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156:Osteoradionecrosis Of Jaw Following Proton Beam Radiation Therapy In A Case Of Oropharyngeal Cancer[AAOM2021]
EP36072
Poster Title: 156:Osteoradionecrosis Of Jaw Following Proton Beam Radiation Therapy In A Case Of Oropharyngeal Cancer[AAOM2021]
Submitted on 29 Mar 2021
Author(s): Annu Singh, Dennis Shem, Andrew Pischek, SaeHee K Yom, Joseph D Randazzo, Joseph Huryn, Cherry L Estilo
Affiliations: Memorial Sloan Kettering Cancer Center, New York, United States of America
This poster was presented at 2021 American Academy of Oral Medicine Virtual Conference
Poster Views: 338
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Poster Information
Abstract: Background: Osteoradionecrosis of jaw (ORN) is a known complication of head and neck radiation therapy (RT). The prevalence of ORN has declined, thanks to the evolution of RT modalities from 2-dimensional RT to 3-dimensional conformal RT to intensity-modulated radiation therapy to proton beam therapy (PBT) which has demonstrated further decrease in the radiation induced toxicities due to the dosimetry advantage over photon therapy. We present an unusual case of spontaneous ORN in oropharyngeal cancer patient treated with PBT and its conservative management.

Case Summary: A 56-year-old male with HPV positive SCC left base of tongue (stage cT1N2bM0) underwent PBT to a total dose of 70Gy in 35 fractions (Relative Biological Equivalent 1.1) with concurrent chemotherapy. Seven months following completion of RT, patient reported to the dental service at MSKCC with a 2-month history of pain on left side of mandible. Intraoral examination revealed exposed bone measuring 1.5cm x 1cm in size involving the lingual surface of the mandibular alveolar ridge along with a Grade II mobility and tenderness on percussion on tooth#18. CT neck showed mixed sclerotic and lucent changes in the posterior left mandible near the angle, corresponding to clinical diagnosis of ORN. FDG-PET scan revealed a prominent standardized uptake values of 7.4 and a focal hypermetabolic activity in the left floor of mouth along the lingual gingiva of posterior left mandible. The patient was prescribed amoxicillin/clavulanic acid 875mg twice daily for 14 days and chlorhexidine rinse 0.12%. On 8-month follow-up visit, bony sequestrum was noted to be mobile and sharp causing traumatic ulceration on the left lateral border of tongue. Panoramic radiograph showed progression of bone loss around tooth#18 with Grade III furcation involvement. The mobile bony sequestrum was removed gently with a pair of forceps and patient was prescibed pentoxifylline 400mg twice daily and Vitamin E 400IU twice daily for 3 months and continued upto 12 months. At the patient’s follow-up visit 22 months following initial visit, complete healing was noted with healthy-appearing mucosa and no evidence of exposed bone.

Conclusion: To our knowledge, this is the first ever reported case of PBT-associated ORN that resolved with conservative management.
Summary: We present an unusual case of spontaneous ORN in oropharyngeal cancer patient treated with PBT and its conservative management.

Ask the author questions about this poster:singhA8@mskcc.org
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