Question: In a patient with osteoradionecrosis, what medical management options have been shown to be of some benefit? [Answer will be posted with next week's new question]
Answer to last week's question, Bad To The Bone (August 31, 2015):
There are many classification systems. These are some of the more commonly referenced. The case patient's stage is indicated in bold for each of the systems below:
Marx Classification (1983):
- Type I: Develops shortly after radiation, due to synergistic effects of surgical trauma and radiation injury.
- Type II: Develops years after radiation and follows a trauma. Generally >6 years after radiation. Due to progressive endarteritis and vascular effusion.
- Type III: Develops spontaneously without a preceding traumatic event. Usually between 6 months and 3 years after radiation. Due to immediate cellular damage and death due to radiation treatment.
Epstein Classification (1987)
- Stage I: Resolved/healed ORN. A) No pathologic fracture. B) Pathologic fracture
- Stage II: Chronic persistent and non-progressive ORN. A) No pathologic fracture, B) Pathologic fracture
- Stage III: Active progressive ORN: A) No pathologic fracture. B) Pathologic fracture.
Yamazaki Classification (2003)
- Grade I: ORN confined to the alveolar bone.
- Grade II: ORN limited to the alveolar bone and/or mandible above the level of the inferior alveolar canal.
- Grade III: ORN involving the mandible below the level of the inferior alveolar canal and ORN with a skin fistula and/or pathologic fracture.