AB287. SOH26AB_0241 Osteoradionecrosis of the mandible during a course of radical radiotherapy: a case report

Background: Osteoradionecrosis of the mandible is an important clinical entity. It represents a diagnostic and therapeutic challenge.

Case Description: The Oral and Maxillofacial Department in University Hospital Limerick was asked to undertake an inpatient consultation for a patient with a 2-month history of a non-healing ulcer on the left buccal mucosa. The patient had been admitted for queried pneumonia. Following an initial biopsy, the patient was subsequently diagnosed and treated for oral squamous cell carcinoma (OSCC) of the left buccal mucosa, undergoing resection of the tumour, nasolabial flap, left neck dissection, and referred to radiation oncology to begin radical radiotherapy. In the interim, the patient subsequently had a recurrence of the OSCC. The patient was then admitted while he underwent radical radiotherapy—70 grays over 35 sessions—for analgesic control. Throughout the radiotherapy, the patient was using his TheraBite device, despite being advised by radiation oncology to stop using the same. In the week following completion of radiotherapy, the patient then starts to complain of severe pain in the left mandibular region. On radiographic investigations, it was found that there was a pathological fracture of the left mandibular body. The differential diagnoses at the time were osteoradionecrosis or metastatic disease.

Conclusions: The patient underwent resection of the necrotic portion, which was sent for histology. The portion was subsequently found to be osteoradionecrosis.

Keywords: Osteoradionecrosis; osteonecrosis of the mandible; osteoradionecrosis of the mandible; metastasis to the mandible; case report