Advanced osteoradionecrosis of the maxilla: a 15-year, single-institution experience of surgical management

Abstract

Background

Osteoradionecrosis (ORN) of the maxilla is a rare disease. In contrast with a mandibular predominance, maxillary ORN has not been widely reported.

Objective

To review clinical features, surgical treatments, and results of maxillary ORN and offer recommendations for surgical decision-making.

Material and methods

We retrospectively reviewed medical records of maxillary ORN at our hospital between 2002 and 2017. Clinical data were collected, including age, sex, primary tumor characteristics, radiotherapy dose, clinical findings of maxillary ORN, and treatment outcomes. Descriptive statistics and multiple factors were analyzed.

Results

Twenty-four patients were included for analysis. The primary symptoms of maxillary ORN were pain, trismus, pus, bone exposure, and skin fistula. Twenty (83.3%) patients were completely cured after single-operation. Thirteen patients underwent sequestrectomy, and the cure rate was 76.9% (10/13). Eleven patients received segmental osteotomy and flap reconstruction, with the cure rate of 90.9% (10/11). There was no significant statistical difference in the cure rate between these two groups (p = .596).

Conclusions and significance

Compared with mandibular ORN, the surgical effect of maxillary lesions is better and the choice of operation methods can be relatively conservative. Both sequestrectomy and segmental osteotomy with flap reconstruction can achieve good results in appropriate conditions.

Chinese abstract

背景：上颌骨放射性骨坏死（ORN）是一种罕见的疾病。与多见的下颌ORN相反, 上颌ORN尚未得到广泛报道。

目的：回顾上颌ORN的临床特征、手术治疗和结果, 并为手术决策提供建议。

材料和方法：我们回顾性分析了本院在2002年至2017年期间的上颌ORN记录, 收集了临床数据, 包括年龄、性别、原发性肿瘤特征、放射治疗剂量、上颌ORN的临床表现以及治疗效果。分析了描述性统计数据和多个因素。

结果：对二十四例患者进行了分析。上颌ORN的主要症状分别是疼痛、三头肌、脓液、骨骼暴露和皮肤瘘。 20名（83.3％）患者单次手术完全治愈。 13例患者进行了脊柱切除术, 治愈率为76.9％（10/13）。 11例患者接受了节段截骨术和皮瓣再造, 治愈率为90.9％（10/11）。两组的隔离手术在治愈率上没有显著的统计学差异（p¼.596）。

结论与意义：与下颌ORN相比, 上颌骨病变的手术效果明显更好, 其操作方法的选择可以相对保守。在适当的条件下, 隔离手术和再造皮瓣节段截骨术都可以取得良好的效果。

Keywords:

• Osteoradionecrosis of maxilla
• surgical treatments
• sequestrectomy
• vascular flap reconstruction
• prognosis

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was supported by The National Key Research and Development Program of China [grants No. 2016YFC1102902], Bejing Municiple Development Foundation [grants No. Z161100000516016].