Management of Skull Base Osteoradionecrosis with Hyperbaric Oxygen Therapy

고압산소요법으로 치료한 뇌기저부 방사선골괴사 1예

  • Hwang, Eun (Department of Otolaryngology, Ajou University School of Medicine) ;
  • Lee, Jong-Joo (Department of Otolaryngology, Ajou University School of Medicine) ;
  • Shin, Yoo-Seob (Department of Otolaryngology, Ajou University School of Medicine) ;
  • Kim, Chul-Ho (Department of Otolaryngology, Ajou University School of Medicine)
  • 황은 (아주대학교 의과대학 이비인후과학교실) ;
  • 이종주 (아주대학교 의과대학 이비인후과학교실) ;
  • 신유섭 (아주대학교 의과대학 이비인후과학교실) ;
  • 김철호 (아주대학교 의과대학 이비인후과학교실)
  • Published : 2011.05.27

Abstract

Skull base osteoradionecrosis(ORN)is a rare complication of radiotherapy for nasopharyngeal carcinoma, but is one of the most severe and possibly fatal condition followed by radiotherapy. However, the treatment of skull base ORN has seldom been thoroughly described yet. Here we report a case of skull base ORN that was successfully treated with hyperbaric oxygen therapy(HBO). A 52-year-old man visited our department complaining of trismus and foul odor. He was diagnosed with nasopharyngeal cancer with multiple lymph node metastasis one year ago and underwent concurrent chemoradiotherapy. On the physical examination, mucopus and crusts with exposed necrotic bone was seen in the right nasopharynx. On the paranasal sinus magnetic resonance imaging, osteoradionecrosis which was extending from the right nasopharynx to the clivus, petrous apex, and cavernous sinus was noted. Nasopharynx biopsy resulted of ulcer with no malignant cells. HBO therapy was performed with debridement of nasopharynx for 3 months. There was no sign of recurrence or residual ORN 18 months after HBO therapy.

Keywords

References

  1. Chang KP, Tsang NM, Chen CY, Su JL, Hao SP. Endoscopic management of skull base osteoradionecrosis. Laryngoscope. 2000;110:1162-1165. https://doi.org/10.1097/00005537-200007000-00018
  2. Fajardo LF. Basic mechanisms and general morphology of radiation injury. Semin Roentgenol. 1993;28:297-302. https://doi.org/10.1016/S0037-198X(05)80091-4
  3. Huang XM, Zheng YQ, Zhang XM, Mai HQ, Zeng L, Liu X, et al. Diagnosis and Management of Skull Base Osteoradionecrosis After Radiotherapy for Nasopharyngeal Carcinoma. Laryngoscope. 2006;116:1626-1631. https://doi.org/10.1097/01.mlg.0000230435.71328.b9
  4. Guida RA, Finn DG, Buchalter IH, Brookler KH, Kimmelman LP. Radiation injury to the temporal bone. Am J Otol. 1990;11:6-11.
  5. Mainous EG, Hart GB. Osteoradionecrosis of the mandible bygrafting with combination of mandible homograft and autogenous iliac marrow and postoperative treatment with hyperbaric oxygenation. Oral Surg. 1973;35:13-20. https://doi.org/10.1016/0030-4220(73)90088-1
  6. Marx RE. A new concept in the treatment of osteoradionecrosis. J Oral Maxillofac Surg. 1983;41:351-357. https://doi.org/10.1016/S0278-2391(83)80005-6
  7. Hao SP, Chen HC, Wei FC, Chen CY, Yeh AR, Su JL. Systematic management of osteoradionecrosis in the head and neck. Laryngoscope. 1999;109:1324-1327. https://doi.org/10.1097/00005537-199908000-00027
  8. Rudge FW. Osteoradionecrosis of the temporal bone: treatment with hyperbaric oxygen therapy. Mil Med. 1993:158:196-198.
  9. Hunt TK, Pai MD. The effect of varying ambient oxygen tensionson wound metabolism and collagen synthesis. Surg Gynecol Obstet. 1972;135:561-567.