Jaw infection after radiotherapy

 

What is osteoradionecrosis?

Osteoradionecrosis (ORN) is a problem with bone healing that can occur in
 people who received high doses of radiation, particularly to the jaw. This
 complication can occur after dental surgery or extraction of teeth. High doses
 of radiation can decrease the bone’s blood supply. If this happens, the bone 
gets less oxygen than it needs, resulting in the death (necrosis) of bone
 tissue.The most commonly affected bone is the jawbone (mandible).

 

Who is at risk for osteoradionecrosis?

Survivors who received high doses of radiation to the jaw area are at risk for
 this complication.

Radiation fields that often include the jawbone are as
 follows:

  • Cranial (head/brain)
  • Nasopharyngeal (area above the roof of the mouth)
  • Oropharyngeal (mouth and throat)
  • Neck or spine (“cervical” portion)
  • Supraclavicular (area above the collarbones)
  • Mantle or mini-mantle (neck/underarm/chest areas)
  • It is important to obtain your medical records so that you know exactly how 
much radiation you received and where the radiation was directed.

 

When does osteoradionecrosis occur?

Although it is uncommon, ORN most often occurs when a survivor
 undergoes a dental procedure (such as pulling of tooth) or other surgery 
involving the jaw bone.

 

What are the symptoms of osteoradionecrosis?

Symptoms of ORN may occur months to years after radiation.

Common 
symptoms include mouth pain, jaw swelling and difficulty opening the
 mouth fully (trismus).

 

How is osteoradionecrosis diagnosed?

ORN can be diagnosed by physical examination, imaging studies (x-ray,
CT scan and/or MRI) and a sample of tissue
(biopsy) of the problem area in order to make a definite diagnosis.

Radiation
therapy records should be reviewed to determine the location and dose o f
radiation that was given.

 

How is osteoradionecrosis treated?

Treatment of ORN is mainly through control of uncomfortable symptoms.
 Salt-water rinses and light scrubbing of affected tissues may be helpful.
 Antibiotics may help if a wound becomes infected.

In the most severe cases free tissue transfer can be used to replace necrotic tissue with new tissue. If you have had radiotherapy treatment in the past involving the
 jaw bone you should:

Tell your dentist that you have received radiation treatment. Your dentist will then be able
to get details about the radiation treatment before doing any tooth
extractions that could lead to ORN.
Have regular dental care checkups and take good care of your teeth and gums, since
 the risk for cavities is higher in people who received large doses of
radiation. The dentist may order daily fluoride treatments (Duraphat) to reduce the
 risk of cavities and the need for extracting teeth in the future.

Frequently there is not enough room to accommodate wisdom teeth and as such they do not come into the mouth normally. When this happens, the wisdom teeth are said to be “impacted”. Wisdom teeth are usually either impacted forwards into the tooth in front or backwards into the jaw bone.

Outline of The Surgical Procedure
  • The necrotic hard and/or soft tissues are removed.
  • Microvascular surgery can be used to replace the defect with new tissue.