Mandibular Changes on Panoramic Imaging after Head and Neck Radiotherapy

Publication date: Available online 13 February 2016
Source:Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Author(s): King Chong Chan, Susanne E. Perschbacher, Ernest W.N. Lam, Andrew J. Hope, Andrea McNiven, Eshetu G. Atenafu, Linda Lee, Michael J. Pharoah
Changes to the radiographic appearance of the jaws after head and neck radiotherapy have not been thoroughly characterized. Objectives: This retrospective study examines changes to the appearance of the mandible on panoramic images following intensity modulated radiotherapy (IMRT), and relates these changes to medical comorbidities and radiation dose. Study Design: The medical and dental charts, and panoramic images of 126 subjects who received IMRT at Princess Margaret Hospital between January 1, 2005 and December 31, 2008 were analyzed independently by three observers. Results: Of the 126 subjects, 75 (60%) had post-IMRT changes on panoramic images; most, 66 (88%), consisted of widened periodontal ligament space (WPLS). The median time to WPLS was 29 months after IMRT. Female sex and radiation dose correlated with decreased time to WPLS. Conclusions: These results indicate that WPLS is a common radiographic sequela after head and neck radiotherapy, underscoring its clinical significance as a reliable marker of irradiated bone. Further, this type of WPLS needs to be differentiated from odontogenic inflammatory disease to avoid unnecessary treatment that may precipitate osteoradionecrosis.



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