Clinical article
Dental extractions in the irradiated head and neck patient: a retrospective analysis of memorial sloan-kettering cancer center protocols, criteria, and end results1

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Abstract

Background

This study was designed to use our institutional experience with irradiated head and neck patients to evaluate 1) dental extraction incidence and sequelae; 2) those patients who developed osteoradionecrosis via extraction and the efficacy of hyperbaric oxygen therapy; and 3) guidelines for extraction protocols in this population.

Materials and methods

A group of 1,194 patients with a history of radiation to the head and neck, who were evaluated and treated in the Dental Service at Memorial Sloan-Kettering Cancer Center, were reviewed. The 187 who required dental extractions were analyzed using patient demographics, tumor location, staging, histopathology, radiation dosage, field, and timing, dental extraction indications, location, surgical methods, and sequelae.

Results

Almost 85% of the patients reviewed did not require extraction. Only 4 of those who underwent extractions at Memorial Sloan-Kettering Cancer Center developed osteoradionecrosis.

Conclusions

The use of multidisciplinary team communications and careful extraction selection by prognosis and symptomatology regardless of preexisting dental pathologies, atraumatic extraction procedures, and meticulous follow-up can lower both extraction and osteoradionecrosis rates.

Section snippets

Study aims

The purpose of this retrospective study was to use our institutional experience to evaluate 1) dental extraction incidence, sequelae, and complications of dental extractions in the irradiated head and neck patients practiced at MSKCC; 2) those patients who developed ORN via extraction and the efficacy of HBO therapy; and 3) guidelines for extraction protocols in this population.

Methods

One thousand one hundred ninety-four patients with a history of radiation therapy to the head and neck region (excluding Hodgkin’s disease, and total body irradiation for bone marrow and/or stem cell transplants) who were evaluated and treated from January 1, 1998, through October 31, 2001, in the Dental Service at the MSKCC were reviewed. A retrospective analysis was performed on 187 patients (15.66%) who required dental extractions in the Dental Service using patient demographics, tumor

Results

Patient ages ranged from 6 to 89 years (mean and median, 58 years), with the majority of patients between 50 to 59 years (31.55%), followed by those between 60 and 69 years old (31.02%). The ethnic makeup of the 112 (59.89%) male and 75 (40.11%) female patients include 150 (80.21%) whites, 17 (9.09%) blacks, 9 (4.81%) Hispanics, 8 (4.28%) Asians, and 3 (1.6%) others.

As of October 30, 2001, 28 of 187 patients (14.97%) died of their disease or other causes, and 159 patients (85.03%) remained

Discussion

Nearly 85% of 1,194 irradiated patients followed in the MSKCC Dental Service from 1998 through 2001 did not require dental extractions to prevent ORN. Our retrospective data review indicated that only 11 of 1,194 patients (0.92%) developed ORN, including 4 patients (2.14%) who had extractions at MSKCC, a much lower rate than that typically reported in the literature. Formal guidelines regarding dental extraction are generally practiced at MSKCC; however, set protocols are not based on

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    1

    Received from Maxillofacial Prosthodontics, Dental Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, NewYork, NY.

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