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. 2022 Jun;50(6):3000605221104186.
doi: 10.1177/03000605221104186.

Fluorescence-guided surgery for osteoradionecrosis of the jaw: a retrospective study

Suad Aljohani  1   2 , Riham Fliefel  2   3   4 , Teresa Franziska Brunner  2 , Aristeidis Chronopoulos  2 , Nada Binmadi  1 , Sven Otto  2
Affiliations

Fluorescence-guided surgery for osteoradionecrosis of the jaw: a retrospective study

Suad Aljohani et al. J Int Med Res. 2022 Jun.

Abstract

Objective: Osteoradionecrosis of the jaw (ORNJ) is one of the most severe head and neck complications in patients treated with radiotherapy. The goal of treatment is to suppress ORNJ progression. Currently, surgical removal of necrotic bone is an effective management approach for advanced stages. In this study, we present our experience in managing ORNJ using fluorescence-guided surgery.

Methods: Nineteen ORNJ lesions in 15 hospitalized patients were treated with fluorescence-guided surgery. We retrospectively reviewed patients' demographic data, comorbidities, local preceding event, location, ORNJ stage, and treatment outcomes with a median follow-up of 12 months.

Results: Twelve lesions (63%) were treated surgically under tetracycline fluorescence, and seven lesions (37%) were surgically treated under auto-fluorescence. Overall, four lesions (21%) achieved complete mucosal healing, eight lesions (42%) showed partial mucosal healing with bone exposure and no signs or symptoms of inflammation, and seven lesions (37%) were progressive. The results showed that either healing or ORNJ stabilization was achieved in 63% of lesions (n = 12).

Conclusion: Fluorescence-guided surgery can be beneficial in curing or stabilizing ORNJ. However, randomized clinical trials are needed to confirm these findings.

Keywords: Osteoradionecrosis; fluorescence-guided surgery; osteonecrosis of the jaw; osteoradionecrosis of the jaw; patient management; radiotherapy.

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Conflict of interest statement

Declaration of conflicting interest: All authors declare that there is no conflict of interest.

Figures

Figure 1.
Figure 1.
(a) A 63-year-old male patient presented with exposed necrotic bone in his left mandible. Medical history was significant for head and neck radiotherapy owing to pharyngeal carcinoma. (b) Intraoperative image after elevation of periosteal flap. (c) Fluorescence view before necrotic bone removal; dull green fluorescence evident at the area of necrosis. (d) and (e) After necrotic bone removal and smoothening of sharp bone edges; bright homogenous green-fluorescent bone was observed and (f) Intraoral image 6 months after surgery with complete mucosal healing.
See this image and copyright information in PMC

References

    1. Nabil S, Samman N. Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. Or Surg or Med or Pa 2012; 113: 54–69. - PubMed
    1. Reuther T, Schuster T, Mende U, et al.. 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 Max Surg 2003; 32: 289–295. - PubMed
    1. Bettoni J, Olivetto M, Duisit J, et al.. The value of reconstructive surgery in the management of refractory jaw osteoradionecrosis: a single-center 10-year experience. Int J Oral Maxillofac Surg 2019; 48: 1398–1404. - PubMed
    1. Rice N, Polyzois I, Ekanayake K, et al.. The management of osteoradionecrosis of the jaws–a review. Surgeon 2015; 13: 101–109. - PubMed
    1. Chrcanovic BR, Reher P, Sousa AA, et al.. Osteoradionecrosis of the jaws–a current overview–Part 2: dental management and therapeutic options for treatment. Oral Maxillofac Surg 2010; 14: 81–95. - PubMed

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