OBJECTIVES: This study was performed to investigate the effects of hyperbaric oxygen and other approaches for treating the osteoradionecrosis of the jaws (ORNJ) systematically. METHODS: According to the preset inclusion and exclusion criteria, randomized controlled trials and cohort studies on hyperbaric oxygen in the treatment of ORNJ were screened, and foreign language databases such as PubMed, EMBASE, and Cochrane library were searched via a computer; Chinese databases such as CNKI, VIP, Wanfang data, and CBM were searched from the established database to September 2020. Relevant books were searched manually to collect all literatures on the efficacy of hyperbaric oxygen and its related therapies in ORNJ treatment. Two researchers were independent and mutually blind, the papers were selected, data were collected, and the bias risk was evaluated. If any difference was detected, it would be decided by discussion or arbitrated by a third party. The data related to the efficacy of hyperbaric oxygen and its related therapy in the treatment of the ORNJ were extracted, and the Revman5.4 software was used for Meta-analysis. In case of large heterogeneity, sensitivity analysis was performed. A funnel chart was used to evaluate possible publication bias qualitatively. RESULTS: Four randomized controlled trials and seven cohort studies were included in Meta-analyses. In ORNJ treatment, no significant differences between the group subjected to hyperbaric oxygen and both surgery and antibiotics and the group that underwent both surgery and antibiotics (RR=1.16, 95%CI: 0.86~1.58, CONCLUSIONS Hyperbaric oxygen therapy cannot replace surgery and antibiotic therapy. Hyperbaric oxygen therapy is not superior to antibiotics and antifibrotic drugs, but the benefits of antifibrotic drugs should be further explored.
Humans ; Hyperbaric Oxygenation ; Jaw ; Osteoradionecrosis/therapy*

Animals ; Humans ; Hyperbaric Oxygenation ; Mandibular Diseases ; prevention & control ; therapy ; Osteoradionecrosis ; prevention & control ; therapy ; Radiation Injuries ; prevention & control ; therapy

PURPOSE: To evaluate the roles of conventional radiotherapy alone or with neoadjuvant chemotherapy for tonsillar carcinomas and any prognostic factors affecting survivals by retrospective analysis. MATERIALS AND METHODS: Thirty four patients received radical radiotherapy for tonsillar carcinomas from Nov. 1985 to Dec. 1993. Of them, 16 patients were treated by conventional radiotherapy alone and the other 18 patients were received radiotherapy with 1 to 3 cycles of neoadjuvant chemotherapy of cisplatin and 5-fluorouracil or pepleomycin. Radiotherapy was performed by 6MV X-ray with daily fraction of 1.8Gy and the range of primary tumor doses was 55.0-86.4Gy(median 66.6Gy), and that of clinically positive nodal doses was 55.8-90Gy(median 69.7Gy). RESULTS: Overall 5-year actuarial survival rate (5YSR) was 32%. The 5YSRs in stage I+II(n=8), III(n=13) and IV(n=13) were 47%, 29% and 25%, respectively(p=0.33). The 5YSRs in T2(n=13), T3(n=10) and T4 (n=7) were 38%, 27% and 0%, respectively and 3 of 4 patients of T1 are alive with NED at 25, 45, 53 months respectively with statistical significance of the trend in survivals among the four T-stages(p=0.01), and those of node negative(n=14) vs node positive patients(n=20) were 31% vs 32%, respectively(p=0.85). There was no significant survival difference between radiotherapy alone group and with neoadjuvant chemotherapy group(22% vs. 38%, p=0.24). The 5YSRs of 21 patients of primary tumor extension to adjacent sites and the other 13 patients of tonsillar proper site were 28% and 38%, respectively but the difference was not significant statistically(p=0.62). There was a statistically significant difference in 5YSRs between the groups of the patients who received radiotherapy in less than 61days vs more than 60days(60% vs. 18%, p=0.027). All living patients without any tumor progression(n=11) had suffered from serious late sequelae such as xerostomia, edentia, dental caries and one patient had the osteoradionecrosis of mandible. On univariate analysis, the duration of radiotherapy and T-stage were the significant prognostic factors affecting 5YSR. On multivariate analysis, also the duration of radiotherapy was the only significant prognostic factor(p=0.01). CONCLUSION: There was no survival difference between the radiotherapy alone and with neoadjuvant chemotherapy groups. Although it was a retrospective study, the role of conventional radiotherapy alone could be effective as the local treatment modality only for the early stage of tonsillar carcinomas. But for the purpose of more improved survivals and better quality of lives of living patients, other altered fractionation such as hyperfractionated radiotherapy with shorter treatment time and smaller fraction size rather than conventional radiotherapy might be beneficial and these prospective studies are needed.
Cisplatin ; Dental Caries ; Drug Therapy ; Fluorouracil ; Humans ; Mandible ; Multivariate Analysis ; Osteoradionecrosis ; Peplomycin ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Tonsillar Neoplasms ; Xerostomia

OBJECTIVETo investigate the treatment effect of mandibular osteoradionecrosis (ORN) by autologous bone marrow mesenchymal stem cells (BMMSC) in miniature pigs.

METHODSSix miniature pigs with mandibular ORN (25 Gy) were used. BMMSC were separated and cultured in vitro and then implanted on to the premolded hydroxyapatite-tricalcium phosphate (HA-TCP). The BMMSC-HA-TCP complexes were implanted into the defective area of mandibular ORN in 4 animals. Implantation of only HA-TCP in 2 animals served as control. Gross observation, spiral CT, coronary CT and histopathologic examination were carried out.

RESULTSFistula disappeared in animals with BMMSC-HA-TCP complexes 3 months after implantation, while fistula was found in controls. Spiral CT analysis showed that cortical bone repair were found 4 months after BMMSC-HA-TCP complexes implantation, while bone damage (cortical and cancellous bone fracture) increased in controls. Histopathologic examination revealed that 4 months later after BMMSC-HA-TCP complexes implantation, new bone formation and bone cells could be observed, but there was a large number of fibrous tissue and no new bone in controls.

CONCLUSIONSTransplantation of autologous BMMSC with HA-TCP may have therapeutic effect in the treatment of mandibular ORN.

Animals ; Bone Marrow Cells ; Calcium Phosphates ; therapeutic use ; Durapatite ; therapeutic use ; Mandibular Diseases ; therapy ; Mesenchymal Stem Cell Transplantation ; Osteoradionecrosis ; therapy ; Swine ; Swine, Miniature ; Transplantation, Autologous

OBJECTIVETo investigate the preventive effect of low-intensity ultrasound on osteoradionecrosis of jaws (ORNJ).

METHODSTwenty-five canines were randomly divided into experimental group (n=20) and control group (n=5). The canines in experimental group received radiation exposure, and then were randomly subdivided into group A (n=10) and group B (n=10). Control group did not undergo radiotherapy. One month after radiotherapy, the fourth mandibular premolars of all animals were extracted. Group B was immediately treated by low-intensity ultrasound for twenty days, group A and control group did not receive any treatment. Two months after tooth extraction, the formation of ORNJ was determined and the occurrence rate of ORNJ was compared between group A and B. The microstructure of the mandible and changes in microvascular density in group A and B were evaluated and compared with those of control group.

RESULTSAll animals in group B and group A developed ORNJ after prophylactic ultrasound was applied for twenty days. Although the imaging examination of bony density of group A and B were lower than normal animals in control group, bone density in group B was significantly better than group A. Micro-CT showed that the trabecular bone volume fraction, trabecular thickness, bone surface/bone volume and trabecular number in group B were respectively (0.187±0.029)%, (0.160±0.039) µm, (12.536±2.558)/mm, (1.227±0.192)/mm, which were all greater than group A [(0.103±0.014)%, (0.069±0.013) µm, (5.598±0.731)/mm, (0.522±0.064)/mm)] (P<0.05).

CONCLUSIONSAlthough the preventive application of low intensity ultrasound can not prevent the formation of ORNJ, but can significantly improve the symptoms of ORNJ.

Animals ; Bone Density ; radiation effects ; Dogs ; Jaw Diseases ; etiology ; prevention & control ; Mandible ; Osteoradionecrosis ; prevention & control ; Radiation Injuries, Experimental ; Random Allocation ; Tooth Extraction ; Ultrasonic Therapy ; methods ; X-Ray Microtomography