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Pathological Fracture Of The Mandible Associated To Osteoradionecrosis With Necrotic Bone And Reconstruction Plate Exposure: Case Report

Stramandinoli-Zanicotti RT, Silva WPP, Schussel JL, Dissenha JL and Sassi LM

Osteoradionecrosis is a severe and devastating late complication of radiotherapy in patients with head and neck cancer. The diagnosis of Osteoradionecrosis is established by clinical and radiographic evidence of bone necrosis after irradiation. The current article reports a case of osteoradionecrosis in an irradiated patient (male; 62-year-old), which evolved into pathological fracture of the jaw, 2 years after the end of radiotherapy for oral cancer treatment. The patient was rehabilitated in other service, with reconstruction plates, without adjuvant hyperbaric oxygen therapy, progressing to a fistula formation and bone exposure. The patient was referred to our service, with an extensive bone and plate exposure, with signs of severe osteoradionecrosis. After the adequacy of the oral environment, the patient underwent surgery for necrotic bone and reconstruction plate resection, with a primary closure of the skin and intraoral mucosa. The post- operative clinical and radiographic examinations performed after 12 month showed no signal of recurrence. Pathologic fracture in conjunction with osteoradionecrosis has a relatively high treatment complication rate. The incorrect diagnosis of mandibular fracture associated with osteoradionecrosis leads to inadequate treatment, with irreversible consequences to the patient, as described in the related case.