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Osteonecrosis in patients previously radiated for head and neck cancer.

Posted Dec 30 2009 9:23pm

I have been asked to estimate the probability of osteonecrosis without hyperbaric oxygen treatment in a previosuly radiated patient for head and neck cancer.

Osteonecrosis is rare in patients who receive less than 60 gray (Gy) radiation therapy. Patients with ORN who receive less than 60 Gy and more than 50 Gy have been reported, but these cases are extremely rare. The overall incidence of ORN has decreased over the last 3 decades. In general, studies from prior to the 1970s showed an ORN incidence from 5.4-11.8%. More recent studies, however, have placed the incidence closer to 3.0%. The true frequency of ORN is impossible to determine because no mechanism exists for reporting the disease.

There are no randimized studies that indicate that prophylactic hyperbaric oxugen HBO reduces ONR in the setting of implants.

1.Wahl MJ. Osteoradionecrosis prevention myths. Int J Radiat Oncol Biol Phys. Mar 1 2006;64(3):661-9.

2.Coulthard, P, Esposito, M, Worthington, HV, Jokstad, A
Therapeutic use of hyperbaric oxygen for irradiated dental implant patients: a systematic review
J Dent Educ. 2003 67: 64-68

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