Challenges of an unusual Osteoradionecrosis of the jaws: case report

Authors

DOI:

https://doi.org/10.33448/rsd-v10i11.19632

Keywords:

Neoplasms; Radiotherapy; Osteoradionecrosis.

Abstract

Osteoradionecrosis (ORN) is the most worrying radiotherapy late complication. It is a condition in which the irradiated bone becomes devitalized and exposed through fistulas in the skin or mucosa. It remains without healing for a period of at least three months. Despite being a well-known entity to the professionals who treat neoplasms of the head and neck, the disease has many controversies. From its classifications to its best treatment plan. Its main signs and symptoms are pain, drainage of secretion, fistulas, ulcers of the oral mucosa, bone exposure, bone necrosis, and the surrounding soft tissue. This study aims to report a clinical case of a patient with ORN in the jaw treated at Bahiana School of Medicine and Public Health and the General Roberto Santos Hospital. A 60-year-old-male patient with a malignant neoplasm in the tonsil region, was diagnosed with ORN in mandible region, three years after radiotherapy. The treatment proposal was conservative (ozone therapy, hyperbaric oxygen and chlorexidine mouth rinse) associated with surgical debridement, with good results that involved the patient’s rehabilitation.  It is concluded that the association of conservative therapies with surgery demonstrated satisfactory results and improving the quality of life of cancer patients with ORN.

References

Anzolin, A. P., & Bertol, C. D. (2018). Ozone therapy as an integrating therapeutic in osteoartrosis treatment: a systematic review. BrJP, 1(2), 171-175. https://www.scielo.br/j/brjp/a/yMmx8KdmxqkTfjx4f77Xhwx/?lang=pt&format=pdf

Aldunate, J. L. C. B., Coltro, P. S., Busnardo, F. D. F., & Ferreira, M. C. (2010). Osteorradionecrose em face: fisiopatologia, diagnóstico e tratamento. Revista Brasileira de Cirurgia Plástica, 381-387. http://www.rbcp.org.br/details/604/pt-BR/osteorradionecrose-em-face--fisiopatologia--diagnostico-e-tratamento

Amorim, W. D. (2016). Manejo de osteorradionecrose em pacientes oncológicos. [Monografia].

Brasil, Ministério da Saúde. (2014). Manual de Bases Técnicas da Oncologia–SIA/SUS-Sistema de Informações Ambulatoriais. https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//manual-oncologia-26a-edicao.pdf

Caparrotti, F., Huang, S. H., Lu, L., Bratman, S.V., Ringash, J., Bayley, A., Cho, J., Giuliani, M., Kim, J., & Waldron, J. (2017). Osteoradionecrosis of the mandible in patients with oropharyngeal carcinoma treated with intensity‐modulated radiotherapy. Cancer, 123(19), 3691-3700. 10.1002/cncr.30803.

Dantas, J. B. L., & Reis, J. V. N. A. (2019). New therapeutic approaches to osteoradionecrosis: Literature Review. Journal of Health Sciences, 21(3), 243-9. http://dx.doi.org/10.17921/2447-8938.2019v21n3p243-249

dos Santos, R., kuhn Dall'Magro, A., Giacobbo, J., Lauxen, J. R., & Dall’Magro, E. (2015). Osteorradionecrose em pacientes submetidos à radioterapia de cabeça e pescoço: relato de caso. Revista da Faculdade de Odontologia-UPF, 20(2), 232-37. https://doi.org/10.5335/rfo.v20i2.4497

Epstein, J., Van der Meij, E., McKenzie, M., Wong, F., Lepawsky, M., & Stevenson-Moore, P. (1997). Postradiation osteonecrosis of the mandible: a long-term follow-up study. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 83(6), 657-662. 10.1016/s1079-2104(97)90314-0

He, Y., Liu, Z., Tian, Z., Dai, T., Qiu, W., & Zhang, Z. (2015). Retrospective analysis of osteoradionecrosis of the mandible: proposing a novel clinical classification and staging system. International Journal of Oral Maxillofacial Surgery, 44(12), 1547-57. 10.1016/j.ijom.2015.04.006

Instituto Nacional de Câncer José Alencar Gomes da Silva. (2019). Estimativa 2020: incidência de câncer no Brasil. Rio de Janeiro: INCA. https://www.inca.gov.br/publicacoes/livros/estimativa-2020-incidencia-de-cancer-no-brasil

Karagozoglu, K. H., Dekker, H. A., Rietveld, D., de Bree, R., Schulten, E. A. J. M., & Kantola, S. (2014). Proposal for a new staging system for osteoradionecrosis of the mandible. Med Oral, Pat Oral and Cir Bucal, 1(19), 433-7. 10.4317/medoral.19623

Lyons, A., Osher, J., Warner, E., Kumar, R., & Brennan, P. (2014). Osteoradionecrosis—A review of current concepts in defining the extent of the disease and a new classification proposal. Brazilian Journal Oral Maxillofacial Surgery, 52, 392–395. 10.1016/j.bjoms.2014.02.017

Martos-Fernández, M., Saez-Barba, M., López-López, J., Estrugo-Devesa, A., Balibrea-del-Castillo, J. M., & Bescós-Atín, C. (2018). Pentoxifylline, tocopherol, and clodronate for the treatment of mandibular osteoradionecrosis: a systematic review. Oral Surgery, Oral medicine, Oral Pathology and Oral Radiology, 125(5), 431-439. 10.1016/j.oooo.2018.02.004

Marx, R. E. (1983). Osteoradionecrosis: a new concept of its pathophysiology. Journal of Oral and Maxillofacial Surgery, 41(5), 283-288. 10.1016/0278-2391(83)90294-x

Moraes, P. D. C., Thomaz, L. A., Silva, M. B. F., Junqueira, J. L. C., & Teixeira, R. G. (2016). Successful in a conservative treatment of osteoradionecrosis of the jaw: a case report and review of literature. RGO-Revista Gaúcha de Odontologia, 64(2), 212-218. https://doi.org/10.1590/1981-863720160002000143190

Oliveira, C. C. B., Dantas, J. B. L., Borges, D. P. O., Martins, G. B., Medrado, A. R. A. P., Reis, J. V. N. A., & Marchionni, A. M. T. (2021). Ozonotherapy for Treatment of Radiation Therapy-induced Jaw Osteonecrosis and Bisphosphonates: Case Report. Revista Brasileira de Cancerologia, 67(2), e-02785. https://doi.org/10.32635/2176-9745.RBC.2021v67n2.785

Raber-Durlacher, J. E., Elad, S., & Barash, A. (2010). Oral Mucositis. Oral Oncology, 46(6), 452-6. 10.1016/j.oraloncology.2010.03.012

Raz, D. J., Clancy, S. L., & Erhunmwunsee, L. J. (2017). Surgical management of the radiated chest wall and its complications. Thoracic Surgery Clinics, 27(2), 171-179. 10.1016/j.thorsurg.2017.01.011

Ribeiro, G. H., Chrun, E. S., Dutra, K. L., Daniel, F. I., & Grando, L. J. (2018). Osteonecrosis of the jaws: a review and update in etiology and treatment. Brazilian Journal of Otorhinolaryngology, 84(1), 102-108. https://doi.org/10.1016/j.bjorl.2017.05.008

Store, G., & Larheim, T. (1999). Mandibular osteoradionecrosis: a comparison of computed tomography with panoramic radiography. Dentomaxillofacial Radiology, 28(5), 295-300. 10.1038/sj/dmfr/4600461

Zhang, Z., Xiao, W., Jia, J., Chen, Y., Zong, C., Zhao, L., & Tian, L. (2020). The effect of combined application of pentoxifylline and vitamin E for the treatment of osteoradionecrosis of the jaws: a meta-analysis. Oral Surgery, Oral medicine, Oral Pathology and Oral Radiology, 129(3), 207-214. 10.1016/j.oooo.2019.08.005

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Published

27/08/2021

How to Cite

SOUSA , S. S. de; CERQUEIRA, B. A. V.; PIMENTEL, A. L. C.; DANTAS, J. B. de L.; MARCHIONNI, A. M. T.; MEDRADO, A. R. A. P. Challenges of an unusual Osteoradionecrosis of the jaws: case report. Research, Society and Development, [S. l.], v. 10, n. 11, p. e181101119632, 2021. DOI: 10.33448/rsd-v10i11.19632. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/19632. Acesso em: 12 nov. 2024.

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Section

Health Sciences