Elsevier

Practical Radiation Oncology

Volume 12, Issue 2, March–April 2022, Pages 90-94
Practical Radiation Oncology

Morbidity and Mortality Conference
Osteoradionecrosis After Radiation to Reconstructed Mandible With Titanium Plate and Osseointegrated Dental Implants

https://doi.org/10.1016/j.prro.2021.10.007Get rights and content

Section snippets

Clinical Scenario

A 68-year-old man with no history of smoking and no notable comorbidities presented to the hospital with a newly diagnosed T4aN2aM0 oral mucosal squamous cell carcinoma (SCC) invading the periosteum and body of the left mandible. He subsequently underwent tracheostomy, radical resection, segmental mandibulectomy, selective neck dissection, and reconstruction with a 3-segment, double-barrel osteocutaneous free fibula flap with immediate placement of 3 osseointegrated dental implants for ease of

Evidence-Based Discussion

Mandibular reconstruction after head and neck cancer resection has successfully restored both form and function.1 As reported in this case, primary reconstruction of the mandible using a vascularized autologous fibular flap with titanium plate fixation is a technique considered the gold standard in mandibular reconstruction. Despite well-designed, preplanned free osteocutaneous flap reconstructions, the damage caused by subsequent ORN can significantly impair patient quality of life and

Management Summary

After conservative treatment was unsuccessful, the patient underwent debridement of the native mandible and fibula from the superior segment of the double-barrel construct. The injury location was directly in line with the maximum titanium plate burden area and the most mesial osseointegrated implant (Fig 3). Final pathology confirmed chronic osteomyelitis and ORN without evidence of tumor recurrence, and owing to persistent pain, difficulty eating, and continued bone exposure, the patient

Implications for Future Practice and Research

Our group's current hypothesis is that the increasing amount of high-Z hardware used in a modern approach to mandibular reconstruction may have a role in observed ORN rates in PORT after fibula flap reconstruction. In support of this notion, Catli8 showed increased backscatter among 4 different implant types (titanium alloy, titanium, crown, and amalgam), which increased the radiation dose in front of the implant while perturbing the dose, or creating a region of infratherapeutic dose, behind

First page preview

First page preview
Click to open first page preview

References (9)

There are more references available in the full text version of this article.

Cited by (0)

Presented at the Morbidity and Mortality Conference on 8 November 2020 at NYU Perlmutter Cancer Center.

Sources of support: This work had no specific funding.

Disclosures: none.

Research data are not available at this time.

1

D.J.B. and D.A.D. contributed equally to this work.

View full text