Osteoradionecrosis is an unfortunate complication of the radiation therapy used to treat cancers of the head and neck.
Radiation is an effective means of killing rapidly-dividing cancer cells. Radiation therapy can also kill healthy cells, however. In doing so, radiation therapy can damage vascular structures that support healthy bone.
Radiation therapy is an important part of any post-ablative course of treatment. It has helped hundreds of thousands of men and women beat cancer. For those few who suffer from osteoradionecrosis, however, there will be additional challenges.
There is hope for relief, however.
For patients in New Orleans and in Mississippi and Louisiana, NOLA Craniofacial offers composite reconstruction of jaw using state-of-the art microsurgical techniques. Indeed, Dr. Hugo St. Hilaire has co-authored several papers on his pioneering work on behalf of patients who suffer from osteoradionecrosis.
Complications of Osteoradionecrosis
Osteoradionecrosis is a chronic effect of radiation therapy. The disease is progressive, and a patient might experience symptoms only many years after post-ablative treatments have been completed.
Radiation therapy commonly causes bone death in mandible, or lower jaw, which does not have the vascularity that is present in the upper jaw and other bones of the face. That vascularity supplies blood, which carries healing factors necessary for healthy bone to repair itself. When radiation affects the soft tissue of the jaw, however, the bone may have trouble responding to damage from radiation, for instance.
The bone dies over time, causing pain and compromising additional soft tissue as it progresses.
Conservative Therapies for Osteoradionecrosis
Thanks to improvements in irradiation techniques and protocols, the incidence of craniofacial ostroradionecrosis has declined.
That is the good news.
Unfortunately for sufferers of osteoradionecrosis, the price of victory can be years of pain and submission to a regime of conservative therapies that offer little comfort. The first step is debridement – the process of removing dead tissue – followed with systemic antibiotics that have side effects of their own. In more recent years, hyperbaric oxygen therapy has been effective in alleviating some suffering.
With that said, advanced or intractable craniofacial osteoradionecrosis has always been a challenging and costly problem.
That is where the creativity of plastic surgeons like Dr. Hugo St. Hilaire is making a difference.
Composite Reconstruction following Osteoradionecrosis
Dr. Hugo St. Hilaire of New Orleans, Louisiana is one of a select few craniofacial plastic surgeons who are using microsurgical techniques in composite reconstruction of the jaw.
Here in New Orleans, we are able to replace diseased bone and soft tissue with healthy tissue from remote parts of the body. The process is complicated, but safe, cost-effective, and restores healthy tissue in those areas compromised by osteoradionecrosis.
We call this meticulous procedure “free flap” microsurgery. The process involves the transfer of healthy skin and bone — with all of its nourishing vascularity — from one site where it is not needed to another where it can aid in healing. In reconstructing the jaw, the “donor” site is typically the fibula, a non-weight bearing bone in the lower leg. For cosmetic purposes, we often borrow a second flap of skin from the outer or inner thigh, which allows for an inconspicuous scar.
Virtual Surgical Planning® and patient-specific implants have offered additional reconstructive options, improving the quality of outcomes and reducing postsurgical complications.