Radiation-induced osteonecrosis of the jaw

Radiation therapy is one of the important methods in cancer treatment, especially for carcinomas of the head, face and neck, which are less susceptible to chemotherapy effects. However, besides the advantages in cancer treatment, patients also need to pay attention to the complications of radiation therapy, including radiation-induced bone necrosis.

In the process of cancer treatment, chemotherapy and radiation are two methods used very commonly. Both cause some serious side effects to the patient's body.
Chemotherapy is a method of causing systemic effects because drugs are injected directly into the blood vessels, causing relatively similar side effects with all types of cancer. Meanwhile, radiation therapy is a method of using high-energy rays (X-rays, Gamma rays, protons, etc.) to act directly on a diseased area, so the side effects will still depend on the cancer patient's location. which area.

Radiation therapy has two main roles in cancer treatment:
Cure: Radiation therapy can be used alone or in combination with other methods to destroy and stop the spread of tumors, help shrink the tumor to perform surgery. Symptomatic relief: For large and metastatic tumors, radiation therapy will help reduce the destructive ability of the tumor, reduce pain and improve the quality of life for cancer patients.

Besides the positive role in cancer treatment, radiation therapy can also bring unwanted side effects.
With its own anatomical and physiological characteristics (thin head, face, neck area, many soft tissues, delicate structure, important functions, easy to damage and difficult to recover...), the cancer treatment with Radiation in the head and neck area is still risky.
Due to the influence of radiation, some areas of the face are mildly hypoplastic, skin burns, subcutaneous tissues and nearby organs are darkened, atrophied, purulent inflammation, boils ... severe. then it hardens the soft tissues causing squeezing the neck area, widening pulse, big tongue.
Some cases have more serious complications when the wound caused by the irradiated area does not heal but continues to spread, leading to radiation-induced bone necrosis. Manifestation of complications is the necrosis of facial soft tissue (eg: orbital skin, cheekbones, cheekbones and bones of orbital wall, nasal bone)... leading to infectious purulent fistula ( necrotizing fistula).

When complications due to radiation, blood vessels often atrophy, so the blood supply to the damaged area is limited, leading to a difficult wound to heal. Depending on the extent of the damage, the treatment will go through different stages.
To treat bone necrosis caused by radiation, doctors need to remove all necrotic tissues (may include bone, soft part of the cheekbone, eye socket, side wall of the nose, etc.). .v), release scar tissue, clean up dead bone, clean the wound, then cover the necrotic area with flaps of free skin or flaps with raised legs to restore organizational defects.
For patients with mandibular necrosis, it is necessary to dredge the surrounding necrotic area and reshape the damaged part, so that the patient can stop the pain and regain a normal appearance to return to life.

Most of the patients come to the clinic with a very severe level of damage: the wounds are inflamed, the necrosis is widespread, the stench is not only in the soft part but also in the bone, causing damage to the functions of the organs. organs and facial deformities. Complications of bone necrosis caused by radiation also cause pain, suffering, and loss of confidence in communication.
Therefore, doctors recommend that patients should go to the doctor and perform early treatment if complications of radiation therapy are detected. Small, necrotic sores can be easily treated if you act early. When the necrosis has spread and into the bone, the treatment will be even more difficult, in fact, in many cases, it is necessary to have plastic surgery 2-3 times to get a positive face.
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