Analysis of surgical margins in cases of mandibular osteoradionecrosis that progress despite extensive mandible resection and free tissue transfer

• Published in: American journal of otolaryngology Vol. 33; no. 5; pp. 576 - 580
• Main Authors: Zaghi, Soroush, MD, Miller, Mia, MD, Blackwell, Keith, MD, Palla, Beth, MD, Lai, Chi, MD, Nabili, Vishad, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2012; Elsevier; Elsevier Limited
• Subjects: Biological and medical sciences; Cranial Irradiation - adverse effects; Diseases of the osteoarticular system; Follow-Up Studies; Free Tissue Flaps; Head and Neck Neoplasms - radiotherapy; Humans; Mandible - surgery; Mandibular Diseases - diagnosis; Mandibular Diseases - etiology; Mandibular Diseases - surgery; Mandibular Reconstruction - methods; Medical sciences; Osteoradionecrosis - diagnosis; Osteoradionecrosis - etiology; Osteoradionecrosis - surgery; Otolaryngology; Otorhinolaryngology. Stomatology; Retrospective Studies; Surgery; Treatment Outcome; Vascular bone diseases; Mandible; Treatment; Surgery; Diseases of the osteoarticular system; Free flap; Surgical resection; Surgical margin; ENT; Osteonecrosis; Radiotherapy
• ISSN: 0196-0709; 1532-818X
• DOI: 10.1016/j.amjoto.2012.03.001

Abstract Introduction Approximately 1 of 4 patients with osteoradionecrosis (ORN) of the mandible develop ongoing disease despite extensive mandible resection to margins determined by the presence of bleeding bone at the time of surgery. Objective To determine whether pathologic examination of bony margins in assessing for the presence of necrotic edges is correlated with ongoing ORN. Methods Resected mandible specimens from 34 patients with severe mandibular ORN were examined histologically for the presence of necrotic margins and compared with clinical outcome of ORN persistence at follow-up. Results Median follow-up was 17.4 months. Eight specimens had histologic evidence of necrotic, nonviable bone at the margins of resections; however, there was no progression of disease among patients in this group. Twenty-six specimens were clear of necrotic margins; however, 8 patients from this group developed persistent disease. Conclusions Irradiated mandible is susceptible to ORN progression even if clinical and final histopathologic assessments confirm complete resection of necrotic bone margins. Progression of disease in ORN is not related to inadequate resection of necrotic bone.