Osteoradionecrosis (ORN) is a serious side effect of head and neck cancer treatment. It causes bone that won’t heal and can lead to infections or fistulas in your mouth or jaw.
Many staging systems have been developed in order to classify and treat ORN. HBO therapy is effective in treating early stages of ORN. However, surgical treatment is required for patients with advanced mORN to prevent progression and complications.
Reconstruction
Reconstructive surgery is an important part of the treatment of head and neck cancers. In addition to restoring function, it also provides cosmetic benefits for the patient. However, the reconstruction of head and neck tumors is complex because of the extensive vascular supply of the affected tissues. In some cases, the vascular supply to the affected tissues may be compromised by the tumor itself or by radiotherapy. This problem can lead to complications such as osteoradionecrosis of the mandible.
Osteoradionecrosis of the mandible occurs in approximately 5% of patients who receive radiation therapy for head and neck cancer. The complication is associated with decreased quality of life and can affect mastication, speech, swallowing, and the ability to chew food. The condition is difficult to treat, and it can lead to recurrent infections and intractable pain. It is recommended to use conservative treatments such as antibiotics, debridement, and hyperbaric oxygen therapy before instituting surgical intervention.
The surgeon must deal with a hostile surgical environment characterized by scarring and fibrosis, which can lead to local infection or bacterial colonization. The surgeon must also manage complications such as recurrent or persistent wound infection, vascular failure, and delayed wound healing. The surgeon must also rely on vessels for anastomosis that are often already depleted due to previous neck dissection or radiation-related endothelial damage.
Using free fibula flaps to reconstruct the mandible in ORN and MRONJ cases is an effective technique that can be used in combination with other reconstructive techniques. The technique allows for restoration of the facial contour, preservation of masticatory function, and coverage of soft tissue defects. It also allows for the installation of dental implants and can be performed without affecting other vital structures. Postoperative wound infection can be managed by cultivating pus or blood from the infected area and consulting with the infectious medicine department.
Treatment Options
A variety of treatment options are available depending on the severity of the complication and patient history. Conservative management is reserved for asymptomatic and mildly symptomatic patients (Notani I or II) and involves close observation, saline irrigation and chlorhexidine mouth rinses, systemic antibiotic therapy for acute infections, avoidance of local irritants such as tobacco or alcohol use, discontinuation of ill-fitting dentures, dietary supplements including anti-fibrotic agents (pentoxifylline and tocopherol), and repositioning or removal of impacted teeth [48].
Progression of ORN is characterized by painful ulcerations of the mucous membrane with exposure of necrotic bone. These changes may be accompanied by ecchymoses, swelling, pain and difficulty of mastication. Affected patients may develop intra-or extraoral draining fistulae, frank open fracture and pathological lytic changes of the bone [49].
Surgical treatment is initiated with debridement, i.e., curettage and/or sequestrectomy and may be supplemented with composite fibular free flap reconstruction if sufficient vessels are available. The surgeon is faced with a hostile surgical environment consisting of scarring, fibrosis, bacterial colonization and possibly previous neck dissection wound infection. The availability of recipient vessels for anastomosis is compromised by the presence of these complications (4).
Orn Free Taa was a corpulent Rutian male senator who represented his homeworld of Ryloth in the Senates of the Galactic Republic and its successor state, the Empire. Although he was one of the Republic’s leading Loyalists, his selfish greed for personal gain and his relationship with Jabba the Hutt made him unpopular on his home planet, where he was widely considered corrupt.
Complications
The treatment of ORN is a multidisciplinary approach with input from radiation oncology, otolaryngology, oral and maxillofacial surgery, and infectious disease. A multidisciplinary approach is also important when assessing patients at risk for ORN and in planning their care. Infection control measures are essential, and patients should be educated on the importance of maintaining excellent oral hygiene and avoiding tobacco use to prevent complications.
In the majority of ORN cases, conservative management with antibiotics and recurrent rinsing is effective. However, severe ORN with cutaneous fistula formation, full-thickness bone involvement, and pathologic fractures require segmental resection and free flap reconstruction. This surgery is associated with substantial expense and prolonged hospital stays and carries a significant short- and long-term complication rate.
A corpulent male Rutian senator, Orn Free Taa represented Ryloth in both the Galactic Republic and its successor state, the Empire. Although he was disliked on his homeworld for enriching himself on Coruscant, Free Taa was one of the Loyalist senators who supported Supreme Chancellor Mas Amedda and Emperor Palpatine against Count Dooku’s separatist Confederacy of Independent Systems. His penchant for self-enrichment and his relationship with Jabba the Hutt made him a target of both the Imperial elite and the Separatists. He was ultimately forced to abandon his senatorial duties and return to Ryloth. His corruption and egotism led to his demise as he attempted to regain his former power base. Despite his failure to reclaim his seat in the Senate, Free Taa’s legacy lives on as a symbol of everything that was wrong with the corrupt and incompetent Republic.
Cost
The player can choose one of three starting classes for free: Mage, Warrior, or Thief. Adding additional starting classes will cost Orns. However, a character can switch to another class at any time for no extra cost.
Senator Orn Free Taa was a corpulent male Rutian Twi’lek who represented his homeworld of Ryloth in both the Senates of the Galactic Republic and its successor state, the Empire. He was highly unpopular on his homeworld for amassing wealth and influence on Coruscant, but his power within the Senate helped propel both Mas Amedda and Sheev Palpatine to prominence.
Free Taa makes only a brief appearance in the video game Star Wars The Phantom Menace, where he is seen standing next to Jabba Desilijic Tiure.