Journal of Prevention and Treatment for Stomatological Diseases ›› 2019, Vol. 27 ›› Issue (7): 409-416.doi: 10.12016/j.issn.2096-1456.2019.07.001

• Expert Forum • Previous Articles     Next Articles

Difficulties and prevention and management of serious complications in surgical treatment of osteoradionecrosis of jaw

HOU Jinsong(),ZHANG Yadong   

  1. Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
  • Received:2019-01-02 Revised:2019-03-06 Online:2019-07-20 Published:2019-07-24
  • Contact: Jinsong HOU E-mail:houjs@mail.sysu.edu.cn

Abstract:

Osteoradionecrosis of the jaw (ORNJ) is a common complication after radiotherapy for head and neck malignant tumors. Surgery is the main treatment method for ORNJ with large lesions. In the case of serious maxillofacial and cervical soft and hard tissue damage caused by radiation, surgical treatment may have some difficulties and risks. In this paper, we discuss the main points for indication selection and treatment as well as surgical difficulties and their causes, including local inflammation and radiation injury during the operation, timing of bone defect reconstruction, condylar preservation, selection of recipient vessels, implant bed treatment, common complications of ORNJ operations (i.e., wound healing and nerve injury), severe complications (i.e., vascular crisis and tissue flap necrosis), pulmonary infection, cerebral pulmonary embolism, important vascular rupture, and severe psychological trauma, including its prevention and treatment. This information will enable clinicians to fully understand the various difficulties and risks that may be encountered during the ORNJ operation and will minimize serious complications, ensure the life, health and safety of the patients, and provide a reference for improvement of the clinical efficacy of ORNJ treatment.

Key words: osteoradionecrosis of the jaw, reconstruction of bone defect, vascularized fibular myocutaneous flap, microsurgery, CAD/CAM, soft tissue fibrosis, condyle, complications

CLC Number: 

  • R78

Figure 1

Mandibular fracture after marginal resection for osteoradionecrosis of the left mandible"

Figure 2

Mandibular deviation and facial appearance change after segmental resection of the right mandible"

Figure 3

Inflammation in soft tissue and a fistula in the patient with osteoradionecrosis of the jaw"

Figure 4

Reconstruction of a titanium plate and pectoralis major flap for the repair of jaw and soft tissue defects after osteoradionecrosis of the jaw"

Figure 5

CAD/CAM assisted fibula myocutaneous flap transplantation for right mandibular defect reconstruction after osteoradionecrosis of the jaw"

Figure 6

Poor wound healing after ORNJ vascularized free flap repair"

Figure 7

The venous stapler was discharged and the flap survived well after ORNJ vascularized free flap repair"

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