What Is the Current Management of Osteoradionecrosis of the Temporal Bone Following Head and Neck Cancer Radiotherapy?

The Laryngoscope, Journal Year: 2025, Volume and Issue: unknown

Published: March 11, 2025

Osteoradionecrosis (ORN) of the temporal bone is a rare but serious late-stage complication head and neck radiation. The most common symptoms include otorrhea, hearing loss, otalgia, tinnitus, facial nerve palsy following radiation therapy for cancers nasopharynx, parotid, ear, skin, central nervous system [1]. pathophysiology ORN related to lateral/superficial location with respect skin soft tissue, which provide limited protection, reduced blood supply, easy pathogen access via Eustachian tube. While true incidence unknown, single-institution retrospective chart review 82 patients undergoing surgery subsequent radiotherapy malignancies over 10-year period from 2011 suggested an 8.5% [2]. Though rare, progression disease can contribute intracranial complications (i.e., abscess, CNS infections) as well cranial neuropathies, even benign having significant negative impact on patients' quality life. There wide variability regarding management this condition, multi-institutional research comprehensive evidence-based management. This, in part, due rarity condition low sample size included current studies. As there are no prospective interventional trials disease, we treatments based upon case series. Case studies reviews categorize intervention by dividing into local diffuse ORN. Local external auditory canal, characterized deeper invasion. Medical includes topical antibiotics, in-office debridement, pain management, new medications adjunctive (such hyperbaric oxygen therapy), whereas surgical range canalplasty, mastoidectomy, lateral resection potential flap reconstruction. goal remove necrotic protect all exposed bone. Of note, numerous acknowledge that universal definition successful treatment ORN; it commonly defined complete resolution [1, 3]. Conservative gentian violet application, adequate analgesia, first-line types [3]. Pentoxifylline-tocopherol (PENTO) was investigated adjunct established conservative medical treatments, supports PENTO may be effective addition standard localized [4]. works decreasing inflammation fibroblast proliferation (inhibitory TNF-alpha effect) reducing oxidative stress stabilizing free radicals (vitamin E effect). It also increases elasticity red cells, improving vascularization where tissue perfusion compromised. clodronate (a bisphosphonate) or PENTOCLO has been described mandibular ORN, not readily available United States, concern bisphosphonate-induced alone regularly studied against Hyperbaric (HBO) another option enhances delivery hypoxic tissues, promoting angiogenesis, proliferation, collagen synthesis. variable evidence effective. Two randomized control series suggest HBO cases although these findings statistically they underpowered did routinely group [5]. its effectiveness does guarantee wound breakdown when needed. One trial cited within guidelines showed counterproductive possibly increased Thus, cancer treated useful other though weak support Surgical primarily recommended intractable pain, uncontrolled infections, cholesteatomas, safe patient. overall obliterate any dead space avoid further extension process. Mastoidectomy vascularized closure shown extensive unresolved When mastoid air cell destruction present, reconstruction Meta-analysis shows outcomes better younger than age 60 Temporal devastating certain malignancies. Evidence suggests antimicrobials, PENTO, therapy, patients, particularly those disease. should reserved ages greater years. Further needs done novel methods determine best course action patients. This level 1, 3a, 3b, two 4 articles. authors declare conflicts interest.

Language: Английский

---

2024 ASCO guidelines for the prevention and management of osteoradionecrosis in patients with head & neck cancer treated with radiation therapy

Current Opinion in Oncology, Journal Year: 2025, Volume and Issue: unknown

Published: Feb. 20, 2025

Purpose of review Osteoradionecrosis may often be prevented in context interprofessional healthcare that includes dental specialists prior to and following completion the patient's head neck radiation therapy. Important factors, however, compromise delivery guideline-concordant management osteoradionecrosis (ORN), including patient access this care. This is directed these related issues, order foster enhanced approaches for ORN management. Recent findings The centered 2024 Journal Clinical Oncology publication ‘Prevention Management Patients With Head Neck Cancer Treated Radiation Therapy: ISOO-MASCC-ASCO Guideline’, companion JCO Practice which clinical insights guideline are addressed. Key recent literature cited provide contemporary decision-making prevention early diagnosis treatment ORN. Although a relatively infrequent complication patients, can have profound financial impact when it occurs. Summary Interprofessional oncology care essential Future research needed enhance management, studies predicting risk development based on patient-centered factors.

Language: Английский

---

Novel Survivorship Paradigms in Head/Neck Cancer

Seminars in Radiation Oncology, Journal Year: 2025, Volume and Issue: 35(2), P. 285 - 300

Published: March 14, 2025

Language: Английский

---

Establishment of an Osteoradionecrosis Model and its Mechanism Via Single Ionizing Radiation Exposure

International Dental Journal, Journal Year: 2025, Volume and Issue: 75(3), P. 1672 - 1682

Published: March 31, 2025

Language: Английский

---

The 2024 International Society of Oral Oncology-Multinational Association of Supportive Care in Cancer-American Society of Clinical Oncology guidelines for the prevention and management of osteoradionecrosis of the jaw

The Journal of the American Dental Association, Journal Year: 2025, Volume and Issue: 156(4), P. 268 - 276

Published: April 1, 2025

Language: Английский

---

Externally validated digital decision support tool for time-to-osteoradionecrosis risk-stratification using right-censored multi-institutional observational cohorts

Radiotherapy and Oncology, Journal Year: 2025, Volume and Issue: unknown, P. 110890 - 110890

Published: April 1, 2025

Language: Английский

---

Oral complications from treatment for human papilloma virus-positive oropharyngeal cancer

Oral Oncology, Journal Year: 2025, Volume and Issue: 165, P. 107306 - 107306

Published: April 25, 2025

Language: Английский

---

Diagnostic and Therapeutic Approaches to Jaw Osteoradionecrosis

Diagnostics, Journal Year: 2024, Volume and Issue: 14(23), P. 2676 - 2676

Published: Nov. 27, 2024

Jaw osteoradionecrosis (ORN) is a major complication of head and neck cancer radiotherapy. Treatment complications account for most the poor outcomes cancers associated racial health disparities in survivorship. The global incidence jaw ORN improving due to pre-radiotherapy patient preparations improved radiotherapy protocols. diagnosis management are based on patient’s history clinical presentation combined with radiological histopathological tests. Evidence-based therapies focus preventive, palliative, surgical principles. However, new innovative therapeutic approaches cellular molecular pathophysiological processes jawbone’s susceptibility radiation bone damage limited. rationale this narrative review highlight current diagnostic basis options ORN.

Language: Английский

---

Planned Dental Extractions After Radiation Therapy

JAMA Otolaryngology–Head & Neck Surgery, Journal Year: 2024, Volume and Issue: 150(10), P. 851 - 851

Published: Aug. 8, 2024

Nonrestorable teeth are recommended to be extracted prior radiation therapy (RT). Occasionally, preradiation extractions introduce unacceptable delays in treatment initiation. Planned dental immediately postradiation presents an alternative strategy, though outcomes uncertain.

Language: Английский

---

Computed tomography radiomics-based cross-sectional detection of mandibular osteoradionecrosis in head and neck cancer survivors

medRxiv (Cold Spring Harbor Laboratory), Journal Year: 2024, Volume and Issue: unknown

Published: Sept. 12, 2024

This study aims to identify radiomic features extracted from contrast-enhanced CT scans that differentiate osteoradionecrosis (ORN) normal mandibular bone in patients with head and neck cancer (HNC) treated radiotherapy (RT).

Language: Английский

---