Treatment of mandibular osteoradionecrosis by cancellous bone grafting

Purpose: This study was undertaken to evaluate a new method in the treatmen t of mandibular osteoradionecrosis. Patients and Methods: Eight patients, seven male and one female, with a mea n age of 64 years (range, 43 to 67 years), suffering from osteoradionecrosi s of the mandible, two bilaterally and six unilaterally, were treated. Five initially had hyperbaric oxygen (HBO) followed by sequestrectomy, and thre e had sequestrectomy alone. Because healing failed to occur, all patients w ere treated by removal of the necrotic bone in the affected part of the man dible and filling the defect with compressed particulated cancellous bone a nd marrow from the tibia. The patients were observed for an average period of 39 months (range, 20 to 93 months). Results: Primary healing was achieved in two patients with unilateral osteo radionecrosis and HBO treatment. In another patient treated with HBO primar y healing occurred on one side while the other healed secondarily. In the r emaining five patients, complete secondary healing took place, but it was c omplicated in three patients by fistulas, two of which were associated with fractures of the mandibular body. The fistulas were excised, and complete healing of the soft tissues occurred, but the fractures resulted in pseudar throsis. Conclusions: The technique presented in this study can be useful in the tre atment of osteoradionecrosis as an alternative to continuity resection and reconstruction with free osteocutaneous flaps, but, whenever possible, it s hould be proceeded by HBO treatment.