and HBO therapies(3 cases) or with the conservative treatment (1 case). The remaining
case could not be controlled by surgical treatment without HBO.
Conclusion : Osteoradionecrosis usually occurred at lateral mandibulotomy sites, especially
combined with sagittal partial mandibulectomies. We recommend that lateral mandibulotomies
should, whenever possible, be avoided if the radiotherapy is planned postoperativiely. And the
patients who received radiotherapy at the mandible should be observed for osteoradionecrosis for
long time. Our treatment results suggest that a combined surgery with HBO therapy can be a
primary treatment modality for ORN.
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