Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 May 28;22(1):213.
doi: 10.1186/s12903-022-02244-9.

Progression and postoperative complications of osteoradionecrosis of the jaw: a 20-year retrospective study of 124 non-nasopharyngeal cancer cases and meta-analysis

Ziqin Kang #  1 , Tingting Jin #  2 , Xueer Li  3 , Yuepeng Wang  1 , Tianshu Xu  1 , Yan Wang  1 , Zixian Huang  4 , Zhiquan Huang  5
Affiliations
Meta-Analysis

Progression and postoperative complications of osteoradionecrosis of the jaw: a 20-year retrospective study of 124 non-nasopharyngeal cancer cases and meta-analysis

Ziqin Kang et al. BMC Oral Health. .

Abstract

Background: To assess the contributing risk factors for the progression of, and the postoperative poor prognosis associated with, osteoradionecrosis of jaw (ORNJ) following non-nasopharyngeal cancer treatment in head and neck.

Methods: A retrospective study of 124 non-nasopharyngeal carcinoma patients in head and neck treated at one institution between 2001 and 2020 was conducted. A cumulative meta-analysis was conducted according to PRISMA protocol and the electronic search was performed on the following search engines: PubMed, Embase, and Web of Science. After assessing surgery with jaw lesions as a risk factor for the occurrence of ORNJ, 124 cases were categorized into two groups according to the "BS" classification, after which jaw lesions, chemotherapy, flap reconstruction and onset time of ORNJ were analyzed through the chi-square test and t-test to demonstrate the potential association between them and the progression of ORNJ. Postoperative outcomes of wound healing, occlusal disorders, and nerve injury were statistically analyzed.

Results: With the statistically significant results of the meta-analysis (odds ratio = 3.07, 95% CI: 1.84-5.13, p < 0.0001), the chi-square test and t-test were used to validate our hypotheses and identified that surgery with jaw lesions could aggravate the progression and accelerate the appearance of ORNJ. Patients who underwent chemotherapy tended to suffer from severe-to-advanced osteonecrosis but did not shorten the onset time of ORNJ. Flap reconstruction presented obvious advantages in wound healing (p < 0.001) and disordered occlusion (p < 0.005). The mean onset time of ORNJ in non-nasopharyngeal cancer patients (4.5 years) was less than that in patients with nasopharyngeal cancer (NPC) (6.8 years).

Conclusions: Iatrogenic jaw lesions are evaluated as a significant risk factor in the occurrence and progression of ORNJ in non-nasopharyngeal carcinoma patients who tend to have more severe and earlier osteonecrosis after radiotherapy than NPC patients. Flap reconstruction is a better choice for protecting the remaining bone tissue and reducing postoperative complications of ORNJ.

Keywords: Chemotherapy; Flap reconstruction; Head and neck cancer; Meta-analysis; Non-nasopharyngeal cancer; Osteoradionecrosis of the jaw; Postoperative complication.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
The screening process was conducted according to the PRISMA flow-diagram. Ten articles were finally included in the meta-analysis
Fig. 2
Fig. 2
The forest plot graph shows the OD of risk of developing ORNJ in irradiated patients undergoing surgery with jaw lesions. Abbreviations: CI, Confidence Interval; I2, Higgins’ Hindex; IV, Inverse Variance
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Lajolo C, Rupe C, Gioco G, Troiano G, Patini R, Petruzzi M, Micciche’ F, Giuliani M. Osteoradionecrosis of the jaws due to teeth extractions during and after radiotherapy: a systematic review. Cancers. 2021;13(22):5798. doi: 10.3390/cancers13225798. - DOI - PMC - PubMed
    1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424. doi: 10.3322/caac.21492. - DOI - PubMed
    1. Bourhis J, Montay-Gruel P, Gonçalves Jorge P, Bailat C, Petit B, Ollivier J, Jeanneret-Sozzi W, Ozsahin M, Bochud F, Moeckli R, Germond JF, Vozenin MC. Clinical translation of FLASH radiotherapy: why and how? Radiother Oncol. 2019;139:11–17. doi: 10.1016/j.radonc.2019.04.008. - DOI - PubMed
    1. Marx RE. Osteoradionecrosis: a new concept of its pathophysiology. J Oral Maxillofac Surg. 1983;41(5):283–288. doi: 10.1016/0278-2391(83)90294-X. - DOI - PubMed
    1. Støre G, Boysen M. Mandibular osteoradionecrosis: clinical behaviour and diagnostic aspects. Clin Otolaryngol Allied Sci. 2000;25(5):378–384. doi: 10.1046/j.1365-2273.2000.00367.x. - DOI - PubMed

Publication types