Microsurgical reconstruction in mandible osteoradionecrosis: a clinical experience from Portugal

Abstract

Background

Osteoradionecrosis (ORN) is one of the most feared complications of head and neck cancer radiotherapy. The most common location for facial ORN is the mandible. Optimal clinical management is still under debate, insofar as a clear definition of its pathological process is yet to be obtained. Osseous surgical debridement is mandatory in advanced stages, but the reconstructive technique has to be specifically tailored to ORN characteristics.

Methods

Data from patients with ORN treated in our institution from 2000 to 2014 was reviewed. Twenty-one patients were included. We retrospectively analyzed risk factors, severity of bone lesions, extension of bone resection, reconstructive option, and complications. A control group without ORN was used for comparison.

Results

In this study, radical excision and reconstruction with free flaps was the treatment of choice for moderate and severe ORN. We found a statistically significant higher rate of salvage procedures in ORN patients when compared with the control non-ORN cohort (p < 0.05). Sixty percent of the patients with ORN achieved stable coverage; 83.3% of the patients had evidence of bone union in imaging exams, and 75% recovered oral feeding capability. There was a tendency towards healing problems in ORN patients, but it did not reach statistical significance.

Conclusion

Although there was a higher rate of surgical complications in ORN patients when compared to the control group, microsurgical approach leads to good morphofunctional results in moderate to severe ORN.

Level of Evidence: Level IV, therapeutic study.

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