• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.7.1-7.7
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• 2015

Background: Osteoradionecrosis is a delayed complication from radiation therapy which causes chronic pain, infection and constant deformity after necrosis. Most of the osteoradionecrosis occurs spontaneously or after the primary oncologic surgery, dental extraction or by trauma of prosthesis. The treatment of osteoradionecrosis relies on both conservative measures and surgical measures. The fibular osteocutaneous free flap has become more popular choice for reconstruction of maxillofacial defects as a treatment of osteoradionecrosis. Methods: We presented our experiences from 7 patients with osteoradionecrosis who have had reconstruction surgery with fibular osteocutaneous free flap at National Cancer Center during the recent 5 years. We performed segmental mandibular resection with fibular osteocutaneous free flap for all 7 patients of advanced osteoradionecrosis who were not controlled by conservative treatment such as wound irrigation, debridement, and antibiotics. Results: A wide range of techniques were available for the reconstruction of composite defects resulted from the treatment of advanced mandibular osteoradionecrosis. Significant improvement was noted in relieving pain and treating trismus after the surgery however difficulty in swallowing and xerostomia showed less improvement. Conclusions: We concluded that fibular osteocutaneous free flap can be performed safely in patients with osteoradionecrosis and yields positive outcomes with significantly increased success rate. The fibular osteocutaneous free flap was our preferred choice for the mandibular reconstruction due to its versatility and predictability.

• Imaging Science in Dentistry
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• v.31 no.1
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• pp.57-65
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• 2001

Osteoradionecrosis is one of the most serious complication after heavy irradiation of bone and most particularly following treatment of cancers within the head and neck. The irradiated bone has the decreased vascularity and is easily infected. As a result, the spread of infection may cause a nonhealing wound that is very difficult to be treated. A comprehensive prophylactic dental care as well as proper blocking of the radiation field before radiotherapy must be considered to reduce the risk of osteoradionecrosis. We present three cases of osteoradionecrosis which developed after extraction of teeth in irradiated patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.32 no.3
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• pp.265-269
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• 2010

Radiation therapy for malignancy of head and neck leads to secondary effects, such as mucositis, xerostomia, dental caries and osteoradionecrosis. Osteoradionecrosis is a delayed complication which causes chronic pain, infection and constant deformity after necrosis. It occurs spontaneously or after primary oncologic surgery, dental extraction or by trauma of prosthesis. To reduce the incidence of osteoradionecrosis, appropriate antibiotic usage, atraumic procedure, tension-free primary suture and hyperbaric oxygen therapy are essential. This case is about a 74 years old woman who was treated for osteoradionecrosis after extraction of right lower molar at year 2006. She had received radiation therapy for angiosarcoma on tongue at year 2004. At year 2008 the patient came to our hospital for extraction of the opposite premolar but despite careful treatment, osteoradionecrosis occurred again. She was successfully treated by surgical procedure so we report this case.

• Archives of Plastic Surgery
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• v.35 no.2
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• pp.174-180
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• 2008

Purpose: While radiotherapy remains an essential part of the multidisciplinary treatment of cancers, it may cause unwanted consequences such as tissue break down and chronic non-healing wounds as a result of hypoxia, hypovascularity, and hypocellularity. The conservative treatment of osteoradionecrosis was effective only in the early stages or has a limited result. The surgical treatment of osteoradionecrosis includes various local fasciocutaneous flaps, local myocutaneous flaps and different kinds of free flaps with cancellous bone graft or alloplastic material after removal of all devitalized tissue. This study reviews recent cases of osteoradionecrosis in Severance hospital and investigates the use of various flaps for reconstruction of osteoradionecrosis. Methods: From 2000 to 2006, a total of 29 patients, nine men and twenty women with a mean age of 60.4 years were identified and included in the study. Fasciocutaneous flaps were used on 7 patients and myocutaneous flaps were used on the remaining patients. Mean follow-up period was 10.4 months. Results: In the fasciocutaneous flap group, we noted two complications including total flap failure and a partial flap necrosis. In the myocutaneous flap group, four complications were noted including a partial flap necrosis and 3 cases of wound dehiscence. Considering the complications noted in this study, the natural history of progression to flap necrosis appeared to follow the following sequence of events: marginal flap necrosis, infection, wound dehiscence, flap floating and partial flap necrosis, serially. Conclusion: Successful surgical treatment of osteoradionecrosis includes wide radical debridement and reconstruction with a well vascularized flap like myocutaneous flap or fasciocutaneous flap.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.3
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• pp.208-210
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• 2020

Recently, after reviewing the online journal, Journal of the Korean Association of Oral and Maxillofacial Surgeons, we found a recently published original article by Manzano et al., entitled, "Retrospective study of osteoradionecrosis in the jaws of patients with head and neck cancer". Although this original article was well written and provided a great deal of information regarding osteoradionecrosis in the jaws, we would like to add a few additional recommendations based on our small concerns and recently updated articles.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.32 no.5
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• pp.458-463
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• 2006

The osteoradionecrosis of the mandible can be a serious complication of radiotherapy for malignancies of the head and neck. The cause and pathogenesis of osteoradionecrosis are unclear and anecdotal. There are various treatment-, patient- and tumor-related risk factors on development of osteoradionecrosis. The treatment of osteoradionecrosis relies on conservative measures (antibiotics, debridement, irrigation and HBO) and surgical measures (sequestrectomy, marginal resection and segmental resection with or without reconstruction). But the indications are not defined. We present the two cases of patients who were not controlled by conservative treatment but good-resulted by surgical treatment.

• Journal of the Korean Society of Radiology
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• v.16 no.6
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• pp.799-805
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• 2022

Radiation therapy of human tissues, including bone tissue, is accompanied by side effects on normal tissues. It has a more lethal effect on stem cells, which play an essential role in tissue regeneration, including the basal cells constituting the tissue. In this study, the mouse parietal model, which implemented an artificial osteoradionecrosis model on the parietal region of the mouse, was artificially defected and then the bone regeneration was tested. In order to overcome the implemented osteoradionecrosis, a fibrin scaffold, widely used as a biomaterial, and stromal cell-derived factor-1 (SDF-1), which is used as a long-term treatment for damaged, were mixed to verify the osteoradionecrosis regeneration effect on the parietal of mouse. In order to expect a synergistic effect in the fibrin scaffolds, a fibrin scaffolds was prepared after maintaining the concentration of SDF-1 (1 ㎍/ml) in the fibrinogen solution. In this study, after artificially creating a osteoradionecrosis model in the parietal region of mouse, fibrin scaffolds were incorporated to analyze the effect of bone regeneration within 4 weeks, the initial stage of bone regeneration. In conclusion, the combined use of these two substances did not show a dramatic regenerative effect in inducing the regeneration of osteoradionecrosis in the parietal region of mouse. However, positive results were obtained that can be maintain the bone regeneration effect environment at the initial stage. Therefore, the combined use of the fibrin scaffold and SDF-1 is considered to be a suitable candidate for the effect of overcoming osteoradionecrosis.

• Korean Journal of Head & Neck Oncology
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• v.27 no.1
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• pp.66-69
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• 2011

Skull base osteoradionecrosis(ORN)is a rare complication of radiotherapy for nasopharyngeal carcinoma, but is one of the most severe and possibly fatal condition followed by radiotherapy. However, the treatment of skull base ORN has seldom been thoroughly described yet. Here we report a case of skull base ORN that was successfully treated with hyperbaric oxygen therapy(HBO). A 52-year-old man visited our department complaining of trismus and foul odor. He was diagnosed with nasopharyngeal cancer with multiple lymph node metastasis one year ago and underwent concurrent chemoradiotherapy. On the physical examination, mucopus and crusts with exposed necrotic bone was seen in the right nasopharynx. On the paranasal sinus magnetic resonance imaging, osteoradionecrosis which was extending from the right nasopharynx to the clivus, petrous apex, and cavernous sinus was noted. Nasopharynx biopsy resulted of ulcer with no malignant cells. HBO therapy was performed with debridement of nasopharynx for 3 months. There was no sign of recurrence or residual ORN 18 months after HBO therapy.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.2
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• pp.150-154
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• 2020

We present a case of osteoradionecrosis treated with leukocyte- and platelet-rich fibrin (LPRF) and surgery and followed up with clinical and tomographic investigations. A 65-year-old woman presented with pain in the posterior region of the right palate. Her medical history included cardiovascular disease and squamous cell carcinoma in the anterior region of the floor of the mouth that had been treated with intensity-modulated radiation therapy. Measurements of isodose curves showed a full dosage of 6,462.6 cGy in the anterior mandibular region, whereas that in the posterior region on the right side of the maxilla reached 5,708.1 cGy. Osteotomy was performed using rotary instruments, and debridement and placement of two LPRF membranes were also carried out. New gum tissue with no bone exposure was noted 14 days postoperatively. Tissue repair was complete, and the patient had no further complaints. During a 39-month follow-up period, the oral mucosa remained intact, and the patient was rehabilitated with a new upper denture. Since there is no consensus regarding the best protocol to treat osteoradionecrosis, LPRF might be an interesting adjuvant to a surgical approach. The use of LPRF is simple and reduces operational costs, time of handling, probability of technical failure, and associated morbidities for patients with osteoradionecrosis.

• Journal of the Korean Society of Radiology
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• v.15 no.4
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• pp.539-545
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• 2021

Radiation therapy is accompanied by adverse radiation effective. In particular, it is accompanied by disorders of the vascular system. Therefore, oxygen and nutrient deficiency occurs in the regeneration area. Eventually, osteoradionecrosis is formed in this cellular environment. According to a precedent study, bone morphogenetic protein-2 is used to overcome osteoradionecrosis. The purpose of this study was to investigate the regeneration ability of osteoradionecrosis by treating bone-forming protein-2 on a fibrinogen scaffold which is a biomaterial that is frequently used for bone regeneration after irradiation of the rat head. In addition, the purpose of this study was to verify the bone regeneration effect from the eight weeks. According to the experimental results, in the calvarial defected model of the irradiated mouse, making bone-formation was obtained after 8 weeks rather than bone-formation period in the early 4 weeks. moreover, it was found that the regenerated bone formation of the fibrinogen scaffold is formed from the inside of the bone of the defect area.