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Decodificación de la osteorradionecrosis de la mandíbula: Progresión radiológica y un nuevo sistema de calificación
Vasundhara Patil1, Pritesh Shah1, Abhishek Mahajan2,3
1Department of Radiodiagnosis, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai 400012, India.
Cancers
|January 28, 2026
Resumen
La osteorradionecrosis (ORN) de la mandíbula progresa de forma predecible en las tomografías computarizadas, desde la reabsorción hasta la fragmentación. Un nuevo sistema de calificación basado en TC ayuda al diagnóstico temprano de esta complicación de la radioterapia.
Área de la Ciencia:
- Radiología
- Oncología
- Cirugía Oral y Maxilofacial
Sus antecedentes:
- La osteorradionecrosis (ORN) de la mandíbula es una complicación grave tras la radioterapia para el cáncer de cabeza y cuello.
- Los hallazgos de imagen de la ORN pueden simular osteomielitis o recurrencia tumoral, complicando el diagnóstico.
- Los sistemas de calificación actuales carecen de especificidad para la progresión de la ORN.
Objetivo del estudio:
- Analizar las características de imagen y la progresión de la osteorradionecrosis (ORN) de la mandíbula.
- Proponer un nuevo sistema de calificación basado en Tomografía Computarizada (TC) para la ORN.
- Basarse en los criterios existentes de ClinRAD para mejorar la evaluación de la ORN.
Principales métodos:
- Estudio de cohorte retrospectivo de 35 pacientes con ORN confirmada por biopsia o diagnosticada clínicamente.
- Evaluación de imágenes iniciales y de seguimiento para evaluar la evolución radiológica.
- Análisis estadístico de los hallazgos de la TC y comparación con la literatura.
Principales resultados:
- La aparición media de ORN fue de 27-28 meses post-radioterapia; los síntomas comunes incluyeron úlceras, dolor y senos paranasales.
- La afectación mandibular fue predominante (51%), con alteraciones óseas focales.
- Los hallazgos de la TC mostraron reabsorción progresiva, erosión, esclerosis y fragmentación, con un 92% mostrando un aumento de la fragmentación y la esclerosis en el seguimiento.
Conclusiones:
- La osteorradionecrosis (ORN) de la mandíbula demuestra una progresión radiológica predecible.
- El sistema de calificación propuesto basado en TC ofrece un enfoque estructurado para el diagnóstico temprano de la ORN.
- Se necesita más investigación con estudios de imagen más amplios para validar el sistema de calificación y refinar los criterios diagnósticos.
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