Difficulties and prevention and management of serious complications in surgical treatment of osteoradionecro⁃ sis of jaw

Abstract

Osteoradionecrosis of the jaw (ORNJ) is a common complication after radiotherapy for head and neck ma⁃lignant tumors. Surgery is the main treatment method for ORNJ with large lesions. In the case of serious maxillofacial and cervical soft and hard tissue damage caused by radiation, surgical treatment may have some difficulties and risks. In this paper, we discuss the main points for indication selection and treatment as well as surgical difficulties and their causes, including local inflammation and radiation injury during the operation, timing of bone defect reconstruction, con⁃ dylar preservation, selection of recipient vessels, implant bed treatment, common complications of ORNJ operations (i.e., wound healing and nerve injury), severe complications (i.e., vascular crisis and tissue flap necrosis), pulmonary infec⁃ tion, cerebral pulmonary embolism, important vascular rupture, and severe psychological trauma, including its preven⁃ tion and treatment. This information will enable clinicians to fully understand the various difficulties and risks that may be encountered during the ORNJ operation and will minimize serious complications, ensure the life, health and safety of the patients, and provide a reference for improvement of the clinical efficacy of ORNJ treatment.

Keywords

• osteoradionecrosis of the jaw
• reconstruction of bone defect
• vascularized fibular myocutaneous flap
• microsurgery
• CAD/CAM
• soft tissue fibrosis
• condyle
• complications