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Postradiation osteonecrosis of the mandible

A long-term follow-up study
  • Joel Epstein
    Correspondence
    Reprint requests: Dr. J.B. Epstein British Columbia Cancer Agency 600 West 10th Avenue Vancouver, BC, Canada VSZ 4E6
    Affiliations
    British Columbia Cancer Agency, Vancouver, BC, Canada

    University of British Columbia, Vancouver, BC, Canada

    Department of Dentistry, Vancouver Hospital Health Sciences Centre, Vancouver, BC, Canada

    Department of Surgery, Faculty of Medicine, University of British Columbia. Vancouver, BC, Canada

    Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada

    Department of Surgery, Faculty of Medicine, University of British Columbia. Vancouver, BC, Canada

    Department of Dentistry, British Columbia Cancer Agency, Vancouver, BC, Canada

    Department of Clinical Dental Sciences, University of British Columbia. Vancouver, BC, Canada
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  • Erik van der Meij
    Affiliations
    University of British Columbia, Vancouver, BC, Canada

    Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada

    Department of Surgery, Faculty of Medicine, University of British Columbia. Vancouver, BC, Canada

    Department of Dentistry, British Columbia Cancer Agency, Vancouver, BC, Canada

    Department of Clinical Dental Sciences, University of British Columbia. Vancouver, BC, Canada
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  • Michael McKenzie
    Affiliations
    Department of Dentistry, Vancouver Hospital Health Sciences Centre, Vancouver, BC, Canada

    Department of Oral Medicine, University of Washington, Seattle. USA
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  • Frances Wong
    Affiliations
    Department of Oral Medicine, University of Washington, Seattle. USA

    Division of Dentistry, British Columbia Cancer Agency. Vancouver, BC, Canada
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  • Michael Lepawsky
    Affiliations
    Hyperbaric Unit, Vancouver General Hospital. Vancouver, BC, Canada
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  • Peter Stevenson-Moore
    Affiliations
    Department of Radiation Oncology, British Columbia Cancer Agency Vancouver, BC, Canada

    Department of Surgery, Faculty of Medicine, University of British Columbia. Vancouver, BC, Canada
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      Abstract

      Objectives. The objective of this study was to assess the long-term progress of 26 patients who experienced postradiation osteonecrosis of the jaw between 1975 and 1989.
      Study design. Of 26 patients who had been previously managed with hyperbaric oxygen therapy as a part of their treatment for postradiation osteonecrosis of the jaw, 20 were evaluated to determine their current status of the condition: resolved, chronic persisting (unresolved), or active progressive (symptomatic).
      Results. Two of 20 patients experienced recurrences of the condition. In one of these patients, surgical treatment was identified as the stimulus of postradiation osteonecrosis. In the other patient, the recurrence appeared to be related to periodontal disease activity. In 60% (12 of 20) of the patients, the condition remained resolved, improvement in clinical staging occurred in 10% (2 of 20) (from symptomatic to unresolved or resolved), and 20% (5 of 20) of the patients continued to demonstrate chronic persisting postradiation osteonecrosis at the end of the long-term follow-up period.
      Conclusion. This study supports the contention that postradiation osteonecrosis can occur at any time after radiation therapy, and that patients remain at risk up to 231 months after treatment of the cancer and probably indefinitely after radiation therapy. Our findings also suggest that risk of second episodes of the condition after management of an initial episode is low. In addition, our follow-up study revealed that chronic nonprogressive postradiation osteonecrosis can remain stable without extensive intervention including combined hyperbaric oxygen therapy and surgery.
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