Expert consensus statement on diagnosis and clinical management of osteoradionecrosis of mandible

doi:10.19438/j.cjoms.2017.05.015

China Journal of Oral and Maxillofacial Surgery ›› 2017, Vol. 15 ›› Issue (5): 445-456.doi: 10.19438/j.cjoms.2017.05.015

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Expert consensus statement on diagnosis and clinical management of osteoradionecrosis of mandible

HE Yue¹, HOU Jin-song², LI Xiao-guang¹, MA Chun-yue¹, PENG Xin³, WANG Hui-ming⁴, WANG Song-ling⁵, LIU Lei⁶, LIU Bing⁷, TIAN Lei⁸, LIU Zhong-long¹, LIU Xi-qiang², XU Xin⁹, ZHANG Dong-sheng¹0, JIANG Can-hua¹¹, WANG Jun¹², YAO Yuan¹³, ZHU Guo-pei¹³, BAI Yong-rui¹⁴, WANG Sheng-zi¹⁵, SUN Chang-fu¹⁶, LI Jin-song¹⁷, HE San-gang⁷, WANG Cheng², Nabil Samman¹⁸, SUN Jian¹, ZHANG Chen-ping¹, ZHANG Zhi-yuan¹, QIU Wei-liu¹.

1.Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011;
2.Department of Oral ａｎｄ　Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat -sen University. Guangzhou 510055;
3.Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology. Beijing 100081;
4.Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University of Medicine, School of Stomatology, Zhejiang University. Hangzhou 310006, Zhejiang Province;
5. Department of Oral and Maxillofacial Surgery, Capital Medical University. Beijing 100050;
6.Department　of Oral and Maxillofacial Surgery, West China Hospital of Stomatology. Chengdu 610041, Sichuan Province;
7.Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Wuhan University. Wuhan 430070, Hubei Province;
8.Department of Oral and Maxillofacial Surgery, The Fourth Military Medical University Hospital of Stomatology. Xi'an 710032, Shaanxi Province;
9. Department of Oral and Maxillofacial Surgery, The Second Affiliated Hospital of Zhejiang University of Medicine. Hangzhou 310009, Zhejiang Province;
10.Department of Oral and Maxillofacial Surgery, Shangdong Provincial Hospital. Jinan 250021, Shandong Province;
11.Department of Oral and Maxillofacial Surgery, Xiangya Hospital Central South University. Changsha 410008, Huｎａｎ Province;
12.Department of Head and Neck Oncology, Gansu Provincial Cancer Hospital. Lanzhou 730050, Gansu Province;
13.Department of Radiotherapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
14.Department of Radiotherapy, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200127;
15.Department of Radiotherapy, Eye and ENT Hospital of Fudan University. Shanghai 200000;
16.Department of Oromaxillofacial Head and Neck Surgery, School and Hospital of Stomatology, China Medical University. Shenyang 110002, Liaoning Province;
17.Department of Oral and Maxillofacial Surgery, Sun Yat -sen Memorial Hospital, Sun Yat-sen University. Guangzhou 510120, Guangdong Province;
18.Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong. Hong Kong 999077, China

Received:2017-06-20 Online:2017-08-30 Published:2017-10-27

Abstract

Abstract: Osteoradionecrosis (ORN) of mandible is one of the most devastating complications caused by radiation therapy in the head and neck region. It is characterized by infection and chronic necrosis of mandible as the main manifestation. Clinically, ORN of mandible related symptoms include swelling, pain, dysphagia, trismus, masticatory or speech disorder, refractory orocutaneous fistula, bone exposure, and even pathological fracture. ORN of mandible has become a challenging clinical problem for oral and maxillofacial surgeons to deal with. But so far, this problem has not been solved due to the lack of widely accepted treatment algorithms or guidelines. Since the nonexistence of standardized treatment criteria, most clinical treatment against ORN of mandible nowadays is largely based on controversial empirical understandings, while recommendations on post-therapeutic evaluations are scarce. Therefore, to further unify and standardize the standard of diagnosis and treatment of mandibular ORN, to decrease the huge waste of medical resources, and ultimately, to improve the wellbeing of the patients, the Chinese Society of Oral and Maxillofacial Surgery (CSOMS) convened an expert panel specialized in ORN of mandible from 17 famous domestic medical colleges and affiliated hospitals to discuss and formulate about the spectrum of diagnosis and treatment. In addition, consensus recommendations were also revised with a comprehensive literature review of the previous treatment experiences and research pearls. This "expert consensus statement on diagnosis and clinical management of osteoradionecrosis of mandible" is for clinical references.

Key words: Mandible, Osteoradionecrosis, Expert consensus

CLC Number:

R782

HE Yue, HOU Jin-song, LI Xiao-guang, MA Chun-yue, PENG Xin, WANG Hui-ming, WANG Song-ling, LIU Lei, LIU Bing, TIAN Lei, LIU Zhong-long, LIU Xi-qiang, XU Xin, ZHANG Dong-sheng0, JIANG Can-hua, WANG Jun, YAO Yuan, ZHU Guo-pei, BAI Yong-rui, WANG Sheng-zi, SUN Chang-fu, LI Jin-song, HE San-gang, WANG Cheng, Nabil Samman, SUN Jian, ZHANG Chen-ping, ZHANG Zhi-yuan, QIU Wei-liu.. Expert consensus statement on diagnosis and clinical management of osteoradionecrosis of mandible[J]. China Journal of Oral and Maxillofacial Surgery, 2017, 15(5): 445-456.

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Expert consensus statement on diagnosis and clinical management of osteoradionecrosis of mandible

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[6]	CHEN Chuan-jun, CHEN Wei-liang, SUN Chang-fu, HE Yue, JIANG Can-hua, PENG Xin, SHANG Zheng-jun, HAN Zheng-xue, LI Jin-song, HOU Jin-song, LIN Li-song, HAN Xin-guang, WEI Jian-hua, WANG Zhi-yong, WU Yu-nong, ZHENG Jia-wei, LI Long-jiang, WANG Hui-ming, LI Zu-bing, GUO Chuan-bin, YANG Chi, SHI Bing, ZHANG Zhi-yuan. Expert consensus on application of submental island flap in oromaxillofacial head and neck defect reconstruction [J]. China Journal of Oral and Maxillofacial Surgery, 2021, 19(5): 385-391.
[7]	XU Xiao-feng, ZHU Fang-xing, LIAO Qian, XU Bing, SHEN Guo-fang, ZHANG Wen-bin, SHI Jun. Evaluation of treatment results of 75 patients with comminuted mandibular fractures [J]. China Journal of Oral and Maxillofacial Surgery, 2021, 19(5): 456-459.
[8]	WANG Yi-zhou, CAI Man, SUN Li-fan, ZHU Qing-hai, HOU Chen-xing, HAN Wei, TANG Yu-ting, SUN Nan-nan, WANG Chen-xing, LI Huai-qi, YE Jin-hai. Preoperative finite element analysis of fibula myocutaneous flap for segmental mandibular reconstruction [J]. China Journal of Oral and Maxillofacial Surgery, 2021, 19(4): 325-331.
[9]	CHEN Fu-min, DAI Qing-gang, WU Chun-lan, WANG Yue-ping. Effect of soybean isoflavoneon on osteoclastic differentiation of mandible bone marrow-derived macrophages [J]. China Journal of Oral and Maxillofacial Surgery, 2021, 19(3): 197-200.
[10]	HE Jie, TIAN Zhuo-wei, HU Yong-jie, WANG Yan-an. Clinical analysis of intraosseous curettage combined with decompression in the treatment of mandibular solid ameloblastoma: report of 24 consecutive cases [J]. China Journal of Oral and Maxillofacial Surgery, 2021, 19(3): 258-261.
[11]	YANG Liu-di, HUANG Long, SU Tong. Oral prednisone for inflammatory myofibroblastic tumor in the mandible: a case report [J]. China Journal of Oral and Maxillofacial Surgery, 2020, 18(6): 574-576.
[12]	HE Yue, JIANG Can-hua, HOU Jin-song, WANG Hui-ming, PENG Xin, LIU Bing, LI Jin-song, ZHENG Lei, XU Zhong-fei, WU Yu-nong, HU Jing-zhou, QIN Xing-jun, AI Song-tao, ZHOU Hui-hong, LI Chun-jie, ZHANG Shi-zhou, WANG Jun, LI Xiao-guang, LIU Zhong-long, ZHU Feng-shuo. Expert consensus statement on application of perforator flap in oromaxillofacial head and neck defect reconstruction [J]. China Journal of Oral and Maxillofacial Surgery, 2020, 18(5): 385-389.
[13]	Professional Committee of Teeth and Alveolar Surgery, Chinese Stomatological Association. Chinese expert consensus on standardized operation process of autotransplantation of teeth [J]. China Journal of Oral and Maxillofacial Surgery, 2020, 18(5): 390-394.
[14]	LIN Zhao-yu, ZHOU Bin, CHEN Wei-liang, WANG Yan, CHEN Rui, ZHONG Jiang-long. Combined bilobed trapezius myocutaneous and scapula osteomyocutaneous flaps for reconstructing a through-and-through defect of the mandible following salvage surgery for recurrent head and neck tumors： report of 6 consecutive cases [J]. China Journal of Oral and Maxillofacial Surgery, 2020, 18(5): 447-450.
[15]	JU Hou-yu, ZHENG Jia-wei, SUN Mo-yi, TANG Zhan-gui, YANG Dao-ke, RAN Wei, BU Rong-fa, SHANG Wei, MENG Jian, WU He-ming, XI Qing, YANG Kai, WANG Jun, WU Yun-teng, REN Guo-xin, GUO Wei. Chinese expert consensus on ultrasound hyperthermia for oral and maxillofacial head and neck squamous cell carcinoma [J]. China Journal of Oral and Maxillofacial Surgery, 2020, 18(3): 193-198.