Systematic management of osteoradionecrosis in the head and neck

Objectives: Osteoradionecrosis is one of the most serious and devastating c omplications of radiotherapy. The proper management of osteoradionecrosis i s currently undetermined. The objective of this study is to evaluate the tr eatment results of a systematic approach to osteoradionecrosis. Study Desig n: A prospective study of a systematic approach to osteoradionecrosis in th e head and neck area was undertaken. Methods: From July 1993 to June 1998, 33 cases of osteoradionecrosis in the head and neck area were treated using a systematic approach that combined sequestrectomy and hyperbaric oxygen t herapy. Results: Seven (21%) had recurrent cancer. The control rate of the other 26 osteoradionecrosis cases was 77% (20/26). Conclusions: Persistent osteoradionecrosis, despite diligent radical treatment, raises the suspicio n of recurrent cancer. Extensive osteoradionecrosis with a multiple dischar ging fistula, a large area of exposed necrotic bone, or a coexistent fractu re should be treated primarily with radical sequestrectomy and microvascula r free flap reconstruction. Surgery still plays a major role in controlling osteoradionecrosis, and hyperbaric oxygen therapy is adjuvant.