Mandibular Osteoradionecrosis

 

 
   Patient was treated at Alaska 
   Regional Hospital Comprehensive  
   Wound  Healing Center which was
   affiliated with  Praxis Clinical
   Services.

 
Mandibular
Osteoradionecrosis
Center for Wound Healing
and Hyperbaric Medicine
240 Williamson Street, Suite 104 - Elizabeth, NJ 07207
(908) 994-5480
PATIENT:
74 year old male
HISTORY:
A 74-year-old male presents to the Comprehensive Wound Healing Center with osteoradionecrosis of the mandible. The patient is status post squamous cell carcinoma of the gum and right mandible. Subsequently, the patient underwent a course of Radiation Therapy and was followed by an Ear, Nose and Throat surgeon, who performed a resection of the carcinoma and a lingual flap in October 1999. The graft provided partial coverage with an area of exposed bone remaining. The patient was then referred for HBO therapy. Other past medical history includes: two pack per day smoker, and alcohol abuse.
CLINICAL CHALLENGE:
Physical evaluation revealed:
- General right angle mandible pain with increased severe pain on palpitation.
- Small areas of exposed bone visible on right mandible with white exudate.
COMPREHENSIVE WOUND HEALING CENTER MANAGEMENT:
11/10/99 HBO therapy initiated in conjunction with oral antibiotics.
12/03/99 Status post 10 HBO treatments. Patient reports less pain, with areas of exposed bone decreased by approximately 50%, white exudate is also decreased.
12/29/99 Status post 30 HBO treatments, the exposed bone is soft and development of granulation tissue in gums surrounding the exposed bone is present.
01/07/00 Exposed bone curetted by ENT, HBO therapy continued.
01/24/00 Finished 40 HBO treatments per protocol. Area of exposed bone is still visible but decreased in size since initiation of HBO treatments. Granulation surrounding area continues.
02/03/00 Areas of exposed bone curetted in ENT office. Continuing frequent follow-ups and conservative management. Patient pain free at this time.
RESULTS:
03/16/00 To date follow-up at Comprehensive Wound Healing Center noted an area of exposed bone markedly decreased and absence of pain at this time. Continues to follow-up with ENT for intermittent bone debridement and in the CWHC for progress reports.

Referral Information
Patients should be referred to the Center for Wound Healing and Hyperbaric Medicine at Trinitas Hospital for aggressive, outcome based wound management. Our center is designed to compliment the attending physician’s services by providing expert wound management consultation and care including the application of advanced wound care technology and hyperbaric oxygen treatment as indicated based on a comprehensive system of evidence based clinical practice guidelines. The referring physician will continue to treat comorbid conditions and provide for the patient’s overall medical care. Hyperbaric oxygen treatment is available specifically for the treatment of soft tissue radionecrosis, osteoradionecrosis, osteomyelitis, clostridial myonecrosis and other necrotizing soft tissue infections, compromised skin grafts and flaps, crush injuries and other acute traumatic ischemias, and diabetic wounds of the lower extremities. All etiologies of wound healing failure are accepted for evaluation and care.

Types of wounds treated include Diabetic, Venous Stasis, Ischemic, Pressure, Traumatic, Surgical and other wounds that resist healing.
Problem wound patients should be referred to the Center when:
The wound has failed to show significant progress in 4 weeks of standard care
When the wound involves deep tissue structures or is limb or life threatening
When the wound is complicated by significant comorbidities including peripheral
    vascular disease, persistent edema, persistent infection, prior radiation treatment
   to the area, or compromised immune status of the patient

To refer a patient, please call (908) 994-5480 or visit us at www.trinitashospital.com


 
 

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