Longitudinal evaluation of health-related quality of life after osteoradionecrosis of the mandible

Abstract

There is a lack of longitudinal data on the effect of osteoradionecrosis (ORN) on health-related quality of life (HRQoL). We report data on HRQoL across groups of patients with ORN at different stages of disease and reconstruction. We identified 71 patients treated for ORN of the mandible, and cross-referenced the data with their medical records. They were divided into 4 groups according to the Notani classification and patients who did not have ORN were used for comparison. Patients with ORN reported the most pain, and rates were relatively high for problems concerning appearance, activity, recreation, swallowing, and chewing. There were significant differences for pain, appearance, swallowing, and chewing between patients who had ORN and those who did not and had not had radiotherapy. On the University of Washington quality of life questionnaire (UWQoL), patients with ORN reported similar levels of morbidity to those who had had radiotherapy but did not have ORN, particularly on the physical and social-emotional subscales. Those with grade III ORN were particularly affected, and the UWQoL scores after mandibular resection and reconstruction were disappointing. HRQoL after composite resection for Notani grade III disease is relatively poor. In patients whose symptoms can be managed without an operation, it seems appropriate to defer resection and reconstruction until there is an appreciable drop in the quality of life, and pain is difficult to control.

Keywords: Head and Neck Cancer; Osteoradionecrosis; Quality of life.; Questionnaires; Reconstruction; UW-QOL.