Hani L. Ashamalla, MD, Kevin Hardy, MD, and Joel W. Goldwein, MD
Ultima Vez Modificado: 1 de noviembre del 2001
Radiation induced soft-tissue and bone necrosis, while rare, presents a challenge to the treatment team. High radiation doses, previous surgery and trauma all increase the risk of the necrosis. When it develops, pain, disability, progression, or even death due to loss of protective barriers may result.
Response to antibiotics and/or conservative debridement can be poor. This is largely due to chronic hypoxia which is characteristic of the necrotic tissue (Marx). Superimposed infectious processes can further compromise the situation.
Roughly /3 of osteoradionecrosis occurs spontaneously with soft tissue breakdown over nonviable bone. Trauma such as tooth extraction, biopsy, or placement of dental appliances initiates the other 2/3.
Hyperbaric oxygen therapy (HBO), the administration of 100% oxygen under high pressure, can improve the situation. Such therapy greatly increases the amount of oxygen availabile to tissue. This is due to the gaseous/fluid (oxygen/plasma) interface that enhances oxygen absorption and transportation into the liquid phase of the blood. Under such circumstances, repair of tissue damaged by high doses of ionizing radiation is facilitated. Mechanisms of repair can be explained on the following bases;
TREATMENT 1 YR COST( $ ) % RESOLUTION =========== ============== ============ SURGERY,AB. 31,000 8 HBO ALONE 20,000 17 SURGERY&HBO 35,000 100
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