Does reconstructive surgery result in measureable improvement in quality of life and function in the setting of mandibular osteoradionecrosis?
Background: Radiation and chemoradiation have been widely accepted as organ preserving techniques for the treatment of patients with advanced head and neck cancer. Unfortunately, even in the setting of complete disease control, some patients may develop mandibular osteoradionecrosis.
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March 2012Study design: A retrospective cohort analysis was accomplished involving all patients with stage II or III mandibular osteoradionecrosis treated at a single institution (University of California, San Francisco) from 1997 through 2007.
Synopsis: Mandibular osteoradionecrosis is characterized by pain, trismus, and progressive oral dysfunction. Pathologic fractures frequently ensue. Mandibular debridement and response to hyperbaric oxygen may help patients with early disease. Full vertical debridement may result in control of pain and infection but is associated with oral dysfunction. In a cohort of 35 patients, 18 were treated with radical resection and reconstruction with microvascular free fibula. These patients were compared with patients treated with debridement and local reconstructive plates. A complication rate of 37 percent was observed in the free flap group; however, significant improvement in quality of life, including relief from pain, improved appearance and better chewing with less dysphagia, were observed in the reconstructed group when compared to those treated with plating.
Bottom line: Resection and free-flap reconstruction of advanced mandibular osteoradionecrosis may result in good functional improvement but comes at a significant risk of treatment-related complications.
Reference: Chang EI, Leon P, Hoffman WY, et al. Quality of life for patients requiring surgical resection and reconstruction for mandibular osteoradionecrosis: 10-year experience at the University of California San Francisco. Head Neck. 2012;34(2):207-212.
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