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Treatment of mandibular osteoradionecrosis by cancellous bone grafting
S Jisander1, B Grenthe, L Salemark
1Department of Oral and Maxillofacial Surgery, University Hospital, Lund, Sweden.
Purpose:
This study was undertaken to evaluate a new method in the treatment of mandibular osteoradionecrosis.
Patients And Methods:
Eight patients, seven male and one female, with a mean age of 64 years (range, 43 to 67 years), suffering from osteoradionecrosis of the mandible, two bilaterally and six unilaterally, were treated. Five initially had hyperbaric oxygen (HBO) followed by sequestrectomy, and three had sequestrectomy alone. Because healing failed to occur, all patients were treated by removal of the necrotic bone in the affected part of the mandible and filling the defect with compressed particulated cancellous bone and 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 osteoradionecrosis and HBO treatment. In another patient treated with HBO primary healing occurred on one side while the other healed secondarily. In the remaining five patients, complete secondary healing took place, but it was complicated 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 pseudarthrosis.
Conclusions:
The technique presented in this study can be useful in the treatment of osteoradionecrosis as an alternative to continuity resection and reconstruction with free osteocutaneous flaps, but, whenever possible, it should be proceeded by HBO treatment.