Osteoradionecrosis of mandible bone in patients with oral cancer Associated factors and treatment outcomes
|
|
- Emory Malone
- 6 years ago
- Views:
Transcription
1 ORIGINAL ARTICLE Osteoradionecrosis of mandible bone in patients with oral cancer Associated factors and treatment outcomes Jyun-An Chen, MD, 1 Chen-Chi Wang, MD, 1,4 Yong-Kie Wong, BDS, MSc, 2 Ching-Ping Wang, MD, 1 Rong-San Jiang, MD, PhD, 1 Jin-Ching Lin, MD, PhD, 3,4 Chien-Chih Chen, MD, 3 Shih-An Liu, MD, PhD 1,4 * 1 Department of Otolaryngology, Taichung Veterans General Hospital, Taichung, Taiwan, 2 Department of Oral and Maxillofacial Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, 3 Department of Radiation Oncology, Taichung Veterans General Hospital, Taichung, Taiwan, 4 Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan. Accepted 10 December 2014 Published online 20 June 2015 in Wiley Online Library (wileyonlinelibrary.com). DOI /hed ABSTRACT: Background. The purpose of this study was to investigate factors associated with osteoradionecrosis (ORN) of the mandible bone in a large cohort of patients with oral cancer. Methods. We reviewed the medical records of patients with oral cancer and identified those with ORN of the mandible bone. Variables of patients with and without ORN were compared and associated factors were investigated by logistic regression model. Results. A total of 1692 patients were included in the final analysis and 105 patients (6.2%) developed ORN in the mandible bone. Primary site, including mouth floor, buccal mucosa, retromolar trigone, or gum, segmental mandibulectomy, and total radiation dose to the primary site 75 Gy were independent factors associated with ORN. After aggressive treatment using surgical intervention with/without hyperbaric oxygen, 93.3% of the patients healed completely. Conclusion. Among patients with oral cancer after radiation, ORN is an uncommon and dreaded complication. Recognition of associated factors can help physicians to identify those at risk. VC 2015 Wiley Periodicals, Inc. Head Neck 38: , 2016 KEY WORDS: oral cancer, osteoradionecrosis, irradiation, surgery, logistic regression model *Corresponding author: S.-A. Liu, Department of Otolaryngology, Taichung Veterans General Hospital, No. 1650, Sec. 4, Taiwan Boulevard, Taichung 40705, Taiwan. saliu@vghtc.gov.tw Contract grant sponsor: The study was partially supported by grants from Taichung Veterans General Hospital (TCVGH C), Taichung, Taiwan, Republic of China. INTRODUCTION Osteoradionecrosis (ORN) is one of the most serious complications in patients with head and neck cancer after radiation therapy. 1 It is a region of exposed necrotic bone without mucosal coverage in the maxillary or mandibular alveolar process that fails to heal after 3 months. 2 The etiology of ORN has been thought to be an avascular necrosis induced by the effects of radiation to the bone. Hypoxia, hypovascularity, and hypocellularity occur when bone is exposed to radiation. 3 In the past decade, radiation-induced fibrosis (RIF), an irreversible pathological process, was also proposed to play a crucial role in the progress of ORN. 4 The reported incidences of ORN of the mandible ranged from 1% to 30% in recent studies. 1,3,5,6 At present, there is no consensus on the optimal management of ORN. The treatment protocol varied from local wound care, empiric antibiotic, and hyperbaric oxygen (HBO) to more aggressive resection of diseased tissues plus freetissue transfer. Few prospective randomized controlled trials of ORN management have been conducted. Therefore, there is scant scientific evidence for management of ORN in the literature. 7 Several risk factors of ORN have been reported, including tumor site, 4,8,9 tumor stage, 4,5,9,10 radiation dose, 1,4,8 11 type of radiation, 8,10,12 fractionation of radiation, 8,10,11 bone invasion, 8,9,11 old age, 9,13 sex, 3,8,9 malnutrition, 4 smoking, alcohol consumption, 5,8 10 chronic renal failure under hemodialysis, 13 neck surgery, 1,9 infection, 3,4 dental extraction, 4,5,8 10,13 periodontal disease, 3,10 and type of mandibular resection. 4,5,10 However, most of the studies reporting such risk factors only included patients with ORN for final analysis. Few studies included a large population of patients with oral cancer and used a logistic regression model for risk factors analyses. Therefore, the purpose of this study was to investigate the factors associated with ORN of the mandible in a large cohort of patients with oral cancer. We also examined patients with ORN undergoing treatment and assessed their outcomes. PATIENTS AND METHODS This study protocol was approved by the Institutional Review Board of Taichung Veterans General Hospital. We retrospectively reviewed over 2000 medical records of patients with oral cancer diagnosed in our hospital 762 HEAD & NECK DOI /HED MAY 2016
2 OSTEORADIONECROSIS AND ORAL CANCER from January 2001 to December The follow-up endpoint was set as December Clinical treatments were according to the consensus guideline of the head and neck cancer team of our hospital. All patients underwent a complete dental assessment by dentists and those with poor dentition received dental extraction before radiotherapy. All patients were treated with intensitymodulated radiotherapy using conventional fractionation. Patients who were lost to follow-up, had received treatment at other institutes, had incomplete medical records, or were under oral bisphosphonates treatment for osteoporosis were excluded from this study. All patients were restaged according to the guidelines of the American Joint Committee on Cancer. Basic demographic data, including age, sex, and tumor-related features were collected. In addition, therapeutic protocols, including type of mandible resection, total radiation dose to the primary site, and re-irradiation, were also recorded. In present study, we defined ORN as loss of mucosal coverage and exposure of the mandible bone for more than 3 months. Patients with pathological proof of tumor recurrence were not regarded as having ORN. We used the Schwartz and Kagan staging system for evaluation of ORN status. 7 We used descriptive statistics for general data presentation. Comparisons of nominal or ordinal variables between subgroups were analyzed by chi-square test or Fisher s exact test, whereas continuous variables were examined by 2-tailed Student s t test. In addition, we used a receiver operating characteristic (ROC) curves to identify a proper cutoff point for the continuous variables at which to divide the patients into 2 groups. Furthermore, stepwise backward logistic regression was used to determine correlations between the presence of ORN and the variables. The logistic regression model was then adjusted for age and sex. All statistical analyses were performed using SPSS for Windows, version 12.1 (SPSS, Chicago, IL), and a p value <.05 was regarded as statistically significant. RESULTS From January 2001 to December 2011, a total of 2103 patients with oral cancer who received treatment in our institute were identified. Two hundred forty-seven patients (11.7%) received surgical intervention alone. In addition, 63 patients (3.0%) were referred from other institutes because of residual or recurrent diseases, 42 patients (2.0%) were lost to follow-up after completion of cancer therapy, 39 patients (1.9%) had incomplete medical records, and 20 patients (1.0%) were under oral bisphosphonates treatment for osteoporosis. Adequate data were obtained from the medical records of 1692 patients. The average age at diagnosis was 52.1 (611.1) years and men accounted for 93.1% (n ) of the studied population. The average follow-up period was 36.8 (616.4) months. The majority of patients had their primary in the oral cavity (n ; 86.8%) whereas 223 patients (13.2%) had their primary in the oropharynx. The detailed descriptions of primary sites are listed in Table 1. Most of the patients presented with stage IV diseases (n ; 68.2%), whereas stages I, II, and III diseases accounted for 6.1% (n 5 103), 16.8% (n 5 285), and 8.9% (n 5 150) of patients, respectively. More than half of the patients (n 5 922; 54.5%) underwent surgical intervention, whereas the remainder (n 5 770; 45.5%) received radiation therapy as their initial treatment modality. Four hundred eighty-one patients (28.4%) developed recurrent or second primary diseases during the follow-up period. Among them, 206 patients (42.8%) received salvage surgery and 328 patients (68.2%) had reirradiation. The average total dose to the primary site was Gy. The descriptive analyses are presented in Table 1. ORN was identified in 105 patients (6.2%) during the follow-up period. Based on the Schwartz and Kagan classification, over half of them were stage II (n 5 53; 50.5%), whereas 23 patients (21.9%) were stage I and 29 patients (27.6%) were stage III. The average age at diagnosis of ORN was years. The majority of patients were men (n 5 101; 96.2%). The average duration from the completion of last radiation to diagnosis of ORN was months. Most of the patients with ORN (n 5 86; 81.9%) underwent surgical intervention, whereas 19 patients (18.1%) received HBO as their first treatment. After initial treatment, 24 patients (22.9%) had persistent disease and further surgical intervention or HBO treatment session was arranged. Finally, 7 patients (6.7%) still had ORN at the end of follow-up. When stratifying patients based on the presence or absence of ORN, there were no statistically significant differences in sex, tumor stage, diabetes mellitus, hypertension, chronic renal failure under hemodialysis, bone invasion, treatment modalities, and chemotherapy between the 2 groups. However, patients with ORN tended to be younger (49.7 vs 52.3 years; p 5.021) and had higher body mass index (BMI; 24.5 vs 23.8 kg/m 2 ; p 5.017) when compared with those without. In addition, patients with ORN received higher total radiation dose to the primary site than those without (87.4 vs 64.6 Gy; p <.001). The rate of ORN was highest in patients with mouth floor cancers (11.8%) followed by those with buccal cancers (9.0%). Patients who underwent segmental mandibulectomy had a highest ORN rate (16.7%) when compared with those without mandibulectomy (3.7%) and those who received marginal (8.2%) or hemimandibulectomy (10.9%; p <.001). Detailed data are shown in Table 1. When patients with ORN were stratified according to the initial treatment modality, there were no significant differences between the 2 groups in age, sex, BMI, total radiation dose to the primary site, primary tumor site, and tumor stage. However, as the Schwartz and Kagan stage increased, the proportion of patients receiving HBO declined. Besides, a higher percentage of patients who underwent HBO had persistent disease when compared with that of patients who underwent surgical intervention as their initial treatment (63.2% vs 14.0%; p <.001). Overall, 98 patients underwent surgical intervention. Among them, 65 patients (66.3%) received simple debridement and 33 patients (33.7%) received pedicled or free flap reconstruction. Detailed data are shown in Table 2. ROC curve was used to identify a proper cutoff point for the continuous variables at which to divide the cases into 2 groups for each factor (BMI 24 kg/m 2 and HEAD & NECK DOI /HED MAY
3 CHEN ET AL. TABLE 1. Descriptive and bivariate analyses of patients with oral cancer with and without osteoradionecrosis after radiation. Variables Total no. of patients (% in column) No. of patients (%) ORN (n 5 105) Without ORN (n ) p value Age at diagnosis, y BMI, kg/m Radiation dosage to the primary site, Gy <.001 Sex.282* Female 116 (6.9) 4 (3.4%) 112 (96.6%) Male 1575 (93.1) 101 (6.4%) 1475 (93.6%) Primary tumor sites <.001 Lip 58 (3.4) 4 (6.9%) 54 (93.1%) Gingiva 136 (8.0) 11 (8.1%) 125 (91.9%) Mouth floor 51 (3.0) 6 (11.8%) 45 (88.2%) Tongue 442 (26.1) 24 (5.4%) 418 (94.6%) Buccal mucosa 589 (34.8) 53 (9.0%) 536 (91.0%) Palate 151 (8.9) 1 (0.7%) 150 (99.3%) Retromolar trigone 35 (2.1) 3 (8.6%) 32 (91.4%) Tonsil 165 (9.8) 3 (1.8%) 162 (98.2%) Tongue base 63 (3.7) 0 (0%) 63 (100%) Posterior pharyngeal wall 2 (0.1) 0 (0%) 2 (100%) Tumor stage.767 I 103 (6.1) 6 (5.8%) 97 (94.2%) II 285 (16.8) 14 (4.9%) 271 (95.1%) III 150 (8.9) 9 (6.0%) 141 (94.0%) IV 1154 (68.2) 76 (6.6%) 1078 (93.4%) Diabetes mellitus.749 No 1047 (83.2) 89 (6.3%) 1318 (93.7%) Yes 285 (16.8) 16 (5.6%) 269 (94.4%) Hypertension.571 No 1241 (73.7) 80 (6.4%) 1161 (93.6%) Yes 451 (26.7) 25 (5.5%) 426 (94.5%) Hemodialysis.385* No 1637 (96.7) 100 (6.1%) 1537 (93.9%) Yes 55 (3.3) 5 (9.1%) 50 (90.9%) Bone invasion.076 No 1289 (76.2) 72 (5.6%) 1217 (94.4%) Yes 403 (23.8) 33 (8.2%) 370 (91.8%) Treatment modalities.075 Surgery then radiation 922 (54.5) 68 (7.4%) 854 (92.6%) Radiation then surgery 206 (12.2) 8 (3.9%) 198 (96.1%) Radiation alone 564 (33.3) 29 (5.1%) 535 (94.9%) Chemotherapy.680 No 766 (45.3) 45 (5.9%) 721 (94.1%) Yes 926 (54.7) 60 (6.5%) 866 (93.5%) Mandibulectomy <.001 No 902 (53.5) 33 (3.7%) 869 (96.3%) Marginal 672 (39.7) 55 (8.2%) 617 (91.8%) Segmental 72 (4.3) 12 (16.7%) 60 (83.3%) Hemi 46 (2.7) 5 (10.9%) 41 (89.1%) Reirradiation.002 No 1364 (80.6) 72 (5.3%) 1292 (94.7%) Yes 328 (19.4) 33 (10.1%) 295 (89.9%) Edentulous status.795* No 1626 (96.1) 102 (6.3%) 1524 (93.7%) Yes 66 (3.9) 3 (4.5%) 63 (95.5%) Extraction after radiation.889 No 1561 (92.3) 96 (6.1%) 1465 (93.9%) Yes 131 (7.7) 9 (6.9%) 122 (93.1%) Abbreviations: ORN, osteoradionecrosis; BMI, body mass index. * Fisher s exact test. <24 kg/m 2, total radiation dose to the primary site 75 Gy and <75 Gy). Those curves were drawn according to the sensitivity and specificity with which the variables could discriminate the development of ORN. The longitudinal axis represents sensitivity whereas the horizontal axis represents 1 specificity (see Figure 1). The area 764 HEAD & NECK DOI /HED MAY 2016
4 OSTEORADIONECROSIS AND ORAL CANCER TABLE 2. Descriptive and bivariate analyses of patients with osteoradionecrosis stratified according to initial treatment modalities. Variables Total no. of patients (% in column) No. of patients (%) HBO (n 5 19) Surgical intervention (n 5 86) p value Age at diagnosis, y BMI, kg/m Radiation dosage to the primary site, Gy Sex.149* Female 4 (3.8) 2 (50.0%) 2 (50.0%) Male 101 (96.2) 17 (16.8%) 84 (83.2%) Primary tumor sites.453 Lip 4 (3.8) 1 (25.0%) 3 (75.0%) Gingiva 11 (12.6) 3 (27.3%) 8 (72.7%) Mouth floor 6 (5.7) 1 (16.7%) 5 (83.3%) Tongue 24 (22.9) 4 (16.7%) 20 (83.3%) Buccal mucosa 53 (50.5) 8 (15.1%) 45 (84.9%) Palate 1 (1.0) 0 (0%) 1 (100%) Retromolar trigone 3 (2.9) 0 (0%) 3 (100%) Tonsil 3 (2.9) 2 (66.7%) 1 (33.3%) Tumor stage.673 I 6 (5.7) 0 (0%) 6 (100%) II 14 (13.3) 3 (21.4%) 11 (78.6%) III 9 (8.6) 2 (22.2%) 7 (77.8%) IV 76 (72.4) 14 (18.4%) 62 (81.6%) Schwartz and Kagan classification of ORN <.001 I 23 (21.9) 14 (60.9%) 9 (39.1%) II 53 (50.5) 5 (9.4%) 48 (90.6%) III 29 (27.6) 0 (0%) 29 (100%) Persistent diseases after initial treatment <.001* No 81 (77.1) 7 (8.6%) 74 (91.4%) Yes 24 (22.9) 12 (50.0%) 12 (50.0%) Abbreviations: HBO, hyperbaric oxygen; BMI, body mass index; ORN, osteoradionecrosis. * Fisher s exact test under ROC curves for BMI and total radiation dose to the primary site were and 0.652, respectively. The sensitivity and specificity of variables were calculated and the cutoff point was chosen when the sensitivity and specificity were both as high as possible (Table 3). Then, a stepwise backward logistic regression model was applied to determine the factors associated with ORN. Table 4 shows that primary tumor site at the gum, mouth floor, buccal mucosa, or retromolar trigone (odds ratio [OR] ; 95% confidence interval [CI] ; p <.001), segmental mandibulectomy (OR ; 95% CI ; p <.001), and total radiation dose to the primary site 75 Gy (OR ; 95% CI ; p <.001) were independent factors associated with development of ORN. size, primary site of tumor, observation periods, and type of radiation delivered, the incidence of ORN varied widely in the literature. 1 A previous animal study using miniature pigs that underwent irradiation and tooth extraction found that DISCUSSION The clinical presentation of ORN varied from asymptomatic bony exposure to erythematous change, purulent discharge, and intractable pain. 3 The incidence of ORN of the mandible was reported to be as high as 56% in the past decades. 6 However, because of the advancements in the radiation techniques, the incidence of ORN has dropped to 10% or less according to recent publications. 1,5,6 In the present study, 6.2% of patients with oral cancer who underwent radiation therapy developed ORN in the mandible during the follow-up period. However, because of dissimilar populations, including the cohort FIGURE 1. Receiver operator characteristic curves for cutoff analysis of body mass index (BMI) and total radiation dose to the primary site in patients with osteoradionecrosis. The area under the curve is for BMI and for total radiation dose to the primary site. HEAD & NECK DOI /HED MAY
5 CHEN ET AL. TABLE 3. Statistical parameters associated with osteoradionecrosis calculated using different cutoff values. Statistical parameter by BMI cutoff, kg/m 2 Statistical parameter by TRD cutoff, Gy Sensitivity (%) Specificity (%) Abbreviation: BMI, body mass index; TRD, total radiation. decreased local blood flow and resultant hypovascularity may have caused an imbalance in mandible bone remodeling. 14 A study of irradiated rats indicated that hypocellularity, hypoxia, and oxidative stress were higher in the irradiated mandible than the tibia and the combination of radiation plus minor trauma promoted mandibular alveolar bone loss. 15 Bone remodeling involves a balance between osteoclast resorption and osteoblast construction. 14 Radiation promotes release of free radicals that play crucial parts in radiation-induced cell death and delayed healing by reducing production of osteoprogenitor cells while stimulating osteoclast proliferation. 15 In addition, radiation-inhibited proliferation and differentiation of existing mesenchymal stem cells and osteoprecursor cells into osteoblast cell lineages. Furthermore, the radiation effects on osteoblast differentiation were dosedependent. 14 RIF, which can cause irreversible damage after radiotherapy, was thought to play a crucial role in the pathophysiology of ORN in recent years. As the radiation doses increased, the impacts of RIF on ORN may be stronger. 4 It is therefore not surprising that higher radiation dose could render the mandible bone more vulnerable to ORN. Although reirradiation and total radiation dose to the primary were both associated with a greater risk of ORN in a bivariate analysis, we found that total radiation dose to the primary site showed the strongest association with ORN in the logistic regression model. Using ROC curves analysis, we further identified a total radiation dose to the primary site of 75 Gy was the best cutoff point to estimate the risk of ORN. To the best of our knowledge, the present study is the first study to investigate associated factors of ORN of the mandible using logistic regression analysis in a large cohort of patients with oral cancer who had undergone radiation therapy. We found total radiation dose to the primary site was the most important factor related to ORN in patients with oral cancer. Patients who received a total radiation dose of equal to or more than 75 Gy to the primary had an 8-fold increased risk of developing ORN in the mandible. Chang et al 16 found that patients who received a dose of more than 70 Gy were at a greater risk of developing ORN. Lee et al 17 indicated that a conventional dose of more than 54 Gy at 1.8 Gy per fraction was a significant factor for development of ORN in multivariate analysis. A systematic review found that extraction of mandibular teeth within the radiation field in patients who received a radiation dose of more than 60 Gy posed the highest risk for development of ORN. 18 The differences in findings TABLE 4. Factors associated with osteoradionecrosis based on logistic regression model. Variables No. of patients (N ) OR p value Lower limit 95% CI Upper limit Age, y.240 <40* Sex Female* Male BMI, kg/m 2 <24* Primary tumor site Gum, mouth floor, buccal mucosa, or retromolar trigone < Others* Mandibulectomy.001 No* Marginal Segmental < Hemi Total radiation dose to the primary site <75 Gy* Gy < Abbreviations: OR, odds ratio; 95% CI, 95% confidence interval; BMI, body mass index. * Reference group. 766 HEAD & NECK DOI /HED MAY 2016
6 OSTEORADIONECROSIS AND ORAL CANCER between our study and abovementioned studies could be due to the diverse studied populations. These studies included a variety of patients with head and neck cancer, whereas our study included only patients with oral cancer. In addition, the radiation techniques were dissimilar. Our patients were all treated with intensity-modulated radiotherapy using conventional fractionation, whereas the abovementioned studies used Cobalt-60 and/or linear accelerator with various techniques, such as hyperfraction, brachytherapy, or accelerated fraction. The type of mandible surgery was the second most important factor related to ORN in our study. 2,4,5 Monnier et al 9 found that mandibular surgery before radiation was the only independent risk factor for developing ORN in multivariate analysis. Lee et al 17 in their study of patients with oropharyngeal cancer also indicated that mandibular surgery was the most significant risk factor for ORN. The compact nature of the mandible bone and the fact that its main blood supply is from the inferior alveolar artery makes it more vulnerable to ORN after mandibular surgery. 3 This could explain why in the current study we found that patients who received segmental mandibulectomy had a more than 4-fold increased risk of developing ORN when compared to those without mandibular surgery. Our study showed that the incidences of ORN after radiation were higher in patients with primary in mouth floor, buccal, retromolar trigone, and gum regions. A previous systemic review also indicated that patients with oral cavity cancers, especially of the tongue, floor of mouth, alveolar ridge, or retromolar trigone region, had a higher risk of developing ORN after radiation. 8 These cancer sites all included the mandible in the field of radiation. This explains why patients with primary sites at mouth floor, gum, buccal mucosa, and retromolar trigone region had a 2.5-fold increased risk of developing ORN in our study. Dental status has long been considered as a risk factor of ORN in patients receiving radiation. 1 5 Patients who need dental extractions after radiation might have delayed wound healing. Such a population was also more prone to have poor dental hygiene, thereby increasing the possibility of development of ORN. 1 However, our study failed to demonstrate such relationships between ORN and extraction after radiation or edentulous status. Careful oral and dental evaluation and systematic dental hygiene performed routinely before and after radiation might reduce the risk of developing ORN. 9 Our institute avoided dental extraction within 2 years after radiation as the average duration between radiation and dental extraction was 27.3 months (range months). A recent systematic review found the incidence of ORN after postirradiation dental extractions was low. The highest risk of developing ORN was in patients who received a radiation dose of more than 60 Gy and had teeth extracted within the radiation field. 18 In the management of ORN, no general consensusbased clinic-therapeutic protocol has been established to treat this serious condition. 2 Our study revealed a low success rate of HBO as an initial treatment (7 of 19; 36.8%), and over half of the patients needed further surgical intervention. After surgical intervention with/without HBO, the majority of patients (98 of 105; 93.3%) were free of ORN. In their review article, Jacobson et al 7 also found that high success rates were achieved by aggressive surgical intervention and microvascular reconstruction with or without HBO. However, most of the published studies represented nothing more than a particular surgeon s practice or an institutional experience. Further randomized control trials are warranted to elucidate the treatment benefits of different types of managements. Although smoking, alcohol consumption, 5,8 chemotherapy, 8 bone invasion, 9 BMI, 10 chronic renal failure under hemodialysis, 13 and tumor stage 5,8 have been reported to be related to ORN, no such association was found in our study possibly because of the difference in study populations. Dissimilar patients with head and neck cancer, different types and techniques, and diverse health and social environments make the comparisons more difficult. Some studies found that periodontitis, 8,10 malnutrition, 4 irradiated volume of the mandible, 11 and poor oral hygiene 10 were related to development of ORN. However, we did not collect relevant data so no comparisons among these factors could be made. Actually, nutritional status and oral hygiene are somewhat difficult to evaluate, and continuous assessment of these health care concerns is hard to implement. A major strength of the present study was the enrollment of a large population of patients with oral cancer in a single hospital (tertiary referral center). However, there were several limitations in our study. First, we could retrieve data on the total dose delivered to the primary site from the summary of radiation note but the note did not include the maximum/mean dose to the mandible, which might more accurately represent the radiation damage to the mandible. Second, although treatment guidelines are standardized at our institute, individual variations among surgeons likely exist. Last, the extent to which our findings can be generalized to other populations may be limited because this study was conducted at a single institute. CONCLUSIONS ORN remains a severe complication with a prevalence rate of 6.2% in patients with oral cancer who have undergone radiation. Patients with primary site at the mouth floor, buccal mucosa, retromolar trigone, or gum, received segmental or marginal mandibulectomy, or received a total radiation dose equal to or more than 75 Gy to the primary site, were at significantly greater risk of developing ORN. Recognition of associated factors can help physicians to identify those at risk. Acknowledgment The authors thank the Biostatistics Task Force of Taichung Veterans General Hospital for assistance with statistical analysis. REFERENCES 1. Tsai CJ, Hofstede TM, Sturgis EM, et al. Osteoradionecrosis and radiation dose to the mandible in patients with oropharyngeal cancer. Int J Radiat Oncol Biol Phys 2013;85: Silvestre Rangil J, Silvestre FJ. Clinico-therapeutic management of osteoradionecrosis: a literature review and update. Med Oral Patol Oral Cir Bucal 2011;16:e900 e Abughazaleh K, Kawar N. Osteonecrosis of the jaws: what the physician needs to know: practical considerations. Dis Mon 2011;57: HEAD & NECK DOI /HED MAY
7 CHEN ET AL. 4. Zhuang Q, Zhang Z, Fu H, He J, He Y. Does radiation-induced fibrosis have an important role in pathophysiology of the osteoradionecrosis of jaw? Med Hypotheses 2011;77: Reuther T, Schuster T, Mende U, K ubler A. Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients a report of a thirty year retrospective review. Int J Oral Maxillofac Surg 2003;32: Gomez DR, Estilo CL, Wolden SL, et al. Correlation of osteoradionecrosis and dental events with dosimetric parameters in intensity-modulated radiation therapy for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2011; 81:e207 e Jacobson AS, Buchbinder D, Hu K, Urken ML. Paradigm shifts in the management of osteoradionecrosis of the mandible. Oral Oncol 2010;46: Nabil S, Samman N. Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113: Monnier Y, Broome M, Betz M, Bouferrache K, Ozsahin M, Jaques B. Mandibular osteoradionecrosis in squamous cell carcinoma of the oral cavity and oropharynx: incidence and risk factors. Otolaryngol Head Neck Surg 2011;144: Goldwaser BR, Chuang SK, Kaban LB, August M. Risk factor assessment for the development of osteoradionecrosis. J Oral Maxillofac Surg 2007; 65: Glanzmann C, Gr atz KW. Radionecrosis of the mandibula: a retrospective analysis of the incidence and risk factors. Radiother Oncol 1995;36: Duarte VM, Liu YF, Rafizadeh S, Tajima T, Nabili V, Wang MB. Comparison of dental health of patients with head and neck cancer receiving IMRT vs conventional radiation. Otolaryngol Head Neck Surg 2014;150: Hoff AO, Toth B, Hu M, Hortobagyi GN, Gagel RF. Epidemiology and risk factors for osteonecrosis of the jaw in cancer patients. Ann N Y Acad Sci 2011;1218: Xu J, Zheng Z, Fang D, et al. Early-stage pathogenic sequence of jaw osteoradionecrosis in vivo. J Dent Res 2012;91: Damek Poprawa M, Both S, Wright AC, Maity A, Akintoye SO. Onset of mandible and tibia osteoradionecrosis: a comparative pilot study in the rat. Oral Surg Oral Med Oral Pathol Oral Radiol 2013;115: Chang DT, Sandow PR, Morris CG, et al. Do pre-irradiation dental extractions reduce the risk of osteoradionecrosis of the mandible? Head Neck 2007;29: Lee IJ, Koom WS, Lee CG, et al. Risk factors and dose-effect relationship for mandibular osteoradionecrosis in oral and oropharyngeal cancer patients. Int J Radiat Oncol Biol Phys 2009;75: Nabil S, Samman N. Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review. Int J Oral Maxillofac Surg 2011;40: HEAD & NECK DOI /HED MAY 2016
Osteoradionecrosis and Radiation Dose to the Mandible in Patients With Oropharyngeal Cancer
International Journal of Radiation Oncology biology physics www.redjournal.org Clinical Investigation: Head and Neck Cancer Osteoradionecrosis and Radiation Dose to the Mandible in Patients With Oropharyngeal
More informationSURGICAL SITE INFECTION AFTER PREOPERATIVE NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH LOCALLY ADVANCED ORAL SQUAMOUS CELL CARCINOMA
ORIGINAL ARTICLE SURGICAL SITE INFECTION AFTER PREOPERATIVE NEOADJUVANT CHEMOTHERAPY IN PATIENTS WITH LOCALLY ADVANCED ORAL SQUAMOUS CELL CARCINOMA Shih-An Liu, MD, PhD, 1,2,3 Yong-Kie Wong, BDS, MSc,
More informationPlate Exposure after Reconstruction by Plate and Anterolateral Thigh Flap in Head and Neck Cancer Patients with composite mandibular Defects
Plate Exposure after Reconstruction by Plate and Anterolateral Thigh Flap in Head and Neck Cancer Patients with composite mandibular Defects Chia-Hsuan Tsai/ Huang-Kai Kao M. D. Introduction Malignant
More informationTitle: Osteoporosis and bisphosphonates related osteonecrosis of the jaw bone
Title: Osteoporosis and bisphosphonates related osteonecrosis of the jaw bone Authors: Alessandro Villa 1, Stefano Castiglioni 1, Alessandro Peretti 1, Marco Omodei 1, Giovanni B Ferrieri 1, Silvio Abati
More informationLocoregional recurrences are the most frequent
ORIGINAL ARTICLE SECOND SALVAGE SURGERY FOR RE-RECURRENT ORAL CAVITY AND OROPHARYNX CARCINOMA Ivan Marcelo Gonçalves Agra, MD, PhD, 1 João Gonçalves Filho, MD, PhD, 2 Everton Pontes Martins, MD, PhD, 2
More informationCT findings of osteoradionecrosis of the mandible
CT findings of osteoradionecrosis of the mandible Poster No.: C-2569 Congress: ECR 2015 Type: Educational Exhibit Authors: J. Abreu e Silva, M. J. Magalhães, N. Costa, S. Ramos Alves, M. V. P. P. Gouvea;
More informationSQUAMOUS CELL CARCINOMA OF THE ORAL CAVITY IN THE ELDERLY
ORIGINAL ARTICLE SQUAMOUS CELL CARCINOMA OF THE ORAL CAVITY IN THE ELDERLY Yi-Shing Leu 1,2,3 *, Yi-Fang Chang 4, Jehn-Chuan Lee 1, Chung-Ji Liu 2,5,6, Hung-Tao Hsiao 7, Yu-Jen Chen 8, Hong-Wen Chen 8,9,
More informationOsteoradionecrosis of Jaw in Head and Neck Cancer Patient Treated with Free Iliac Bone and Umbilical Fat Pad Graft
Maxillofac Plast Reconstr Surg 2014;36(2):62-66 http://dx.doi.org/10.14402/jkamprs.2014.36.2.62 ISSN 2288-8101(Print) ISSN 2288-8586(Online) Case Report Osteoradionecrosis of Jaw in Head and Neck Cancer
More informationDental Issues In Cancer Patients Using Bone Modifying Agents What Every GPO Must Know
Dental Issues In Cancer Patients Using Bone Modifying Agents What Every GPO Must Know Dr. Allan Hovan, DMD, MSD, FRCD (C) 2016 CAGPO Annual Meeting Four Seasons Hotel, Vancouver, B.C. Sunday, October 2
More informationResearch Article Smoking, Alcohol, and Betel Quid and Oral Cancer: A Prospective Cohort Study
Oncology Volume 2011, Article ID 525976, 5 pages doi:10.1155/2011/525976 Research Article Smoking, Alcohol, and Betel Quid and Oral Cancer: A Prospective Cohort Study Wen-Jiun Lin, 1 Rong-San Jiang, 1
More informationA novel classification system for the evaluation and reconstruction of oral defects following oncological surgery
ONCOLOGY LETTERS 14: 7049-7054, 2017 A novel classification system for the evaluation and reconstruction of oral defects following oncological surgery WEI WEI LIU, CHU YI ZHANG, JIAN YIN LI, MING FANG
More informationSurvival impact of cervical metastasis in squamous cell carcinoma of hard palate
Vol. 116 No. 1 July 2013 Survival impact of cervical metastasis in squamous cell carcinoma of hard palate Quan Li, MD, a Di Wu, MD, b,c Wei-Wei Liu, MD, PhD, b,c Hao Li, MD, PhD, b,c Wei-Guo Liao, MD,
More informationOsteoradionecrosis (ORN) of the Jaw Ms. Anam Ashraf, Mr. Shakeel Akhtar July 2012 Volume 2 Issue 1 Doctors Academy Publications
Osteoradionecrosis (ORN) of the Jaw Ms. Anam Ashraf, Mr. Shakeel Akhtar July 2012 Volume 2 Issue 1 Publications The World Journal of Medical Education and Research () is the online publication of the Group
More informationOral Cavity. 1. Introduction. 1.1 General Information and Aetiology. 1.2 Diagnosis and Treatment
Oral Cavity 1. Introduction 1.1 General Information and Aetiology The oral cavity extends from the lips to the palatoglossal folds and consists of the anterior two thirds of the tongue, floor of the mouth,
More informationUPDATE ON RADIOTHERAPY
1 Miriam Kleiter UPDATE ON RADIOTHERAPY Department for Companion Animals and Horses, Plattform Radiooncology and Nuclear Medicine, University of Veterinary Medicine Vienna Introduction Radiotherapy has
More informationSquamous Cell Carcinoma of the Oral Cavity: Radio therapeutic Considerations
Squamous Cell Carcinoma of the Oral Cavity: Radio therapeutic Considerations Troy G. Scroggins Jr. MD Chairman, Department of Radiation Oncology Ochsner Health Systems 1 Association of Postoperative Radiotherapy
More informationOsseointegrated dental implant treatment generally
Placement of Dental Implants Without Flap Surgery: A Clinical Report Bader H. Al-Ansari, BDS, MScD*/Robert R. Morris, DMD** Traditionally, the procedure of implant placement requires a surgical periosteal
More informationIrradiation for locoregionally recurrent, never-irradiated oral cavity cancers
ORIGINAL ARTICLE Irradiation for locoregionally recurrent, never-irradiated oral cavity cancers Benjamin H. Lok, MD, 1 Christine Chin, BS, 1 Nadeem Riaz, MD, 1 Felix Ho, MD, 1 Man Hu, MD, 1 Julian C. Hong,
More informationOral Cavity and Oropharynx Cancer Trends
Oral Cavity and Oropharynx Cancer Trends Darien Weatherspoon, DDS, MPH Diplomate, American Board of Dental Public Health Program Officer, National Institute of Dental and Craniofacial Research National
More informationOriginal article J Bas Res Med Sci 2018; 5(3):49-51.
Age related changes in clinicopathologic features of oral squamous cell carcinoma (OSCC) in Iranian patients: An epidemiologic study Ramin Ghafari 1, Noushin Jalayer Naderi 2*, Amirnader Emami Razavi 3
More informationCancer of the Oral Cavity
The International Federation of Head and Neck Oncologic Societies Current Concepts in Head and Neck Surgery and Oncology Cancer of the Oral Cavity Ashok Shaha Principals of Management of Oral Cancer A)
More informationReconstruction with fibular osteocutaneous free flap in patients with mandibular osteoradionecrosis
Kim et al. Maxillofacial Plastic and Reconstructive Surgery (2015) 37:7 DOI 10.1186/s40902-015-0007-3 RESEARCH ARTICLE Open Access Reconstruction with fibular osteocutaneous free flap in patients with
More information(loco-regional disease)
(loco-regional disease) (oral cavity) (circumvillae papillae) (subsite) A (upper & lower lips) B (buccal membrane) C (mouth floor) D (upper & lower gingiva) E (hard palate) F (tongue -- anterior 2/3 rds
More informationBisphosphonates, inhibitors of osteoclasts, have
ABSTRACT Osteonecrosis of the jaws in patients with a history of receiving bisphosphonate therapy Strategies for prevention and early recognition MAICO D. MELO, D.M.D.; GEORGE OBEID, D.D.S. Bisphosphonates,
More informationOral Cancer FAQs. What is oral cancer? How many people are diagnosed with oral cancer each year?
Oral Cancer FAQs What is oral cancer? Oral cancer or oral cavity cancer, is cancer that starts in the mouth. Areas affected by this type of cancer are the lips, the inside lining of the lips and cheeks
More informationPrinciples of Management of Head & Neck Cancer. Jinka Sathya Associate professor of Oncology
Principles of Management of Head & Neck Cancer Jinka Sathya Associate professor of Oncology Oral cavity Oro-pharynx Larynx Hypopharynx Nasophaynx Major sites of Mucosal H&N Cancers Head & Neck Cancer Oral
More informationRola brachyterapii w leczeniu wznów nowotworów języka i dna jamy ustnej. The role of brachytherapy in recurrent. oral cavity
Rola brachyterapii w leczeniu wznów nowotworów języka i dna jamy ustnej The role of brachytherapy in recurrent tumours of the tongue and fundus of the oral cavity Janusz Skowronek, MD, PhD, Ass. Prof.
More informationPRINCIPLES OF RADIATION ONCOLOGY
PRINCIPLES OF RADIATION ONCOLOGY Ravi Pachigolla, MD Faculty Advisor: Anna Pou, MD The University of Texas Medical Branch Department of Otolaryngology Grand Rounds Presentation January 5, 2000 HISTORY
More informationThe current treatment for oral cancer is wide
ORIGINAL ARTICLE RARE INVOLVEMENT OF SUBMANDIBULAR GLAND BY ORAL SQUAMOUS CELL CARCINOMA Tseng-Cheng Chen, MD, 1 Wu-Chia Lo, MD, 1 Jenq-Yuh Ko, MD, PhD, 1 Pei-Jen Lou, MD, PhD, 1 Tsung-Lin Yang, MD, 1,2
More informationHead and Neck Reirradiation: Perils and Practice
Head and Neck Reirradiation: Perils and Practice David J. Sher, MD, MPH Department of Radiation Oncology Dana-Farber Cancer Institute/ Brigham and Women s Hospital Conflicts of Interest No conflicts of
More informationFor the Patient: Bisphosphonates and Oral Health in Multiple Myeloma
For the Patient: Bisphosphonates and Oral Health in Multiple Myeloma Regular dental care is very important for all cancer patients. As soon as possible after your cancer diagnosis, your dentist should
More informationCase Scenario. 7/13/12 Anterior floor of mouth biopsy: Infiltrating squamous cell carcinoma, not completely excised.
Case Scenario 7/5/12 History A 51 year old white female presents with a sore area on the floor of her mouth. She claims the area has been sore for several months. She is a current smoker and user of alcohol.
More informationCASE REPORT Reconstruction and Characterization of Composite Mandibular Defects Requiring Double Skin Paddle Fibular Free Flaps
CASE REPORT Reconstruction and Characterization of Composite Mandibular Defects Requiring Double Skin Paddle Fibular Free Flaps Austin M. Badeau, BA, a and Frederic W.-B. Deleyiannis, MD, MPhil, MPH b
More informationHealth-related quality of life after mandibular resection for oral cancer: Reconstruction with free fibula flap
Journal section: Oral Surgery Publication Types: Research doi:10.4317/medoral.19399 http://dx.doi.org/doi:10.4317/medoral.19399 Health-related quality of life after mandibular resection for oral cancer:
More informationCase Scenario 1. 7/13/12 Anterior floor of mouth biopsy: Infiltrating squamous cell carcinoma, not completely excised.
Case Scenario 1 7/5/12 History A 51 year old white female presents with a sore area on the floor of her mouth. She claims the area has been sore for several months. She is a current smoker and user of
More informationUniversity of Groningen. Dental implants in maxillofacial prosthodontics Korfage, Anke
University of Groningen Dental implants in maxillofacial prosthodontics Korfage, Anke DOI: 10.1016/j.bjoms.2014.05.013 10.1016/j.ijom.2013.04.003 10.1002/hed.24053 IMPORTANT NOTE: You are advised to consult
More informationOral Cancer Risk and Detection
Oral Cancer Risk and Detection Evan M. Graboyes, MD Assistant Professor Department of Otolaryngology-Head & Neck Surgery Cancer Control Program, Hollings Cancer Center Medical University of South Carolina
More informationOSTEORADIONECROSIS OF THE MANDIBLE
OSTEORADIONECROSIS OF THE MANDIBLE Verna Vanderpuye, MD, and Alfred Goldson, MD, FACR Washington, DC Osteoradionecrosis is a major complication of surgery or trauma in previously irradiated bone in the
More informationORIGINAL ARTICLE. Predicting the Prognosis of Oral Squamous Cell Carcinoma After First Recurrence
ORIGINAL ARTICLE Predicting the Prognosis of Oral Squamous Cell Carcinoma After First Recurrence Michael D. Kernohan, FDSRCS, FRCS, MSc; Jonathan R. Clark, FRACS; Kan Gao, BEng; Ardalan Ebrahimi, FRACS;
More informationDisclosures. The Expanding Role of Microvascular Reconstruction. Overview. Things they are a Changing. Surgical Advisory Board, Genentech Corp
Disclosures Surgical Advisory Board, Genentech Corp The Expanding Role of Microvascular Reconstruction P. Daniel Knott, MD FACS Associate Professor Director, Facial Plastic and Reconstructive Surgery UCSF
More informationTITLE: Immediate Osseointegrated Implants for Cancer Patients: A Review of Clinical and Cost-Effectiveness
TITLE: Immediate Osseointegrated Implants for Cancer Patients: A Review of Clinical and Cost-Effectiveness DATE: 13 January 2015 CONTEXT AND POLICY ISSUES According to the World health Organization, the
More informationImproved outcomes in buccal squamous cell carcinoma
ORIGINAL ARTICLE Improved outcomes in buccal squamous cell carcinoma Chun Shu Lin, MD, 1 * Yee Min Jen, MD, PhD, 1 Woei Yau Kao, MD, PhD, 2 Ching Liang Ho, MD, 2 Ming Shen Dai, MD, PhD, 2 Chia Lin Shih,
More informationHiroyuki Hanakawa, Nobuya Monden, Kaori Hashimoto, Aiko Oka, Isao Nozaki, Norihiro Teramoto, Susumu Kawamura
Accepted Manuscript Radiation-induced laryngeal angiosarcoma: Case report Hiroyuki Hanakawa, Nobuya Monden, Kaori Hashimoto, Aiko Oka, Isao Nozaki, Norihiro Teramoto, Susumu Kawamura PII: S2468-5488(18)30005-5
More informationNasolabial Flap Reconstruction of Oral Cavity Defects: A Report of 18 Cases
J Oral Maxillofac Surg 58:1104-1108, 2000 Nasolabial Flap Reconstruction of Oral Cavity Defects: A Report of 18 Cases Yadranko Ducic, MD, FRCS (C),* and Mark Burye, DDS Purpose: This article describes
More informationHead and Neck Case 1 PATIENT HISTORY
Head and Neck Case 1 PATIENT HISTORY Patient History May 7, 2007 Otolaryngology Head & Neck Subjective: Patient was recently seen by a dentist, who noted a roughness in his lower alveolus, and wanted to
More informationEFFICACY OF NECK DISSECTION FOR LOCOREGIONAL FAILURES VERSUS ISOLATED NODAL FAILURES IN NASOPHARYNGEAL CARCINOMA
ORIGINAL ARTICLE EFFICACY OF NECK DISSECTION FOR LOCOREGIONAL FAILURES VERSUS ISOLATED NODAL FAILURES IN NASOPHARYNGEAL CARCINOMA Raymond King Yin Tsang, FRCSEd, Joseph Chun Kit Chung, MRCSEd, Yiu Wing
More informationFACIAL NODE INVOLVEMENT IN HEAD AND NECK CANCER
FACIAL NODE INVOLVEMENT IN HEAD AND NECK CANCER Patrick Sheahan, MB, AFRSCI, 1 Michael Colreavy, MB, FRCS (ORL), 1 Mary Toner, MB, FRCPath, 2 Conrad V. I. Timon, MD, FRCS (ORL) 1 1 Department of Otolaryngology
More informationThis Presentation Is Trademarked by Lawrence H. Zager, D.D.S.
This Presentation Is Trademarked by Lawrence H. Zager, D.D.S.! The next presentation is from the private collection of patient s treated in my practice with the use of implants and other prosthetic devices
More informationMalignant transformation of oral submucous fibrosis in Taiwan: A nationwide population-based retrospective cohort study
Accepted: 9 March 2017 DOI: 10.1111/jop.12570 ORIGINAL ARTICLE Malignant transformation of oral submucous fibrosis in Taiwan: A nationwide population-based retrospective cohort study Po-Yu Yang 1,2 Yi-Tzu
More informationLester Burket Memorial Award Thursday, 04/12/2018, 11:00-11:45am
Lester Burket Memorial Award Thursday, 04/12/2018, 11:00-11:45am *Presenter/Awardee To conserve space, we list only the institution and the country submitted as 1 st organization. Abstracts Committee:
More informationFINE NEEDLE ASPIRATION OF ENLARGED LYMPH NODE: Metastatic squamous cell carcinoma
Case Scenario 1 HNP: A 70 year old white male presents with dysphagia. The patient is a current smoker, current user of alcohol and is HPV positive. A CT of the Neck showed mass in the left pyriform sinus.
More informationResults of interstitial HDR brachytherapy for cancer of the lower lip
Original Paper Received: 2005.01.06 Accepted: 2005.05.13 Published: 2005.09.20 Results of interstitial HDR brachytherapy for cancer of the lower lip Andrzej Lebioda 1,2, Roman Makarewicz 1,2, Joanna Terlikiewicz
More informationReconstruction of large oroantral defects using a pedicled buccal fat pad
Yang et al. Maxillofacial Plastic and Reconstructive Surgery (2018) 40:7 https://doi.org/10.1186/s40902-018-0144-6 Maxillofacial Plastic and Reconstructive Surgery CASE REPORT Open Access Reconstruction
More informationLymph node ratio as a prognostic factor in head and neck cancer patients
Chen et al. Radiation Oncology (2015) 10:181 DOI 10.1186/s13014-015-0490-9 RESEARCH Open Access Lymph node ratio as a prognostic factor in head and neck cancer patients Chien-Chih Chen 1*, Jin-Ching Lin
More informationConsensus Statements and Recommended Clinical Procedures Regarding Risk Factors in Implant Therapy
Consensus Statements and Recommended Clinical Procedures Regarding Risk Factors in Implant Therapy David L. Cochran, DDS, MS, PhD, MMSci 1 /Søren Schou, DDS, PhD, Dr Odont 2 / Lisa J. A. Heitz-Mayfield,
More informationLong Term Toxicities of Head & Neck Cancer Therapies. Faith Mutale Abramson Cancer Center University of Pennsylvania
Long Term Toxicities of Head & Neck Cancer Therapies Faith Mutale Abramson Cancer Center University of Pennsylvania Head & Neck Cancer 2-3% of all cancers 1-2% of all cancer deaths Incidence includes:
More informationSurgery in Head and neck cancers.principles. Dr Diptendra K Sarkar MS,DNB,FRCS Consultant surgeon,ipgmer
Surgery in Head and neck cancers.principles Dr Diptendra K Sarkar MS,DNB,FRCS Consultant surgeon,ipgmer Email:diptendrasarkar@yahoo.co.in HNC : common inclusives Challenges Anatomical preservation R0 Surgical
More informationSurvey of Laryngeal Cancer at SBUH comparing 108 cases seen here from to the NCDB of 9,256 cases diagnosed nationwide in 2000
Survey of Laryngeal Cancer at comparing 108 cases seen here from 1998 2002 to the of 9,256 cases diagnosed nationwide in 2000 Stony Brook University Hospital Cancer Program Annual Report 2002-2003 Gender
More informationIDENTIFYING RISK FACTORS FOR POSTOPERATIVE CARDIOVASCULAR AND RESPIRATORY COMPLICATIONS AFTER MAJOR ORAL CANCER SURGERY
ORIGINAL ARTICLE IDENTIFYING RISK FACTORS FOR POSTOPERATIVE CARDIOVASCULAR AND RESPIRATORY COMPLICATIONS AFTER MAJOR ORAL CANCER SURGERY Jasjit K. Dillon, BDS, MBBS, DDS, Stanley Y. Liu, DDS, Chirag M.
More informationThe buccal mucosa includes all the intraoral mucosal. Carcinoma of the buccal mucosa
Carcinoma of the buccal mucosa DINESH K. CHHETRI, MD, JEFFREY D. RAWNSLEY, MD, and THOMAS C. CALCATERRA, MD, Los Angeles, California OBJECTIVE: The goal was to analyze the outcome of surgical therapy for
More informationDoes Buccal Cancer Have Worse Prognosis Than Other Oral Cavity Cancers?
The Laryngoscope VC 2014 The American Laryngological, Rhinological and Otological Society, Inc. Does Buccal Cancer Have Worse Prognosis Than Other Oral Cavity Cancers? P. Ryan Camilon, BA; William A. Stokes,
More informationThe influence of radiotherapy on osseointegration
Experience with Osseointegrated Implants Placed in Irradiated Tissues in Japan and the United States Atsushi Niimi, DDS, DMSc*/Minoru Ueda, DDS, PhD**/ Eugene E. Keller, DDS, PhD***/Philip Worthington,
More informationBRACHYTHERAPY IN HEAD & NECK CANCERS DR. GIRI G.V.
BRACHYTHERAPY IN HEAD & NECK CANCERS DR. GIRI G.V. BASICS High dose to tumor = local control Spare normal structures i.e. salivary gland, mandible and muscles of mastication. Seed 100 Relative dose 10
More informationPrognostic Impact of Hyperglycemia in Patients with Locally Advanced Squamous Cell Carcinoma of Cervix Receiving Definite Radiotherapy
Prognostic Impact of Hyperglycemia in Patients with Locally Advanced Squamous Cell Carcinoma of Cervix Receiving Definite Radiotherapy 2016.04.08 KCCH 김문홍 DM and prediabetes in cancer Negative impact on
More informationCLASSIFICATIONS. Established in 1994 as a subcommittee of the. Prosthodontic Care Committee
CLASSIFICATIONS Established in 1994 as a subcommittee of the Prosthodontic Care Committee Committee Members Thomas J. McGarry, DDS, Chair Arthur Nimmo, DDS James F. Skiba, DDS Christopher R. Smith, DDS
More informationRe-irradiation with or without chemotherapy. Jozsef Lövey National Institute of Oncology, Budapest, Hungary
Re-irradiation with or without chemotherapy Jozsef Lövey National Institute of Oncology, Budapest, Hungary Disclosures Occasional advisory board and educational activity to Merck, Roche, Nutricia, Takeda,
More informationDiagnosis and what happens after referral
Diagnosis and what happens after referral Dr Kate Newbold Consultant in Clinical Oncology The Royal Marsden Women's cancers Breast cancer introduction 1 Treatment Modalities Early stage disease -larynx
More informationDelayed diagnosis of oral squamous cell carcinoma following dental treatment
ORAL doi 10.1308/003588413X13629960045599 T Singh 1, M Schenberg 2 1 Maxillofacial Surgery Unit, Dandenong Hospital, Melbourne, Australia 2 Honorary Senior Lecturer, Department of Surgery, Monash University,
More informationProtons for Head and Neck Cancer. William M Mendenhall, M.D.
Protons for Head and Neck Cancer William M Mendenhall, M.D. Protons for Head and Neck Cancer Potential Advantages: Reduce late complications via more conformal dose distributions Likely to be the major
More informationOral cancer: Prognosis & Treatment. Dr. Hani Al Sheikh Radhi
Oral cancer: Prognosis & Treatment Dr. Hani Al Sheikh Radhi Prognostic factors in Oral caner TNM staging T stage N stage M stage Site Histological Factors Vascular & Perineural Invasion Surgical Margins
More informationIncidence and risk predictors for osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates
Basic research Incidence and risk predictors for osteonecrosis of the jaw in cancer patients treated with intravenous bisphosphonates Marcin Kos Department of Maxillofacial Surgery, Klinikum Minden, Minden,
More informationNew modalities in the salvage of recurrent nasopharyngeal carcinoma
New modalities in the salvage of recurrent nasopharyngeal carcinoma Dr Jeeve Kanagalingam FRCS Eng (ORL-HNS) Department of Otorhinolaryngology Tan Tock Seng Hospital SINGAPORE Nasopharyngeal carcinoma
More informationThe efficacy of postoperative radiation therapy in patients with carcinoma of the buccal mucosa and lower alveolus with positive surgical margins
Original Article The efficacy of postoperative radiation therapy in patients with carcinoma of the buccal mucosa and lower alveolus with positive surgical margins Badakh Dinesh K, Grover Amit H Dr. D.
More informationIntroduction ORIGINAL RESEARCH
Cancer Medicine ORIGINAL RESEARCH Open Access The effect of radiation therapy in the treatment of adult soft tissue sarcomas of the extremities: a long- term community- based cancer center experience Jeffrey
More informationARTICLE IN PRESS. Available online at British Journal of Oral and Maxillofacial Surgery xxx (2010) xxx xxx
Available online at www.sciencedirect.com British Journal of Oral and Maxillofacial Surgery xxx (2010) xxx xxx Review Hyperbaric oxygen in the management of late radiation injury to the head and neck.
More informationClinical analysis of 29 cases of nasal mucosal malignant melanoma
1166 Clinical analysis of 29 cases of nasal mucosal malignant melanoma HUANXIN YU and GANG LIU Department of Otorhinolaryngology Head and Neck Surgery, Tianjin Huanhu Hospital, Tianjin 300060, P.R. China
More informationWojciech K. Mydlarz, M.D. Pharyngocutaneous Fistulas after Salvage Laryngectomy: Need for Vascularized Tissue
Wojciech K. Mydlarz, M.D. Pharyngocutaneous Fistulas after Salvage Laryngectomy: Need for Vascularized Tissue Disclosures No Relevant Financial Relationships or Commercial Interests Educational Objectives
More informationORIGINAL ARTICLE. Retromolar Trigone Carcinoma Treated by Primary Radiation Therapy
ORIGINAL ARTICLE Retromolar Trigone Carcinoma Treated by Primary Radiation Therapy An Alternative to the Primary Surgical Approach Tareck Ayad, MD; Michel Gélinas, MD; Louis Guertin, MD; Daniel Larochelle,
More informationThe use of pedicled buccal fat pad combined with sequestrectomy in bisphosphonate-related osteonecrosis of the maxilla
Journal section: Oral Surgery Publication Types: Review doi:10.4317/medoral.17422 http://dx.doi.org/doi:10.4317/medoral.17422 The use of pedicled buccal fat pad combined with sequestrectomy in bisphosphonate-related
More informationIDENTIFICATION OF A HIGH-RISK GROUP AMONG PATIENTS WITH ORAL CAVITY SQUAMOUS CELL CARCINOMA AND pt1 2N0 DISEASE
doi:10.1016/j.ijrobp.2010.09.036 Int. J. Radiation Oncology Biol. Phys., Vol. 82, No. 1, pp. 284 290, 2012 Copyright Ó 2012 Elsevier Inc. Printed in the USA. All rights reserved 0360-3016/$ - see front
More informationClinical and imaging characteristics of 53 ulcers of post radiation nasopharyngeal necrosis in patients with nasopharyngeal carcinoma
MOLECULAR AND CLINICAL ONCOLOGY 5: 351-356, 2016 Clinical and imaging characteristics of 53 ulcers of post radiation nasopharyngeal necrosis in patients with nasopharyngeal carcinoma FENGQIN YAN *, ZHIMIN
More informationCover Page. The handle holds various files of this Leiden University dissertation.
Cover Page The handle http://hdl.handle.net/1887/31632 holds various files of this Leiden University dissertation. Author: Mensink, Gertjan Title: Bilateral sagittal split osteotomy by the splitter-separator
More informationOsteonecrosis of the jaw (ONJ)
Osteonecrosis of the jaw (ONJ) This Infosheet explains what osteonecrosis of the jaw (ONJ) is, a rare condition related to long-term treatment with drugs known as bisphosphonates. What is ONJ? ONJ is a
More informationMALIGNANT TUMOURS OF THE JAWS
MALIGNANT TUMOURS OF THE JAWS MALIGNANT TUMOURS OF THE JAWS Squamous cell carcinoma Osteogenic sarcoma Chondrosarcoma Fibrosarcoma Malignant lymphomas (incl. Burkitt s) Multiple myeloma Ameloblastoma Secondary
More informationReconstruction for Oral Neoplasms in Indian Setup: Redebating the Utility of Radial Artery Free Flaps
World Articles of Ear, Nose and Throat ---------------------Page 1 Reconstruction for Oral Neoplasms in Indian Setup: Redebating the Utility of Radial Artery Free Flaps Authors: Ranjan G Aiyer*, Rahul
More informationIn Scandinavia, malignant tumors in the maxillofacial
Oral Implant Rehabilitation in Irradiated Patients Without Adjunctive Hyperbaric Oxygen Gunilla Andersson, DDS, PhD*/Lars Andreasson, MD, PhD**/Göran Bjelkengren, MD*** In 15 patients treated for malignant
More informationProsthodontic Rehabilitation of a Partially Edentulous Hemiglossectomy Patient: A Clinical Report
case report 10.5005/jp-journals-10031-1067 Prosthodontic Rehabilitation of a Partially Edentulous Hemiglossectomy Patient: A Clinical Report 1 Ragini Sudhakar Sanaye, 2 Sabita M Ram, 3 Naisargi Shah, 4
More informationAccepted 5 September 2008 Published online 3 March 2009 in Wiley InterScience (www.interscience.wiley.com). DOI: /21013
ORIGINAL ARTICLE MARGINAL MANDIBULAR NERVE INJURY DURING NECK DISSECTION AND ITS IMPACT ON PATIENT PERCEPTION OF APPEARANCE Martin D. Batstone, MPhil(Surg), FRACDS(OMS), FRCS(OMFS), 1 Barry Scott, BSc,
More informationRadiographic changes of the mandible after proton beam radiotherapy for oral cancer: A case report
www.edoriumjournals.com CASE REPORT PEER REVIEWED OPEN ACCESS Radiographic changes of the mandible after proton beam radiotherapy for oral cancer: A case report Masaru Konishi, Yoshikazu Suei, Minoru Fujita,
More informationPlastic Surgery: An International Journal
Plastic Surgery: An International Journal Vol. 2013 (2013), Article ID 874416, 29 minipages. DOI:10.5171/2013.874416 www.ibimapublishing.com Copyright 2013 Akira Saito, Noriko Saito, Emi Funayama and Hidehiko
More informationHead and Neck Cancer in FA: Risks, Prevention, Screening, & Treatment Options David I. Kutler, M.D., F.A.C.S.
Head and Neck Cancer in FA: Risks, Prevention, Screening, & Treatment Options David I. Kutler, M.D., F.A.C.S. Associate Professor Division of Head and Neck Surgery Department of Otolaryngology-Head and
More informationSurgical Outcome of T4a and Resected T4b Oral Cavity Cancer. BACKGROUND. The American Joint Committee on Cancer (AJCC) 2002 staging
337 Surgical Outcome of T4a and Resected T4b Oral Cavity Cancer Chun-Ta Liao, MD 1,2 Joseph Tung-Chieh Chang, MD, MHA 2,3 Hung-Ming Wang, MD 2,4 Shu-Hang Ng, MD 2,5 Chuen Hsueh, MD 2,6 Li-Yu Lee, MD 2,6
More informationBone Health in the Cancer Patient. Stavroula Otis, M.D. Primary Care and Oncology: Practical Lessons Conference Brea Community Center May 10, 2018
Bone Health in the Cancer Patient Stavroula Otis, M.D. Primary Care and Oncology: Practical Lessons Conference Brea Community Center May 10, 2018 Overview Healthy bone is in a constant state of remodelling
More informationOsteoradionecrosis of the jaws - a current overview - part 1: Physiopathology and risk and predisposing factors
Osteoradionecrosis of the jaws - a current overview - part 1: Physiopathology and risk and predisposing factors Author Chrcanovic, Bruno Ramos, Reher, Peter, Souza, Alexandre Andrade, Harris, Malcolm Published
More informationMedical Review Criteria Dental and Oral Surgery Services
Medical Review Criteria Dental and Oral Surgery Services Subject: Dental and Oral Surgery Services Effective Date: 11/2001 Policy: HPHC covers medically necessary dental/oral surgery services included
More informationAccepted Manuscript. High-volume surgeons deliver larger surgical margins in oral cavity cancer
Accepted Manuscript High-volume surgeons deliver larger surgical margins in oral cavity cancer Owen G. Ellis, Michael C. David, Daniel J. Park, Martin D. Batstone PII: S0278-2391(16)00118-X DOI: 10.1016/j.joms.2016.01.026
More informationCharacteristics and prognostic factors of synchronous multiple primary esophageal carcinoma: A report of 52 cases
Thoracic Cancer ISSN 1759-7706 ORIGINAL ARTICLE Characteristics and prognostic factors of synchronous multiple primary esophageal carcinoma: A report of 52 cases Mei Li & Zhi-xiong Lin Department of Radiation
More informationSpontaneous fractures of the mandible concept & treatment strategy
Journal section: Oral Surgery Publication Types: Research doi:10.4317/medoral.20716 http://dx.doi.org/doi:10.4317/medoral.20716 concept & treatment strategy Anja Carlsen 1, Mette Marcussen 2 1 DDS. Resident
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES HEAD AND NECK ORAL CAVITY SQUAMOUS CELL CARCINOMA Head & Neck Site Group Oral Cavity Squamous Cell Carcinoma 1. INTRODUCTION 3 2. PREVENTION
More information