POSTRADIATION OSTEONECROSIS OF THE MANDIBLE - A LONG-TERM FOLLOW-UP-STUDY

Objectives. The objective of this study was to assess the long-term pr ogress of 26 patients who experienced postradiation osteonecrosis of t he jaw between 1975 and 1989. Study design. Of 26 patients who had bee n previously managed with hyperbaric oxygen therapy as a part of their treatment for postradiation osteonecrosis of the jaw, 20 were evaluat ed to determine their current status of the condition: resolved, chron ic persisting (unresolved), or active progressive (symptomatic). Resul ts. Two of 20 patients experienced recurrences of the condition. In on e of these patients, surgical treatment was identified as the stimulus of postradiation osteonecrosis. In the other patient, the recurrence appeared to be related to periodontal disease activity. In 60% (12 of 20) of the patients, the condition remained resolved, improvement in c linical staging occurred in 10% (2 of 20) (from symptomatic to unresol ved or resolved), and 20% (5 of 20) of the patients continued to demon strate chronic persisting postradiation osteonecrosis at the end of th e long-term follow-up period. Conclusion. This study supports the cont ention that postradiation osteonecrosis can occur at any time after ra diation therapy, and that patients remain at risk up to 231 months aft er treatment of the cancer and probably indefinitely after radiation t herapy. Our findings also suggest that risk of second episodes of the condition after management of an initial episode is low. In addition, our follow-up study revealed that chronic nonprogressive postradiation osteonecrosis can remain stable without extensive intervention includ ing combined hyperbaric oxygen therapy and surgery.