Risk factors for pathological fracture in patients with mandibular osteoradionecrosis.
Journal
Scientific reports
ISSN: 2045-2322
Titre abrégé: Sci Rep
Pays: England
ID NLM: 101563288
Informations de publication
Date de publication:
01 04 2023
01 04 2023
Historique:
received:
10
10
2022
accepted:
28
02
2023
medline:
4
4
2023
entrez:
3
4
2023
pubmed:
4
4
2023
Statut:
epublish
Résumé
Osteoradionecrosis (ORN) often results in pathological fractures through progression. We aimed to identify the risk factors for pathological fracture in patients with mandibular ORN. Seventy-four patients with mandibular ORN were included in this retrospective study. We investigated various risk factors for pathological fracture in patients with mandibular ORN, including number of mandibular teeth with a poor prognosis each at initial evaluation before radiation therapy (RT) and when fracture occurred, and the proportion of antibiotic administration period in a follow-up duration after RT. The rate of occurrence of pathological fractures in patients with mandibular ORN was 25.7%. The median of duration between RT completion and fracture occurrence was 74.0 months. We found that pathological fracture was significantly associated with a larger number of mandibular teeth with a poor prognosis at initial evaluation before RT (P = 0.024) and when fracture occurred (P = 0.009). Especially, a larger number of mandibular teeth with P4 periodontitis, in other words severe periodontal status, was related to pathological fracture in both timings. The proportion of antibiotic administration period in a follow-up duration was also significant risk factor (P = 0.002). Multivariate analyses showed statistically significant associations between pathological fracture and a larger number of mandibular teeth with a poor prognosis when fracture occurred (hazard ratio 3.669). The patient with a larger number of mandibular teeth with P4 periodontitis may have a risk of not only occurrence of ORN but resulting in pathological fracture by accumulation of infection. Surgeons should consider extraction of those teeth regardless of before/after RT if necessary for infection control.
Identifiants
pubmed: 37005454
doi: 10.1038/s41598-023-30735-4
pii: 10.1038/s41598-023-30735-4
pmc: PMC10067852
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
5367Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2023. The Author(s).
Références
Golusinski, P. et al. De-escalation studies in HPV-positive oropharyngeal cancer: How should we proceed?. Oral Oncol. 123, 105620 (2021).
doi: 10.1016/j.oraloncology.2021.105620
pubmed: 34798575
Reuther, T. et al. Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients—A report of a thirty-year retrospective review. Int. J. Oral Maxillofac. Surg. 32, 289–295 (2003).
doi: 10.1054/ijom.2002.0332
pubmed: 12767877
Thorn, J. J. et al. Osteoradionecrosis of the jaws: Clinical characteristics and relation to the field of irradiation. J. Oral Maxillofac. Surg. 58, 1088–1093 (2000).
doi: 10.1053/joms.2000.9562
pubmed: 11021701
Willaert, R. et al. Does intensity-modulated radiation therapy lower the risk of osteoradionecrosis of the jaw? A long-term comparative analysis. Int. J. Oral Maxillofac. Surg. 48, 1387–1393 (2019).
doi: 10.1016/j.ijom.2019.04.018
pubmed: 31230773
NCCN Clinical Practice Guidelines in Oncology [NCCN guidelines]. Head and Neck Cancers Version 1. https://www.nccn.org/professionals/physician_gls/default.aspx#site . (2020).
Wang, T. H. et al. Risk factors for and the role of dental extractions in osteoradionecrosis of the jaws: A national-based cohort study. Head Neck. 39, 1313–1321 (2017).
doi: 10.1002/hed.24761
pubmed: 28370713
Chang, C. T. et al. Dental prophylaxis and osteoradionecrosis: A population-based study. J. Dent. Res. 96, 531–538 (2017).
doi: 10.1177/0022034516687282
pubmed: 28095728
Schuurhuis, J. M. et al. Patients with advanced periodontal disease before intensity-modulated radiation therapy are prone to develop bone healing problems: A 2-year prospective follow-up study. Support Care Cancer. 26, 1133–1142 (2018).
doi: 10.1007/s00520-017-3934-y
pubmed: 29090383
Beaumont, S. et al. Timing of dental extractions in patients undergoing radiotherapy and the incidence of osteoradionecrosis: A systematic review and meta-analysis. Br. J. Oral Maxillofac. Surg. 59, 511–523 (2021).
doi: 10.1016/j.bjoms.2020.10.006
pubmed: 33685773
Kubota, H. et al. Risk factors for osteoradionecrosis of the jaw in patients with head and neck squamous cell carcinoma. Radiat. Oncol. 16, 1 (2021).
doi: 10.1186/s13014-020-01701-5
pubmed: 33402192
pmcid: 7786900
Jiang, Y.-M. et al. Incidence of osteoradionecrosis in patients who have undergone dental extraction prior to radiotherapy: A systematic review and meta-analysis. J. Oral Maxillofac. Surg. Med. Pathol. 26, 269–275 (2014).
doi: 10.1016/j.ajoms.2014.03.010
Treister, N. S. et al. Exposed bone in patients with head and neck cancer treated with radiation therapy: An analysis of the observational study of dental outcomes in head and neck cancer patients (OraRad). Cancer 128, 487–496 (2021).
doi: 10.1002/cncr.33948
pubmed: 34665873
Muraki, Y. et al. Dental intervention against osteoradionecrosis of the jaws in irradiated patients with head and neck malignancy: A single-arm prospective study. Oral Maxillofac. Surg. 23, 297–305 (2019).
doi: 10.1007/s10006-019-00783-0
pubmed: 31172389
Wanifuchi, S. et al. Cause and occurrence timing of osteoradionecrosis of the jaw: A retrospective study focusing on prophylactic tooth extraction. Oral Maxillofac. Surg. 20, 337–342 (2016).
doi: 10.1007/s10006-016-0570-5
pubmed: 27401528
Hiraoka, Y. et al. Association between pain severity and clinicohistopathologic findings in the mandibular canal and inferior alveolar nerve of patients with advanced mandibular osteoradionecrosis. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 126, 264–271 (2018).
doi: 10.1016/j.oooo.2018.03.017
pubmed: 29776771
Mayland, E. et al. Impact of preoperative and intraoperative management on outcomes in osteoradionecrosis requiring free flap reconstruction. Head Neck. 44, 698–709 (2022).
doi: 10.1002/hed.26957
pubmed: 34918862
Tso, T. V. et al. Predictive factors of osteoradionecrosis necessitating segmental mandibulectomy—A descriptive study. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 2022(134), e8–e13 (2021).
Sathasivam, H. P. et al. Predictive factors for osteoradionecrosis of the jaws: A retrospective study. Head Neck. 40, 46–54 (2018).
doi: 10.1002/hed.24907
pubmed: 29149496
Zhu, Y. et al. Bacterial spectrum analysis and antimicrobial susceptibility study of osteoradionecrosis of the jaw in Southern China. Oral Dis. 2022(28), 2015–2025 (2021).
Takeda, D. et al. Bacterial colonization of the condyle in patients with advanced mandibular osteoradionecrosis: Analysis of hemimandibulectomy specimens. Int. J. Dent. 22, 9998397 (2021).
Sugimoto, K. et al. Osteoradionecrosis of the jaw caused by periapical periodontitis: A case report. J. Oral Maxillofac. Surg. 29, 328–333 (2017).
Huang, Y. F. et al. The association between dental therapy timelines and osteoradionecrosis: A nationwide population-based cohort study. Clin. Oral. Investig. 24, 455–463 (2020).
doi: 10.1007/s00784-019-02866-4
pubmed: 31111283
Owosho, A. A. et al. The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensity-modulated radiation therapy (IMRT): The Memorial Sloan Kettering Cancer Center experience. Oral Oncol. 64, 44–51 (2017).
doi: 10.1016/j.oraloncology.2016.11.015
pubmed: 28024723
Kojima, Y. et al. Risk factors for osteoradionecrosis of the jaw in patients with oral or oropharyngeal cancer: Verification of the effect of tooth extraction before radiotherapy using propensity score matching analysis. J. Dent. Sci. 17, 1024–1029 (2022).
doi: 10.1016/j.jds.2021.10.019
pubmed: 35756814
Koga, D. H. et al. Dental extractions related to head and neck radiotherapy: ten-year experience of a single institution. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. Endod. 105, 1–6 (2008).
doi: 10.1016/j.tripleo.2008.01.007
Watson, E. et al. Clinical practice guidelines for dental management prior to radiation for head and neck cancer. Oral Oncol. 123, 105604 (2021).
doi: 10.1016/j.oraloncology.2021.105604
pubmed: 34775180
Beech, N. et al. Oral Surg. Oral Med. Oral Pathol. Oral Radiol. 122, 672–679 (2016).
doi: 10.1016/j.oooo.2016.07.020
pubmed: 27727106
Coletti, D. et al. Treatment rationale for pathological fractures of the mandible: A series of 44 fractures. Int. J. Oral Maxillofac. Surg. 37, 215–222 (2008).
doi: 10.1016/j.ijom.2007.09.176
pubmed: 18023145
Wahl, M. J. Osteoradionecrosis prevention myths. Int. J. Radiat. Oncol. Biol. Phys. 64, 661–669 (2006).
doi: 10.1016/j.ijrobp.2005.10.021
pubmed: 16458773
Choi, B. J. et al. Aneurysmal bone cyst causing a pathologic fracture of the mandibular condyle. J. Oral Maxillofac. Surg. 69, 2995–3000 (2011).
doi: 10.1016/j.joms.2010.10.058
pubmed: 21444139
Ueda, N. et al. Oral risk factors associated with medication-related osteonecrosis of the jaw in patients with cancer. J. Bone Miner. Metab. 39, 623–630 (2021).
doi: 10.1007/s00774-020-01195-x
pubmed: 33420576