Abstract
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. Medical management including oral rinses, irrigations,
antibiotics, and pharmacological treatments is viable for mild-to-moderate ORN. More
severe disease is best addressed with a combination of medical management and surgical
intervention aimed at aggressively removing devitalized tissue until bleeding bone
is encountered and reconstructing the soft tissue and bone defect. Reconstruction
with either regional vascularized flaps or vascularized osteocutaneous free flaps
in case of larger full-thickness bone defects (greater than 6 cm) or anterior mandible
(medial to mental foramen) is most appropriate. Maxillary ORN complications can present
with a wide range of functional problems and facial disfigurement. Life-threatening
and time-sensitive problems should be treated first, such as skull base bone coverage
or correction of severe ectropion, to avoid blindness from exposure keratopathy. Then,
less time-sensitive issues can be addressed next, such as nasal obstruction, velopharyngeal
insufficiency, and chronic tearing. It may require a combination of specialists from
different disciplines to address various issues that can arise from maxillary ORN.
Keywords
osteoradionecrosis - mandible reconstruction - midface reconstruction - maxillary
reconstruction - fibula free flap - scapula free flap - nasal reconstruction - hyperbaric
oxygen - PENTOCLO - pentoxifylline - tocopherol - clodronate
