s p o n s o r e d l i n k s
Experience and documentation of the use of direct reconstruction of the mandible using free bone flap has been reported in the literature. Microvascular free tissue transfer is considered as the standard of care for treatment of stage III ORN. Particular attention should be given when determining the limits of resection if the primary bone flap was planned. Pre-operative planning must also cope with the availability of suitable recipient vessels in the neck for microvascular anastomosis.
After resection of dead bone, vascular free tissue transfer can provide a direct reconstruction and restoration of mandibular continuity. Free tissue transfer offers a shorter treatment, often without the need for HBO.
Early criticism of microvascular reconstruction for the mandible include inadequate bone stock for dental prosthetic reconstruction, residence time in a long ICU and inpatient care in hospitals, as well as donor site morbidity increases. Experience with microvascular reconstruction has reduced these concerns.
Literature actually indicates that dental rehabilitation can be solved by good and convincing in patients who received free fibula flap or iliac bone. Cases have also been reported on implant supported dental rehabilitation in patients who experience the scapula and radial bone flap, although this is an exception. The total cost of treatment is reduced when the primary mandibular reconstruction were completed with free tissue transfer.
Details of postoperative
A careful clinical practice can reduce the incidence of ORN at specific intervals ie 2 pre-treatment phase and the rehabilitation phase.
ORN clear risk to experience nature in relation to cumulative dose of radiation, and this risk continues during the lifetime of the patient. Actually, the risk of ORN in patients who must undergo procedures involving the mandible in the treatment of radiation continue to increase. Prior to dental rehabilitation , perform a careful assessment of the risk of ORN. Prior to tooth extraction or dental implant installation, the fields of radiation and dose must be determined. Subsequent clinical personnel must determine the benefits that can be obtained from the patient’s HBO therapy on the basis of case-by-case basis.
The use of HBO therapy before implant installation has also been debated. The use of HBO can reduce morbidity and improve the success of dental implant therapy. Recent studies have shown increased failure of long-term dental implants in patients who do not get HBO with implant installation. Installation of dental implants in irradiated jaws carry the same risk for experiencing ORN, as seen in tooth extraction in a similar clinical setting.
Before the removal of tooth implant installation, consider HBO if surgery will occur in a radiation field of energy known to have received 60 Gy radiation. Follow the standard HBO regimen of 20 treatment and 10 praoperatif postoperative care. Perform surgery in a way that might not cause as much trauma. When installing dental implants, allow reduction in the rate of integrity (65-80% versus 95%).
RESULTS AND Antibiotics
Not enough data available to help physicians who are faced with managing osteoradionekrosis (ORN). Additional documentation regarding the costs and outcomes for both primary and secondary reconstruction is still needed. Patient satisfaction for each of the available therapies should be investigated further. The basic problem occurs when consulting with patients who received radiation therapy before tooth extraction. Cost of hyperbaric oxygen therapy (HBO) prophylaxis is the main consideration because of inadequate outcome data often result in failure to obtain insurance authorization for HBO prophylaxis.
FUTURE DEVELOPMENTS AND Controversy
The use of radiation therapy together with chemotherapy increased need attention with respect to the increasing incidence of osteokardionekrosis (ORN). The potential for increased sensitivity in the network such therapy has not been well studied. The occurrence of late complications of therapy is rarely considered in the short-term studies multimodalitas therapy. Efforts should be made to monitor patients who have undergone long this kind of protocols to evaluate the quality of life and late complications of therapy.
The modalities and treatment of mandibular ORN and controversial enough. Although some recommend a combination of hyperbaric oxygen (HBO), sequestrektomi, resection, and bone graf free, but others recommend bervaskularisasi free tissue transfer without HBO. Each method has advantages and disadvantages. Several important facts have been known, which includes:
* HBO reduces hypoxia impact of radiation, hipovaskularitas, and hiposelularitas and improve wound healing.
* Necrotic dead bone requires resection
* Bervaskularisasi free tissue transfer offers the option of immediate reconstruction with a short treatment time.
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