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Peterson DE, Koyfman SA, Yarom N, Lynggaard CD, Ismaila N, Forner LE, Fuller CD, Mowery YM, Murphy BA, Watson E, Yang DH, Alajbeg I, Bossi P, Fritz M, Futran ND, Gelblum DY, King E, Ruggiero S, Smith DK, Villa A, Wu JS, Saunders D. Prevention and Management of Osteoradionecrosis in Patients With Head and Neck Cancer Treated With Radiation Therapy: ISOO-MASCC-ASCO Guideline. J Clin Oncol 2024; 42:1975-1996. [PMID: 38691821 DOI: 10.1200/jco.23.02750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 01/22/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE To provide evidence-based recommendations for prevention and management of osteoradionecrosis (ORN) of the jaw secondary to head and neck radiation therapy in patients with cancer. METHODS The International Society of Oral Oncology-Multinational Association for Supportive Care in Cancer (ISOO-MASCC) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. PubMed, EMBASE, and Cochrane Library databases were searched for randomized controlled trials and observational studies, published between January 1, 2009, and December 1, 2023. The guideline also incorporated systematic reviews conducted by ISOO-MASCC, which included studies published from January 1, 1990, through December 31, 2008. RESULTS A total of 1,539 publications were initially identified. There were 487 duplicate publications, resulting in 1,052 studies screened by abstract, 104 screened by full text, and 80 included for systematic review evaluation. RECOMMENDATIONS Due to limitations of available evidence, the guideline relied on informal consensus for some recommendations. Recommendations that were deemed evidence-based with strong evidence by the Expert Panel were those pertaining to best practices in prevention of ORN and surgical management. No recommendation was possible for the utilization of leukocyte- and platelet-rich fibrin or photobiomodulation for prevention of ORN. The use of hyperbaric oxygen in prevention and management of ORN remains largely unjustified, with limited evidence to support its practice.Additional information is available at www.asco.org/head-neck-cancer-guidelines.
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Affiliation(s)
| | | | - Noam Yarom
- Sheba Medical Center, Tel Hashomer, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Charlotte Duch Lynggaard
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Lone E Forner
- Department of Oral and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark
| | | | - Yvonne M Mowery
- UPMC Hillman Cancer Center, Pittsburgh, PA
- University of Pittsburgh, Pittsburgh, PA
| | | | - Erin Watson
- Department of Dental Oncology, Princess Margaret Cancer Center/Faculty of Dentistry, University of Toronto, Toronto, Canada
| | - David H Yang
- BC Cancer/University of British Columbia, Vancouver, Canada
| | - Ivan Alajbeg
- University of Zagreb School of Dental Medicine, Zagreb, Croatia
| | - Paolo Bossi
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- IRCCS Humanitas Research Hospital, Milan, Italy
| | | | - Neal D Futran
- University of Washington School of Medicine, Seattle, WA
| | | | - Edward King
- Northern Colorado Head and Neck Cancer Support Group, Windsor, CO
| | - Salvatore Ruggiero
- New York Center for Orthognathic and Maxillofacial Surgery, New York, NY
| | | | | | - Jonn S Wu
- BC Cancer/University of British Columbia, Vancouver, Canada
| | - Deborah Saunders
- Health Sciences North Research Institute, Northern Ontario School of Medicine, Health Sciences North, Sudbury, Ontario, Canada
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Kostares E, Kostares M, Kostare G, Tsakris A, Kantzanou M. Prevalence of free flap failure in mandibular osteoradionecrosis reconstruction: a systematic review and meta-analysis. Sci Rep 2024; 14:11087. [PMID: 38750124 PMCID: PMC11096303 DOI: 10.1038/s41598-024-61862-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
Our study aimed to estimate the prevalence of total free flap failure following free flap reconstruction for mandibular osteoradionecrosis (mORN) and assess the impact of potential moderators on this outcome. A comprehensive systematic literature search was independently conducted by two reviewers using the Medline, Scopus, Web of Science and Cochrane Library databases. Quality assessment of the selected studies was performed, and prevalence estimates with 95% confidence intervals (CI) were calculated. Outlier and influential analyses were conducted, and meta-regression analyses was employed to investigate the effects of continuous variables on the estimated prevalence. Ultimately, forty-six eligible studies (involving 1292 participants and 1344 free flaps) were included in our meta-analysis. The findings of our study revealed a prevalence of 3.1% (95% CI 1.3-5.4%) for total free flap failure after reconstruction for mORN. No study was identified as critically influential, and meta-regression analysis did not pinpoint any potential sources of heterogeneity. These findings provide valuable insights for researchers and serve as a foundation for future investigations into the management of mandibular osteoradionecrosis and the prevention of free flap failure in this context.
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Affiliation(s)
- Evangelos Kostares
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece.
| | - Michael Kostares
- Department of Anatomy, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Georgia Kostare
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
| | - Maria Kantzanou
- Department of Microbiology, Medical School, National and Kapodistrian University of Athens, 115 27, Athens, Greece
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Bevans S, Hammer D. Tenants of Mandibular Reconstruction in Segmental Defects. Otolaryngol Clin North Am 2023:S0030-6665(23)00066-X. [PMID: 37246030 DOI: 10.1016/j.otc.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The premises of mandibular reconstruction are the restoration of occlusion and mandibular contour for the purpose of preserving the facial identity, oral airway, and effective speech and mastication. Establishing functional occlusion is the primary tenant in all mandibular reconstruction. In cases of segmental defects, particularly in dentate regions of the mandible, there has been a paradigm shift over the past two decades in how surgeons are approaching the restoration of load-bearing mandibular continuity with capacity for dental implantation. Here we discuss considerations for deciding the most effective method of reconstruction in segmental defects.
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Affiliation(s)
- Scott Bevans
- Department of Otolaryngology, Tripler Army Medical Center, 1 Jarrett White Road, TAMC, HI 96818, USA; Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA.
| | - Daniel Hammer
- Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814, USA; Department of Oral Maxillofacial Surgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
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Choi M, Wo L, Joshi P, Nugent A, Thaller SR. Synchronous Reconstruction of the Jaw Using a "One and a Half"-Barrel Fibular Bone Graft for Ossifying Fibroma Patients. J Craniofac Surg 2022; 33:2059-2062. [PMID: 37771105 PMCID: PMC9432421 DOI: 10.1097/scs.0000000000008540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/20/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Ossifying fibroma is one of the common benign tumors that affect the appearance and functions of the jaw. Ossifying fibroma may exhibit a wide range of biological behaviors, leading to deformities involving the jaw and other secondary facial deformities. Hence, to improve the function of the jaw and the patient's general facial appearance (bearing in mind each patient's facial shape and, or appearance), the authors thus, however, used a ''one and a half"-barrel fibular bone graft to achieve the ideal height and radian of the bone graft. CASE PRESENTATION Between July 2017 and January 2021, the authors retrospectively collected and analyzed clinical and surgical data from 39 patients who had undergone operations in our hospital. Twenty patients were operated on using our new surgical method, whereas 19 patients received conventional or debulking operation. Clinical factors associated with the operation were assessed, including classification of the jaw defects, perioperative complications, and postoperative outcomes. RESULTS All the flaps ultimately survived. According to the postoperative satisfaction survey, patients who underwent reconstruction were satisfied with their postoperative facial appearance, with an average of 8.5 out of 10. Based on the preoperative clinical data, 26 patients had suitable bone grafts for dentures to improve their oral function. CONCLUSIONS A ''one and a half''-barrel fibular bone graft effectively improves the facial appearance of patients and as well as provides an appropriate height and radian for the bone graft.
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Affiliation(s)
- Melinda Choi
- Division of Plastic and Reconstructive Surgery, De Witt Daughtry Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL
| | - Luccie Wo
- Division of Plastic and Reconstructive Surgery, De Witt Daughtry Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL
| | - Priyashma Joshi
- Division of Plastic and Reconstructive Surgery, De Witt Daughtry Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL
| | - Ajani Nugent
- Division of Plastic and Reconstructive Surgery, De Witt Daughtry Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL
| | - Seth R. Thaller
- Division of Plastic and Reconstructive Surgery, De Witt Daughtry Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL
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Nocini R, Favero V, Chiarini L, Nocini PF. Bilateral reconstruction of the mandibular body with symphyseal preservation using a single fibula free flap: operative technique. J Otolaryngol Head Neck Surg 2022; 51:29. [PMID: 35902896 PMCID: PMC9330650 DOI: 10.1186/s40463-022-00579-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/20/2022] [Indexed: 11/14/2022] Open
Abstract
Background Mandibular osteonecrosis may occur in 5% of the patients who undergo radiotherapy for the treatment of head and neck malignancies. Resection and microvascular reconstruction is the treatment of choice in complicated osteoradionecrosis, however multifocal presentation may complicate the management of the disease given the poor quality and limited availability of adequate recipient vessels.
Operative technique A 74-year-old man affected by multifocal severe osteoradionecrosis of the mandible underwent bilateral resection of the mandibular bodies while preserving the symphysis. The defects were reconstructed with a single fibula flap composed by two bony segments connected by a central segment, corresponding to the symphyseal region, in which the bone was dissected and removed. The anastomosis was performed on a single side of the neck. Healing was uneventful and the adopted technique allowed for a quick functional and esthetic recovery.
Conclusion The presented technique provided a safe and efficacious, although technically challenging, solution in a case presenting multifocal osteonecrosis of the jaw. The morbidity of the procedure was limited because the tissue resection and reconstruction processes were minimized. Graphical Abstract ![]()
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Affiliation(s)
- Riccardo Nocini
- Unit of Otolaryngology - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
| | - Vittorio Favero
- Unit of Maxillo-Facial Surgery and Dentistry - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy.
| | - Luigi Chiarini
- Unit of Cranio-Maxillo-Facial Surgery, University of Modena and Reggio Emilia, Via del Pozzo 71, 41125, Modena, Italy
| | - Pier Francesco Nocini
- Unit of Maxillo-Facial Surgery and Dentistry - Head and Neck Department, University of Verona, P.le L.A. Scuro 10, 37134, Verona, Italy
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Free vascularized flap reconstruction for osteoradionecrosis of the mandible: a 25-year retrospective cohort study. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01980-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Abstract
Background
Osteoradionecrosis of the jaw is a severe complication of radiotherapy in head and neck cancer patients. If conservative treatment and surgical debridement have been unsuccessful, the preferred treatment for symptomatic mandibular osteoradionecrosis (mORN) is radical surgery and subsequent reconstruction with a free vascularized flap. This study aims to assess the outcomes of free vascularized flap reconstruction in mORN.
Methods
A retrospective study was conducted on all patients who underwent a free vascularized flap reconstruction for mORN between 1995 and 2021 in Amsterdam UMC – VUmc, The Netherlands.
Results
In our cohort study, three of the twenty-eight flap reconstructions failed (10.7%). No recurrences of mORN were observed during a mean follow-up of 8 years.
Conclusions
The success rate of free vascularized flap reconstruction for mORN is high. The fibula is the preferred free flap for mandibular reconstruction in mORN cases. However, this type of surgery is at risk for complications and patients need to be informed that these complications may require surgical re-intervention.
Level of evidence: Level IV, Therapeutic; Risk/Prognostic.
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Chen R, Huang Z, Chen W, Ou Z, Li S, Wang J. Value of a smartphone‐compatible thermal imaging camera in the detection of peroneal artery perforators: Comparative study with computed tomography angiography. Head Neck 2019; 41:1450-1456. [PMID: 30636085 DOI: 10.1002/hed.25581] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 09/16/2018] [Accepted: 12/05/2018] [Indexed: 11/11/2022] Open
Affiliation(s)
- Rui Chen
- Department of Oral and Maxillofacial SurgerySun Yat‐sen Memorial Hospital, Sun Yat‐sen University Guangzhou China
| | - Zhi‐Quan Huang
- Department of Oral and Maxillofacial SurgerySun Yat‐sen Memorial Hospital, Sun Yat‐sen University Guangzhou China
| | - Wei‐Liang Chen
- Department of Oral and Maxillofacial SurgerySun Yat‐sen Memorial Hospital, Sun Yat‐sen University Guangzhou China
| | - Zhan‐Peng Ou
- Department of Oral and Maxillofacial SurgerySun Yat‐sen Memorial Hospital, Sun Yat‐sen University Guangzhou China
| | - Shi‐Hao Li
- Department of Oral and Maxillofacial SurgerySun Yat‐sen Memorial Hospital, Sun Yat‐sen University Guangzhou China
| | - Jian‐Guang Wang
- Department of Oral and Maxillofacial SurgerySun Yat‐sen Memorial Hospital, Sun Yat‐sen University Guangzhou China
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Computer-assisted resection and reconstruction of bilateral osteoradionecrosis of the mandible using 2 separate flaps prepared from a single fibula. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:102-106. [PMID: 29627200 DOI: 10.1016/j.oooo.2018.02.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 01/06/2018] [Accepted: 02/25/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Osteoradionecrosis of the mandible is a late radiation-induced complication, which is a major concern in survivors of head and neck cancer. STUDY DESIGN In this study, we present a case of a patient with nasopharyngeal carcinoma who developed extensive bilateral osteoradionecrosis of the ascending ramus of the mandible. After preoperative virtual surgical planning, the obtained data were used to fabricate patient-specific cutting templates. The bilateral mandibular defects were reconstructed using 2 separate flaps prepared from a single fibula. RESULTS Both defects were successfully reconstructed, and satisfactory aesthetic and functional results were achieved. CONCLUSIONS Bilateral mandibular osteoradionecrosis can be managed with virtual surgical planning, and the defects can be reconstructed using 2 separate flaps prepared from a single fibula.
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