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Lateral skull-base osteoradionecrosis: a 15-year series of 20 consecutive cases and a suggested management protocol

Published online by Cambridge University Press:  27 August 2024

Emma Richards Open the ORCID record for Emma Richards [Opens in a new window] ,
Jameel Muzaffar ,
Raghu Kumar ,
Peter Monksfield  and
Richard Irving
Emma Richards*
Affiliation:
ENT Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
Jameel Muzaffar
Affiliation:
ENT Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
Raghu Kumar
Affiliation:
ENT Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
Peter Monksfield
Affiliation:
ENT Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
Richard Irving
Affiliation:
ENT Department, Queen Elizabeth Hospital Birmingham, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
*
Corresponding author: Emma Richards; Email: [email protected]
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Abstract

Background

Temporal bone osteoradionecrosis is a rare but significant complication of radiation for head and neck malignancies. Various management techniques have been described, but no clear protocol exists.

Methods

A retrospective case review of patients with temporal bone osteoradionecrosis managed over 15 years was carried out to highlight multidisciplinary team (MDT) management. The review findings were compared with the published literature and a protocol was derived for the management of future cases.

Results

A total of 20 patients were included. The sites of osteoradionecrosis included the external auditory canal, the middle ear and the lateral skull base, presenting with features including recalcitrant pain, infection, neuropathies and intracranial sepsis. Treatments included hyperbaric oxygen, antibiotics, debridement and, in advanced cases, lateral temporal bone resection with vascularised tissue transfer. Post-operative and long-term outcomes were discussed.

Conclusion

Early temporal bone osteoradionecrosis may be managed conservatively. Refractory osteoradionecrosis can be life-threatening because of intracranial complications and sepsis. Such cases need an MDT approach with radical skull-base surgery for removal of necrotic foci and reconstruction using vascularised tissue transfer.

Keywords

head and neck neoplasmstemporal boneradiologyradiotherapyosteoradionecrosis
Type
Main Article
Information
The Journal of Laryngology & Otology , Volume 138 , Issue 12 , December 2024 , pp. 1149 - 1153
Copyright
Copyright © The Author(s), 2024. Published by Cambridge University Press on behalf of J.L.O. (1984) LIMITED

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Footnotes

Emma Richards takes responsibility for the integrity of the content of the paper

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