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OSOMOP > Osteoradionecrosis > Flashcards

Osteoradionecrosis Flashcards

1
Q

Describe radiotherapy as a management method for head and neck cancers

A
  • Most commonly used in conjunction with surgery
  • Can be used alone but usually in palliative setting
  • Kills cancer cells and normal cells in field of radiation
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2
Q

What is osteoradionecrosis?

A

Exposed irradiated bone that fails to heal over a period of 3 months excluding areas of residual or recurrent tumour

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3
Q

Describe when the risk of ORN is at its greatest

A
  1. Radiation dose > 60 Gy
  2. From 10 days before to several years after surgery
  3. Malnourished / Immunocompromised patients
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4
Q

Describe the aetiology of ORN

A
  • More common in mandible as poorer blood supply
  • Initiation factor often extraction
  • Affects approx. 7% of irradiated patients
  • Risk thought to increase as dose increases
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5
Q

Describe 3 risk factors of a patient developing ORN

A
  1. Radiation related factors - Total dose / field size
  2. Trauma and surgery
  3. Drug use
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6
Q

Explain why smoking is a risk factor for ORN

A

Tends to dry out the mouth which reduces the chances of proper healing

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7
Q

Describe the pathogenesis of ORN

A
  • Irradiated bone, periosteum and overlying soft tissue undergo inflammation and obliterative endarteritis
  • Lead to cellular death, hypovasularity and fibrosis
  • Radiated bed is hypocellular and devoid of fibroblasts, osteoblasts and osteocompetent cells
  • Bone death due to alveolar necrosis
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8
Q

Describe the clinical features of ORN

A

Exposed bone in previously irradiated mouth with possibility of pain, discharge, external sinus or pathological fracture

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9
Q

Describe the radiological appearance of ORN

A
  • Areas of large radiolucency present which can be ill defined
  • Similar looking to recurrent tumour
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10
Q

Explain one pro and one con of the Notani Classification for ORN

A

Pro - Very straightforward and easy to understand

Con - Only discusses mandible which is draw back

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11
Q

When does a pathological fracture usually occur in the mandible if ORN is present?

A

Usually only get fracture if ORN has gone past inferior dental canal

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12
Q

What are the clinical features of Notani Grade I?

A

ORN confined to dentoalveolar bone

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13
Q

What are the clinical features of Notani Grade II?

A

ORN limited to dentoalveolar bone or mandible above the IDC or both

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14
Q

What are the clinical features of Notani Grade III?

A

ORN involving mandible below IDC, or pathological fracture, or skin fistula

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15
Q

Name 3 types of management for ORN

A
  1. Local debridement
  2. Ultrasound therapy
  3. Hyperbaric Oxygen Therapy (HBOT)
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16
Q

Describe 4 pharmacological agents used in the management of ORN

A
  1. Chlorhexidine mouthwash (10ml bd)
  2. Doxycycline (100mg od)
  3. Pentoxifylline (400mg bd)
  4. Tocopherol (1000 IU caps / 1000mg susp)
17
Q

Describe local debridement as a management strategy for ORN

A
  • Removing dead bone so exposed bone is vital

- Bony sequestra to remove sharp pieces of bone at the surface

18
Q

Describe ultrasound therapy as a management strategy for ORN

A
  • Improves vascular supply to the area
  • Can only do when there is 0% chance of tumour being present as ultrasound therapy aids progression of tumour
  • Limited to patients over 2 years from surgery
19
Q

Describe HBOT as a management strategy for ORN

A
  • Increases oxygen delivered to the area

- Reduction in hypoxia and increase in angiogenesis

20
Q

Describe the action of the pharmacological agents which make up triple therapy treatment for ORN

A

Chlorhexidine - Antibacterial to prevent infection
Doxycycline - Anti fibrolytic and has high bone penetration properties
Pentoxifylline - Anti inflammatory
Tocopherol - Anti oxidant so removes free radicals causing ORN

21
Q

Describe the key points in prevention of ORN

A
  • Extract teeth with poor prognosis prior to radiotherapy (at least 2 weeks before)
  • Ensure dentures fit well
  • Avoid need for further extractions (check ups, OHI etc)
22
Q

Describe the key points for GDPs with regards to prevention of ORN

A
  • Very difficult to treat so prevention most important
  • Highest risk post radiotherapy, then decreased slightly and as patient gets older, risk increases again
  • Patient has big part to play with tooth brushing and cleaning (OHI)
  • Dietary advice as taste will change due to reduced salivary flow so patients opt for higher sugar and salt content foods as they taste these better

OSOMOP (14 decks)

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