A Case of Maxillofacial Prosthesis for Progressive Osteoradionecrosis of Maxilla

Abstract

Radiotherapy for head and neck cancer is a significant modality compared to surgery in terms of QOL, because it can preserve the shape and functions of the head and neck region, but osteoradionecrosis is one of the most severe late adverse effects related to radiotherapy of the head and neck. In particular, the jaws, which are just covered with vulnerable alveolar mucosa, are easily exposed. Once infection occurs, osteomyelitis spreads rapidly because of impairment of bone remodeling resulting from damaged osteoblasts by irradiation, and leads to osteoradionecrosis via a chronic process. Osteoradionecrosis occurs more frequently in the mandible than in the maxilla, because the cortical bone is thicker and blood supply is less abundant in the mandible. In spite of the rare occurrence of osteoradionecrosis of the maxilla, necrotic bone that sequesters from the maxilla causes leakage of food and drink in the oral cavity into the nasal cavity, maxillary sinus and orbit, and thus markedly deteriorates QOL of patients. We report our experience of making a maxillofacial prosthesis repeatedly for progressive osteoradionecrosis of the maxilla resulting from radiotherapy for carcinoma of the maxillary sinus.