Mandible Fracture After Radiotherapy: Case Report

Year 2022, Volume: 8 Issue: 3, 476 - 480, 31.08.2022

Ferhat Ayrancı Hasan Akpınar

https://doi.org/10.19127/mbsjohs.1081469

Abstract

Oral cancers are among the most common types of cancer. Squamous cell carcinoma accounts for approximately %90 of oral cancers. The prognosis in oral squamous cell carcinomas differs depending on the treatment and the size of the lesion. Treatment options for squamous cell carcinomas include marginal resection, radiotherapy and chemotherapy. Although radiotherapy is an effective treatment option in head and neck cancers, it is known to cause some complications. Treatment options for squamous cell carcinomas include. In this case report, the complication of mandibular fracture seen after radiotherapy treatment is presented.
A 77-year-old female patient who was treated at the medical oncology clinic with the diagnosis of oral squamous cell carcinoma was referred to our clinic for pathological mandibular fracture and extraoral fistula caused by radiotherapy. As a result of intraoral examination, it was observed that the ramus was exposed due to pathological fracture in the right mandible corpus region. After the antimicrobial washing in the mouth, sequestrotomy was performed. Palliative treatment of the patient was performed, then the patient was followed up with telemedicine methods.
A detailed evaluation should be made before oral surgery in patients with a history of radiotherapy from the head and neck region. Precautions should be taken against the possible risk of osteoradionecrosis.

Keywords

Pathological fracture, radiotherapy, osteoradionecrosis

References

• 1. Massano J, Regateiro FS, Januário G, Ferreira A. Oral squamous cell carcinoma: review of prognostic and predictive factors. Oral surgery, oral medicine, oral pathology, oral radiology, and endodontology 2006; 102: 67-76.
• 2. Scully C, Field J, Tanzawa H. Genetic aberrations in oral or head and neck squamous cell carcinoma (SCCHN): 1. Carcinogen metabolism, DNA repair and cell cycle control. Oral oncology 2000; 36: 256-263.
• 3. Scully C, Bagan J. Oral squamous cell carcinoma: overview of current understanding of aetiopathogenesis and clinical implications. Oral diseases 2009; 15: 388-399.
• 4. Feller L, Lemmer J. Oral squamous cell carcinoma: epidemiology, clinical presentation and treatment. 2012.
• 5. Sundermann BV, Uhlmann L, Hoffmann J, Freier K, Thiele OC. The localization and risk factors of squamous cell carcinoma in the oral cavity: a retrospective study of 1501 cases. Journal of Cranio-Maxillofacial Surgery 2018; 46: 177-182.
• 6. Shah JP, Gil Z. Current concepts in management of oral cancer–surgery. Oral oncology 2009; 45: 394-401.
• 7. Gassner R. Complications from Radiotherapy, Complications in Cranio-Maxillofacial and Oral Surgery: Springer, 2020: 295-307.
• 8. Chronopoulos A, Zarra T, Ehrenfeld M, Otto S. Osteoradionecrosis of the jaws: definition, epidemiology, staging and clinical and radiological findings. A concise review. International dental journal 2018; 68: 22-30.
• 9. Nadella KR, Kodali RM, Guttikonda LK, Jonnalagadda A. Osteoradionecrosis of the jaws: clinico-therapeutic management: a literature review and update. Journal of maxillofacial and oral surgery 2015; 14: 891-901.
• 10. Lambade PN, Lambade D, Goel M. Osteoradionecrosis of the mandible: a review. Oral and maxillofacial surgery 2013; 17: 243-249.
• 11. Epstein JB, Wong FL, Stevenson-Moore P. Osteoradionecrosis: clinical experience and a proposal for classification. Journal of oral and maxillofacial surgery 1987; 45: 104-110.
• 12. Marx RE. Osteoradionecrosis: a new concept of its pathophysiology. Journal of oral and maxillofacial surgery 1983; 41: 283-288.
• 13. Pandey R, Gupta R, Bhagat N, Tripathi S. Pathological fracture of mandible due to osteoradionecrosis. Universal Research Journal of Dentistry 2016; 6: 246-246.
• 14. Monnier Y, Broome M, Betz M, Bouferrache K, Ozsahin M, Jaques B. Mandibular osteoradionecrosis in squamous cell carcinoma of the oral cavity and oropharynx: incidence and risk factors. Otolaryngology--Head and Neck Surgery 2011; 144: 726-732.
• 15. Kabir R, Durand R, Roberge D, Dufresne E, Nguyen-Tân PF, Schmittbuhl M. Incidence of osteoradionecrosis of the jaws: A retrospective study of 620 head and neck cancer patients treated by radiotherapy. 2020.
• 16. Chang DT, Sandow PR, Morris CG, Hollander R, Scarborough BS, Amdur RJ, et al. Do pre‐irradiation dental extractions reduce the risk of osteoradionecrosis of the mandible? Head & Neck: Journal for the Sciences and Specialties of the Head and Neck 2007; 29: 528-536.
• 17. Abed H, Burke M, Scambler S, Scott SE. Denture use and osteoradionecrosis following radiotherapy for head and neck cancer: A systematic review. Gerodontology 2020; 37: 102-109.
• 18. Notani Ki, Yamazaki Y, Kitada H, Sakakibara N, Fukuda H, Omori K, et al. Management of mandibular osteoradionecrosis corresponding to the severity of osteoradionecrosis and the method of radiotherapy. Head & Neck: Journal for the Sciences and Specialties of the Head and Neck 2003; 25: 181-186.
• 19. Rice N, Polyzois I, Ekanayake K, Omer O, Stassen LF. The management of osteoradionecrosis of the jaws–a review. the surgeon 2015; 13: 101-109.
• 20. Anisuzzaman M, Khan S, Kamrujjaman M, Abdullah M. Pathological fracture of mandible due to oral squamous cell carcinoma: A Clinical Notes.
• 21. Floriano TF, Heguedusch D, Pareja GN, Oliveira SV, Domaneschi C, de Barros Gallo C. Dental management in palliative care of a patient with advanced oral cancer: A case report. Journal of Oral Diagnosis 2021; 6: 1-6.