The effects of irradiation and hyperbaric oxygen on bone formation during rabbit mandibular distraction

[18F-]fluoride positron-emission tomography (PET) was used to assess bone formation during mandibular distraction osteogenesis. There were three study groups: irradiation, irradiation+hyperbaric oxygen and control. The two experimental groups received a tumoricidal dose of irradiation to the mandible, and one group was also given hyperbaric oxygen (2.5 ATA (atmospheres absolute) for 90 min) 18 times preoperatively. Control animals received neither irradiation nor oxygen. A unilateral osteotomy was made and, after a period of latency, bone distraction was started, continued for 2 weeks, and the distraction generated was then allowed to consolidate for 4 weeks. The first PET study was performed at the end of distraction and the second at the end of consolidation. At the end of distraction, the metabolic activity of bone in the distracted area was significantly higher in the controls than in either experimental group; differences between the experimental groups were not statistically significant. By the end of consolidation, activity in the control group had diminished to the same as in the two experimental groups, in which no significant change had occurred. Radioactivity was still significantly higher at second imaging on the distracted than non-distracted side in the control and irradiation+hyperbaric oxygen groups, but not in the group that was only irradiated. The results indicate that previous irradiation disturbs bone formation during mandibular distraction osteogenesis. Hyperbaric oxygen was not able to prevent the suppression of osteogenesis caused by radiotherapy but it might improve bone formation by prolonging high osteogenic activity.

Osteodistraction of a previously irradiated mandible with or without adjunctive hyperbaric oxygenation: an experimental study in rabbits

The purpose of this study was to analyse the effects of irradiation and hyperbaric oxygenation (HBO) on mandibular osteodistraction (OD). Eighteen rabbits were divided into three groups: 1. Irradiation (R), 2. Irradiation+HBO (R-HO), and 3. Control group (C). Animals of groups R and R-HO received in the mandible irradiation 22.4 Gy in four 5.6 Gy fractions (equivalent to 50 Gy/25 fractions). In addition, group R-HO was given HBO at 2.5 ATA for 90 min per day 18 times preoperatively. Unilateral osteotomy was made 1 month after completion of radiotherapy. After a 1 week latency period bone distraction was started at rate of 1 mm per day, continued for 2 weeks, and left to consolidate for 4 weeks. Amount of new bone was measured histomorphometrically from midsagittal sections. Area of new bone was equal in all groups. Bone was more mature and bone spicules better organized in group C than in groups R and R-HO. Cartilaginous cells were found in distracted bone in all groups but larger chondroid islands were evident only in group R. It seems that despite delayed bone formation, OD can be performed after radiotherapy. HBO had a beneficial effect on bone quality of a previously irradiated mandible.

Morphological changes of bovine mandibular bone irradiated by Er,Cr:YSGG laser: an in vitro study

OBJECTIVE

The purpose of this study was to investigate the morphological changes of bovine mandibular bone following Er,Cr:YSGG laser irradiation in different methods in vitro.

BACKGROUND DATA

Recently, an erbium, chromium/yttrium, scandium, garmet (Er,Cr:YSGG) laser device that emits a laser beam at the wavelength of 2.78 micro m was introduced. This type of infrared laser proved to ablate dental hard tissues effectively. However, the different effects of bone ablation by this laser in different irradiation methods were still unknown.

MATERIALS AND METHODS

Adult bovine mandibular bones were cut into 24 small pieces, 3-4 cm in length. The parameters of Er,Cr:YSGG laser irradiation were as follows: wavelength was 2.78 micro m, pulse duration was 140-200 micro sec, repetition rate was 20 pulse/sec, power was 4 W, spot size was 1.26 x 10(-3) mm(2), and energy density was 160 J/cm(2). Irradiation methods were different in four groups (six specimens in each group): group A, fixed position and contact mode; group B, fixed position and noncontact mode; group C, nonfixed position and contact mode; and group D, nonfixed position and noncontact mode.

RESULTS

Ablation depth in group A was significantly greater than in group B (p < 0.01). In group A, thermal damage was apparent. In group B, C, and D, thermal damage was minimal.

CONCLUSION

Er,Cr:YSGG laser allows for precise surgical bone cutting and ablation with minimal thermal damage to adjacent tissue. Irradiation in different methods may achieve different ablation rates and thermal damage.

Implant osseointegration in the irradiated mandible. A comparative study in dogs with a microradiographic and histologic assessment

This research focuses on the effects of radiotherapy on the osseointegration of dental implants placed before or after radiotherapy in 11 male beagles. After the extraction of all mandibular premolars 1st and 2nd molars, three dogs were implanted without radiotherapy (Control group), four dogs were irradiated 4 weeks after implantation (IrA group) and four dogs were irradiated 8 weeks before implantation (IrB group). Eight implants were placed in each dog, in an alternating pattern: four nonsubmerged ITI Bonefit titanium plasma spray-coated and four submerged Steri-Oss hydroxyapatite-coated. The irradiated dogs received 4.3 Gy daily for 10 days. Two different fluorescent markers were administered at the time of implantation and of irradiation. The dogs were sacrificed 6 months after implantation, i.e. 5 months after radiotherapy for the IrA group and 8 months for the IrB group. Each mandible was submitted to histological and microradiographic analysis. Bone formation occurred around 85 of the 88 implants and consisted mostly of the successive deposit of woven and lamellar bone. Both irradiated groups showed obvious bone remodeling in alveolar bone as well as in the basilar part of the mandible. Nevertheless, in the IrA group, the resorption phenomena predominated over osteogenesis. The balance between these two opposite processes seemed to be restored 8 months after the end of radiotherapy (IrB group). In spite of focal lesions of radiation-specific bone destruction emphasized in some irradiated dogs, we conclude from our results that osseointegration of dental implants is possible in irradiated bone tissue.

A comparison of the effective dose from scanography with periapical radiography

OBJECTIVES

To compare organ and effective doses from analogue scanographic and periapical radiography.

METHODS

Thermoluminescent dosimeters (TLD-700) were inserted in the parotid glands (bilateral), submandibular glands (bilateral) and bone marrow (left ascending ramus) of three human cadavers. Dosimeters were also attached to the skin, thyroid gland and lens of both eyes. Central, left lateral and left posterior scanograms were obtained with a Cranex Tome (Soredex, Helsinki, Finland) multimodal imaging system. A similar procedure was applied for periapical radiographs of the midline, left lateral and left molar regions using E-speed film both with and without rectangular collimation. Organ and effective doses were calculated for scanograms and periapical radiographs.

RESULTS

The effective doses for the scanograms were 0.001 mSv (central), 0.011 mSv (lateral) and 0.015 mSv (posterior). The effective doses for periapical radiographs were 0.001 mSv (anterior), 0.001 mSv (lateral) and 0.003 mSv (posterior) for rectangular collimation and 0.001 mSv (anterior), 0.002 mSv (lateral) and 0.005 mSv (posterior) for round collimation.

CONCLUSIONS

When a larger area of the upper or lower jaw needs to be visualised, scanograms might be considered as an alternative to periapical radiography since the effective dose is lower.

Bone growth is impaired by uranium intoxication

Acute and chronic uranium intoxication leads to the inhibition of bone formation and impaired bone modeling and remodeling. As these are processes directly involved in bone growth the aim of this paper is to present a biometric study of bone growth--tibiae and mandibles of rats intoxicated with uranium. Wistar ratios weighing 60-80 g were used as follows, a) one intraperitoneal injection (IPI, 2 mg/Kg of body weight)) of uranyl nitrate; b) 30 daily applications on the dorsal skin of aliquots of a mixture of U308, concentrated at 2% and at 4%--percutaneous absorption(PA)-. Tibia and mandible length were smaller in both experimental groups than in their respective controls. Some of the mandibular parameters were lower in intoxicated animals than their controls which in turn results in the alteration of the mandibular shape. We conclude that impairment in bone growth can be achieved by uranium intoxication.

Radiation dose in dental radiology

The aim of this study was to compare radiation exposure in panoramic radiography (PR), dental CT, and digital volume tomography (DVT). An anthropomorphic Alderson-Rando phantom and two anatomical head phantoms with thermoluminescent dosimeters fixed at appropriate locations were exposed as in a dental examination. In PR and DVT, standard parameters were used while variables in CT included mA, pitch, and rotation time. Image noise was assessed in dental CT and DVT. Radiation doses to the skin and internal organs within the primary beam and resulting from scatter radiation were measured and expressed as maximum doses in mGy. For PR, DVT, and CT, these maximum doses were 0.65, 4.2, and 23 mGy. In dose-reduced CT protocols, radiation doses ranged from 10.9 to 6.1 mGy. Effective doses calculated on this basis showed values below 0.1 mSv for PR, DVT, and dose-reduced CT. Image noise was similar in DVT and low-dose CT. As radiation exposure and image noise of DVT is similar to low-dose CT, this imaging technique cannot be recommended as a general alternative to replace PR in dental radiology.

Radiation-induced craniofacial bone growth inhibition: development of an animal model

Craniofacial deformities caused by therapeutic radiation-induced bone growth inhibition can occur in up to 100% of survivors of childhood head and neck cancers. The mechanism of radiation-induced craniofacial bone growth inhibition is poorly understood. The objective of this study is to establish a model of radiation-induced craniofacial bone growth inhibition to study the pathophysiology of radiation on growing membranous bone. Seven-week-old male New Zealand white rabbits were randomized into 4 groups (n = 10/group) and received a single dose of orthovoltage radiation (0, 15, 25, or 35 Gy) to the right orbital-zygomatic complex. Serial radiographs and computed tomography scans were performed for cephalometric analysis, bone volume, and bone density measurements until skeletal maturity at 21 weeks. Statistically significant ( P < 0.05) reductions in orbital-zygomatic complex linear bone growth, bone volume, and bone density were found after radiation with 25 or 35 Gy compared with nonirradiated control animals. A significant ( P < 0.05) decrease in orbital-zygomatic complex volume was noted after 15-Gy radiation but there were no significant effects on linear bone growth as assessed by cephalometric analysis at this dose. This study establishes the rabbit orbital-zygomatic complex as a suitable model for the study of radiation-induced craniofacial bone growth inhibition and will permit investigation into the underlying cellular and molecular basis of this injury.

Paediatric absorbed doses from rotational panoramic radiography

OBJECTIVES

To determine the paediatric doses in rotational panoramic radiography with film/screen and photostimulable phosphor receptors.

STUDY DESIGN

A paediatric anthropomorphic head and neck phantom was used. Absorbed doses were measured for two panoramic systems, the Orthophos (Sirona Dental Systems, Bensheim, Germany) and the PM 2002 CC (Planmeca Oy, Helsinki, Finland), with and without programmable child settings, using both screen/film and photostimulable phosphor receptors.

RESULTS

Absorbed doses to the eye ranged from 5 to 24 micro Gy. Doses to the dental arches with the Orthophos unit ranged from 50 to 555 micro Gy with the adult and from 27 to 436 micro Gy with the child program; using the PM 2002 CC unit, doses ranged from 56 to 1040 micro Gy using the adult settings, and from 60 to 890 micro Gy with the paediatric settings. The paediatric exposure settings reduced doses at most locations for both panoramic systems. The highest doses were measured near the rotational axes of the X-ray beam. Paediatric settings with the Orthophos P10 resulted in the dose reduction more than 50% to the thyroid but not with the PM 2002 CC. When lower kVcp or mA settings were used, absorbed doses were effectively reduced for all combinations of machines, programs and detectors.

CONCLUSIONS

Specific program settings for children reduced the absorbed doses from panoramic radiography irrespective of the machine or receptor used.

Effects of erbium,chromium:YSGG laser irradiation on canine mandibular bone

BACKGROUND

Only relatively few reports have described the morphological effects on bone produced by erbium,chromium: yttrium,scandium,gallium,garnet (Er,Cr:YSGG) laser irradiation, and none has investigated the atomic changes or estimated the temperature increases involved. The objectives of this study were to investigate the morphological, atomic, and temperature changes in irradiated areas during and after laser irradiation, and to evaluate the cutting effect on canine mandibular bone in vitro.

METHODS

Two canine mandibular bones were cut into 3 to 5 cm pieces and irradiated by an Er,Cr:YSGG laser utilizing a water-air spray at 5 W and 8 Hz for 10 or 30 seconds. During and after laser irradiation, temperature increases in the irradiated areas were measured by thermography. The samples were then observed by stereoscopy and scanning electron microscopy to determine morphological changes and by energy dispersive x-ray spectroscopy to evaluate atomic alterations.

RESULTS

Regular holes or grooves having sharp edges and smooth walls were produced, but no melting or carbonization was observed. The maximum temperature increase was an average 12.6 degrees C for 30-second irradiation. The continuous time of a temperature increase of more than 10 degrees C was consistently less than 10 seconds. An atomic analytical examination revealed that the calcium:phosphorus ratio was not significantly changed between the lased and unlased areas (P>0.0 1).

CONCLUSION

These results showed that the Er,Cr:YSGG laser cuts canine mandibular bone effectively without burning, melting, or altering the calcium:phosphorus ratio of the irradiated bone.

Comparison of patient dose from imaging protocols for dental implant planning using conventional radiography and computed tomography

OBJECTIVES

To compare the radiation doses from imaging protocols for dental implant planning either using conventional radiography only (dental panoramic radiography (DPR), cephalometry and linear cross-sectional tomography) or involving computed tomography (CT).

METHODS

Organ absorbed doses were measured using a female Rando anthropomorphic phantom loaded with lithium fluoride thermoluminescent dosemeters (TLD). Standard mandibular protocols for dental implant planning were followed using either a conventional dental radiographic unit (PM 2002 CC Planmeca, Helsinki, Finland) or CT scanner (Excel Twin Elscint, Haifa, Israel). Organ absorbed and effective doses were calculated. Effective dose was calculated using two approaches, one based on the ICRP method which excludes the salivary tissue from the remainder organs (designated E(exc)), and the other with its inclusion (E(inc)).

RESULTS

The greatest individual organ doses for any examination were measured in the salivary tissue. E(exc) for panoramic, cephalometric and cross-sectional tomography using DPR was 0.004 mSv, 0.002 mSv and 0.002 mSv, respectively, whereas with CT it was 0.314 mSv. The value of E(inc) calculated using these data was between two and five times E(exc).

CONCLUSIONS

E(inc) greatly increases the apparent radiation burden, especially with high dose procedures. CT techniques can provide excellent images, but at the cost of increased radiation detriment. DPR with a cross-sectional tomography facility may give adequate clinical information at a greatly reduced dose.

Peri-implant care of ailing implants with the carbon dioxide laser

One of the many applications for which lasers have been proposed in implant dentistry is for the decontamination process. The purposes of this study were to assess possible alterations in titanium implants in vitro and in vivo by use of the carbon dioxide (CO2) laser and to determine whether new bone formation can occur on previously contaminated implants. In vitro, temperature changes at the bone-titanium implant interface were recorded during use of a CO2 laser-scanning system (Swiftlase). Additionally, the effects of laser irradiation on titanium implants at various power settings were examined. In 6 beagle dogs, a total of 60 implants and bony defects resulting from plaque accumulation were treated by air-powder abrasive (the conventional treatment), laser irradiation, or both. Depending on the parameters chosen, melting and other surface alterations were seen in vitro, especially in the superpulse mode. Otherwise, no alterations were found, even at high power settings in the continuous mode. In vivo, corresponding histologic examination of 4-month sections showed evidence of new direct bone-to-implant contact after laser-assisted therapy, especially when the implants had been treated concomitantly with submerged membranes. These results support the hypothesis that peri-implant defects can be treated successfully by laser decontamination without damaging the surrounding tissues in the dog model. Nevertheless, further investigations will be required to determine the clinical efficacy of the treatment.

An ultrastructural study of osteoclasts and chondroclasts in poorly calcified mandible induced by high doses of strontium diet to fetal mice

A high dose strontium diet was fed to fetal mice from day 1 of gestation to birth in order to investigate the ultrastructural changes of osteoclasts/chondroclasts when associated with poorly calcified bone/cartilage. Calcification in the mandibular bone and condylar cartilage was extensively inhibited by this diet. Multinucleated osteoclasts and chondroclasts were observed on the mandibular alveolar bone and in the resorption area of the condylar cartilage, respectively. However, both cell types never formed ruffled borders and clear zones at the cell surfaces facing the matrices indicative of bone resorption, although they had well-developed organelles and vacuoles. Furthermore, they revealed signs of phagocytosis of the matrix vesicles. These results indicate that osteoclasts/chondroclasts can exhibit phagocytotic activity in response to requirements.

Morphological changes of rat mandibular bone with ArF excimer laser in vivo

OBJECTIVE

The purpose of this study was to investigate the morphological changes of bone tissue by ArF excimer laser irradiation in vivo.

SUMMARY BACKGROUND DATA

Recently, it has been demonstrated that soft and hard tissues can be removed by excimer laser irradiation with little thermal damage.

METHODS

ArF excimer laser was irradiated on the surface of the rat mandibular bone using the following parameters: wavelength; 193 nm; output: 0.12 W; pulse repetition rate: 10 Hz; spot size: 1.0 x 4.0 mm; irradiation time: 90 and 120 seconds. The ablation depth was measured at 90 and 120 seconds. Furthermore, the irradiated surface was examined histologically using scanning electron microscopy (SEM).

RESULTS

The relationship between ablation depth and irradiation time was almost linear. Macroscopically, the ArF excimer laser beam produced a defect with clean-cut margins without carbonization in the mandibular bone. Histologically, there was minimal evidence of thermal damage to the surrounding tissue. The bottom of the defect revealed a sawtooth appearance. In SEM observation, mosaic structures corresponded to the sawtooth structures observed with light microscopy.

CONCLUSIONS

These findings suggest that it is possible to remove bone tissue using ArF excimer laser irradiation without thermal damage. The effectiveness of this laser can be attributed to the photoablation of the bone tissue.

A histomorphometric study of the tissue reaction around hydroxyapatite implants irradiated after placement

PURPOSE

The tissue reaction around hydroxyapatite (HA) implants irradiated at 3 different time points after placement was histologically and histomorphometrically analyzed to further determine the relation between irradiation and tissue reaction.

MATERIALS AND METHODS

Cylindrical high-density HA implants were placed in the mandibles of 48 Japanese white rabbits. The mandible was then irradiated with a single 15-Gy dose 5, 14, or 28 days after implantation. The rabbits were sacrificed on days 7, 14, 28, or 90 after irradiation. Nonirradiated rabbits with implants were used as controls. Nondecalcified specimens stained with toluidine blue were used for histologic analysis and histomorphometric measurements.

RESULTS

In the rabbits irradiated 5 days after implantation, the HA-bone contact occurred later than in the controls. The bone-implant contact surface ratio was lower than in the controls at each time of sacrifice because of necrosis of the newly formed bone just after irradiation. The HA-bone contact in rabbits irradiated 14 and 28 days after implantation was similar to that of the controls. Bone remodeling was suppressed in the rabbits in each group sacrificed 90 days after irradiation.

CONCLUSIONS

Therapeutic irradiation shortly after implantation inhibits direct contact between the HA implant and the surrounding bone. Bone contact occurring before irradiation was minimally affected. Regardless of the interval between implantation and irradiation, postimplantation irradiation inevitably delays bone remodeling.

Hyperbaric oxygen in the therapeutic management of osteoradionecrosis of the facial bones

This paper reviews all 17 cases of facial bone osteoradionecrosis (ORN) which were treated in Adelaide, South Australia, in a nine-year period (1987 1996). This was 1.2% of all cases of head and neck cancer treated with radiotherapy (RT). Fourteen cases received treatment following the Marx principles of staging and the protocols of hyperbaric oxygen plus or minus surgery. The three exclusions were two patients who died of recurrent cancer before treatment was complete and one who declined treatment. The eleven cases of mandibular ORN occurred within a few years of the initial RT treatment. All except one occurred after surgical trauma, with dental extractions being the factor in nine cases. All responded to HBO, with or without surgery depending on stage. The three cases of temporal bone ORN were all of late spontaneous onset. All were stage I and all responded to HBO alone. This study shows that the incidence of ORN in Adelaide is low, probably through use of conservative doses of RT and good preventative protocols. The treatment with HBO plus or minus surgery was effective.

Impaired dentofacial development after radiotherapy of a non-Hodgkin lymphoma: report of case

Since the advances in therapy of childhood malignancies have improved life expectancy attention is now increasingly focused on the long-term effects of antineoplastic therapy. Developmental abnormalities due to antineoplastic therapy have been claimed to preferentially occur in children treated before the age of six years. This report of a case demonstrates severe developmental disturbances following radiotherapy of a cervical non-Hodgkin lymphoma at the age of eight years. The morphological changes included microdontia, root shortening, blunting and thinning as well as mandibular hypoplasia.

Osteoradionecrosis of the jaws: clinical characteristics and relation to the field of irradiation

PURPOSE

This study focuses on the clinical characteristics of patients with osteoradionecrosis (ORN) of the jaws and on the relation between the extent of the ORN and the field of irradiation.

PATIENTS AND METHODS

The study group consisted of 80 patients referred for treatment of ORN. Charts of the extent of ORN, based on panoramic radiographs, were drawn by the clinical investigator and compared with charts of the field of irradiation drawn by the oncologists. Also recorded was diagnosis of the lesion, stage, location, treatment schedule, and period and dose of irradiation. Also documented were various potential initiating factors for ORN.

RESULTS

Smoking habits of ORN patients were similar to those of other patients with head and neck cancer. A new primary tumor or a recurrence was diagnosed in 10% of the patients at the time of ORN. Only 3 patients had received accumulated doses of less than 60 Gy. More than half of the cases were initiated by removal of teeth; however, one third occurred spontaneously. ORN developed within the first 3 years in 74%; but ORN can emerge on a traumatic basis for an infinite number of years after radiation therapy. Widespread ORN may be symptomless apart from a discrete dehiscense of the oral mucosa. The predilection site for ORN is the mandibular molar region. All cases of ORN but 1 were found in the field of radiation.

CONCLUSION

Because many ORN case are symptomless, more focus on mucosal dehiscence in the follow-up after radiation therapy is advocated in an effort to detect ORN at an early stage. The consequence of practically all ORN cases being located in the field of irradiation, together with tooth removal frequently being the initiating factor, should lead to a more aggressive preirradiation approach to dental pathology located within the field of radiation.

[Hyperbaric oxygen therapy. Clinical use in treatment of osteomyelitis, osteoradionecrosis and reconstructive surgery of the irradiated mandible]

The aim of hyperbaric oxygenation (HBO) is to increase transported oxygen in the blood over the rise of the physiologically solved part. In oral and maxillofacial surgery, treatment-resistant osteomyelitis and osteoradionecrosis are indications for HBO (according to Undersea and Hyperbaric Medical Society). Furthermore, there is an indication to apply HBO to compromised transplants of bone or soft tissue. Since 1994, 28 patients have been treated with HBO in the department of oro-, maxillofacial surgery of the Medical School Hannover. Sixteen patients had a treatment-resistant osteomyelitis. Two patients were suffering from an osteoradionecrosis in the irradiated mandible. Nine patients had received autogenous transplants, which were threatened by infection or an insufficient recipient-side. One patient was treated because of a chronic non-healing wound. In six patients we found that the chronic osteomyelitis had healed. This was proven by clinical examination and scintigraphic findings. In eight patients we had a decrease in turnover in scintigraphy and an improvement of the clinical situation. Two patients with osteoradionecrosis showed clinical improvement under HBO. In nine patients with threatened transplants we saw good healing of all critical grafts under HBO. One patient with a non-healing wound could be cured with HBO. It was shown that with HBO we could cure osteomyelitis, osteoradionecrosis and non-healing wounds to a large extent. Grafts which were threatened by infection or insufficient recipient-side healed after the application of HBO.

Morbidity after midline mandibulotomy and radiation therapy

PURPOSE

To assess the morbidity of mandibulotomy in patients treated for neoplasms of the oropharynx and oral cavity, and to determine if postoperative radiation therapy to the mandibulotomy site carries an increased risk of complications.

PATIENTS AND METHODS

The medical charts of 30 patients treated between 1992 and 1996 undergoing midline mandibulotomy for tumors of the oral cavity (7 patients) and oropharynx (23 patients) were retrospectively reviewed. Three patients presented with recurrent disease, 1 of whom was previously irradiated. Twenty-five patients received postoperative radiation after mandibulotomy to a median dose of 60 Gy to the primary tumor bed, whereas 5 patients were treated with surgery alone. The patients were separated into those whose mandibulotomy site was within the radiation treatment field (n = 9), and those whose site was shielded (n = 10). Median follow-up was 27.8 months (range 5-81 months). End points included significant pain involving the mandibulotomy site, trismus, malocclusion, wound infection, osteoradionecrosis, and time to oral intake.

RESULTS

There were no postoperative deaths. Minor wound infection or breakdown occurred in 4/30 patients (13%). All of these resolved with local care and parenteral antibiotics. More serious complications involving the mandibulotomy occurred in 2 patients (7%). One patient had chronic wound drainage at the mandibular osteotomy site, which healed after plate removal. Another patient developed osteoradionecrosis. No patient developed trismus or malocclusion. With a median follow-up of 27.8 months, 4 patients have recurred locally. The complication rate was 11% for patients whose mandibulotomy site was irradiated, and 30% for those whose site was shielded.

CONCLUSION

Mandibulotomy can be safely performed in patients who are likely to require postoperative external radiation.

[Effect of bFGF on regeneration of distracted mandibles after radiation]

The potential of distraction osteogenesis in mandibular reconstruction has been limited by its questionable efficacy in previously irradiated bone. The possible osteogenetic effect of recombinant human basic fibroblast growth factor (bFGF) on lengthening of irradiated mandibles was investigated in beagle dogs. We studied nine adult dogs which underwent a full course of external beam radiation therapy (60 Gy/30 fractions). Six months after completion of radiotherapy, the molars were extracted bilaterally followed by bone lengthening of the mandible using an intraoral device. On postoperative day 3 and 7 we injected 10 micrograms bFGF into the osteotomy site of each right hemimandible. The left sides were used as controls. The time course in ossification of the distracted area was evaluated at 2, 4, and 6 weeks after completion of bone lengthening. The radiographs of the newly formed bone tissue were measured by digital image analysis. Corresponding to the radiographic findings, the histological examination of the removed jaws showed an earlier and more intensive bone formation in the treated side after 2, 4, and 6 weeks compared to the control side. We conclude that bFGF promotes the ossification of distracted mandibles after radiation therapy in dogs.