Measures to prevent radiation osteomyelitis in patients with nasopharyngeal carcinoma

After radiotherapy for nasopharyngeal carcinoma patients, the jaw is exposed to a certain amount of radiation, and the internal mandibular artery is prone to inflammatory reaction, which can lead to intimal swelling, vascular embolism, periosteal fibrosis, local blood supply and nutritional disorders, reduced bone vitality, and aseptic radiation osteonecrosis.

Since the mandible has a higher bone density and less blood vessels, more than 90% of radioactive osteonecrosis occurs in the mandible, usually 2 to 3 years after radiotherapy. After radioactive osteonecrosis occurs, patients will initially experience persistent tingling or severe pain, swollen gums, alveolar pus, loose and falling teeth, and in severe cases, jaw defects and maxillofacial deformities. In the later stages, it may manifest as chronic osteomyelitis, bone surface exposure, and even fistula formation in the oral mucosa and facial skin, long-term pus discharge, and long-term treatment.

To prevent radiation osteomyelitis, we must first formulate a reasonable radiotherapy plan to avoid dose overlap between irradiation fields and minimize the radiation dose to normal tissues around the target area.

Secondly, patients should clean their teeth and repair caries before radiotherapy. Caries or residual roots that cannot be repaired should be extracted decisively, and the interval between extraction and radiotherapy should be no less than 1 week.

Third, patients should receive hyperbaric oxygen and systemic supportive therapy while receiving radiotherapy, and appropriate use of antibacterial drugs. Hyperbaric oxygen therapy is currently a relatively effective adjuvant treatment for osteoradionecrosis in clinical practice.