Late Oesteoradionecrosis of Mandible Five Years after Radiotherapy for Carcinoma Base of Tongue

Abstract

Introduction

Osteoradionecrosis (ORN) is a process where irradiated bone undergoes necrosis and becomes exposed through soft-tissue. It is a late effect of radiotherapy. Early presentation within 2 years, is thought to be related to high dose of Radiation therapy, whereas late presentation is usually secondary to trauma and delayed wound healing with in compromised tissue.

We present a case of late presentation where there was no history of trauma to the associated region; therefore making the case unique.

Case report                                             

50 years old male patient from rural Bengal presented with history of invasive squamous cell carcinoma (SCC) of right base tongue with bilateral cervical nodal metastasis treated with external beam radiotherapy of 70 Gy in 35 fractions in 2009. In April 2014 he developed pain in the right side of lower jaw with foul breath and progressive difficulty and pain while opening mouth. Biopsy established the diagnosis of oesteoradionecrosis.

Discussion

ORN can be spontaneous, but most commonly results from tissue injury. The absence of reserve reparative capacity is a result of the prior radiation injury. The irradiated mandible, periosteum, and overlying soft tissue undergo hyperemia, inflammation, and endarteritis.

Conclusion

During follow up any lesion suspicious of recurrence or second malignancy with clinical features of pain, swelling, trismus, halitosis, mucosal ulceration, bare bone etc a differential diagnosis of oesteoradionecrosis should be kept in mind, even long time after radiotherapy & absence of trauma.