Abstract
Background
Osteoradionecrosis (ORN) of the jaw is a potentially devastating consequence of head
and neck irradiation. Despite recent advances, there are patients who fail to respond
to conventional therapies. Historically, free flaps were reserved for advanced cases
requiring segmental resection and composite reconstruction, with early and intermediate
disease treated with more conservatively. We have adopted a more active surgical approach
in selected intermediate cases.
Methods
A retrospective review of patients with intermediate stage ORN who received debridement
and either fascio-cutaneous or fascio-periosteal free flap reconstruction was performed.
Demographic data, ORN severity, treatment, and outcomes are described.
Results
From 2019, nine cases in seven patients were identified. All cases were Notani grade
II. There were six Epstein stage IIa and three Epstein stage IIIa. The mandible was
the most common site (n = 8). Of the seven patients, two had oropharyngeal primaries
treated with chemoradiation, five had oral cavity primaries treated with surgery and
adjuvant radiation therapy. Three patients had prior hyperbaric oxygen therapy, and
two had pentoxifylline/tocopherol therapy. Following debridement, the radial forearm,
ulnar artery perforator and antero-lateral thigh fascio-cutaneous free flaps were
each used in one case and the temporoparietal fascio-periosteal free flap was used
in six cases. There was no recurrence or progression of ORN at the site of surgery,
however two patients developed additional sites of ORN.
Conclusions
For patients with unresponsive intermediate ORN, debridement and soft-tissue free
flap reconstruction is an alternative to ongoing conservative management or composite
resection and reconstruction.
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Article info
Publication history
Accepted:
December 9,
2022
Received in revised form:
December 9,
2022
Received:
October 17,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
