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Osteoradionecrosis & Soft Tissue Radiation Necrosis

Radiation therapy has been used to control and treat disease for many years. Many types of cancers are treated with radiation, such as cancers involving the head, neck, breast, and cervix, to name a few. The goal of this therapy is to destroy the tumor with only minimal damage to the surrounding healthy tissue. The radiation oncologist (a physician that specializes in radiation therapy) uses highly sophisticated techniques to determine the correct dosage of radiation. Even with these great technical advances in radiation therapy, complication still occur. A 10 year study of 128 patients found the rate of complications to be about 65%. But, because complications can develop years after the initial radiation, the exact rate of complications is difficult to determine. As mentioned earlier, when a tumor is radiated normal tissue can also be damaged. The damage can occur immediately or over a period of time. The boundary between healthy tissue and damaged, irradiated tissue is ill-defined leading to healing difficulties. This unhealthy, damaged tissue is deficit in many factors that are necessary for healing to occur. The term "3 H" has been used to describe the tissue found in radiated patients. Tissues are hypovascular, hypocelluar, and hypoxic. In other words, tissues are lacking in sufficient blood vessels, cells, and oxygen. Often, most tissue can survive in these circumstances, but if there is even a minor break in integrity, intentional or accidental, infection and nonhealing wounds can occur. The wound progresses because the demand for oxygen exceeds the supply. Once the damage occurs it is referred to as radiation necrosis or late radiation tissue injury. This should not be confused with wounds that occur immediately following radiation therapy. It is termed late radiation tissue injury when it occurs at least 6 months after the last dose of radiation. There are two basic types of radiation necrosis:

Osteoradionecrosis (ORN) – which is radiation injury to the bone. The jaw bone is most frequently affected, but any bone can be applied to the other bones of the skull and rest of the skeleton.

Soft tissue radiation necrosis – this refers to damage to the underlying tissues, such as, skin, muscle, fascia, and central nervous system.

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