Surgical Treatment of Osteoradionecrosis of the Jaw with Adjunctive Hyperbaric Oxygen Therapy: A Multidisciplinary Case-Report

(Pages: 32-39)

Carlo Maiorana1, Pier Paolo Poli1, Fulvia Milena Cribiù2, Andrea Bovio3, Marco Berti1 and Mario Beretta1

1Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS CàGranda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy; 2Division of Pathology, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; 3School of Dentistry, University of Milan, Milan, Italy




Abstract: Osteoradionecrosis (ORN) of the jaw is a serious oral complication of radiation therapy in head and neck cancer patients. The radiation-induced fibro-atrophic tissue injury may result in bone necrosis and failure to heal, often secondary to operative interventions in the oral cavity. The management of ORN can be complex and often requires a multimodality approach. Since to date no consensus has been established for the ideal treatment protocol. The aim of the present report was to strengthen the current evidence on the treatment of ORN according to a multidisciplinary approach. A 74-year-old female patient with a history of radiotherapy presented with a mobile fragment of exposed necrotic bone covered by bacterial biofilm in correspondence with post-extractive unhealed socket of the upper right canine. The histopathological analysis confirmed the diagnosis of ORN. A combined multidisciplinary approach consisting of surgical treatment and hyperbaric oxygen therapy was performed. The healing was uneventful and no recurrence of the disease was observed both clinically and radiographically at the 6-month follow-up. Limited to the outcome reported herein, surgical treatment of ORN with adjunctive hyperbaric oxygen therapy proved to be effective in the resolution of the disease, although long-term clinical trials are mandatory to validate this approach.

Keywords: Bone necrosis, hyperbaric oxygen therapy, oral complication, oral surgery, radiation therapy.