Oral cavity and oropharyngeal cancers – surgical treatments

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This update of a Cochrane review of the relative benefits and harms of different surgical treatment modalities for oral cavity and oropharyngeal cancers includes 15 RCTs. Moderate-certainty evidence from 5 RCTs showed trials that elective neck dissection of clinically negative neck nodes at the time of removal of the primary oral cavity tumour is superior to therapeutic neck dissection, with increased survival and disease-free survival, and reduced locoregional recurrence.

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Radiotherapy and dental implant survival

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This review assessing the effect of radiotherapy on the survival of dental implants in patients with head and neck cancer included 7 studies involving a total of 441 patients. implant survival rate was lower in irradiated patients with odds ratio = 4.77 (95%CI; 2.57 to 8.89) based on 4 studies.

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Tooth extraction prior to head and neck radiotherapy and osteoradionecrosis risk

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28 mainly retrospective studies were included in this review which aimed to determine if tooth extraction prior to head and neck radiotherapy (RT )is associated with a reduced risk of developing osteoradionectosis (ORN). The findings showed a significant association of post-RT dental extractions with the risk of ORN development, odds ratio = 1.98 (95%CI: 1.17 to 3.35. However the certainty of the evidence was low to moderate.

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Osteoradionecrosis and tooth extraction before radiotherapy

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This review of the osteoradionecrosis rate in patients with head and neck cancer having toothth extraction performed before radiotherapy included 8 mainly retrospective studies. The pooled incidence rate was estimated at 2.2% (95% CI: 0.6% to 3.9%) although none of the studies controlled for other risk factors.

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Intraoral stents to reduce oral toxicity of radiotherapy

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This review assessing the effectiveness of intraoral stents in reducing toxicities in oral cavity induced by radiotherapy in head and neck region included 7 small studies. While the analysis suggests a beneficial effect from the use of intraoral stents the included studies only provide verylow certainty evidence so further high-quality RCTs are needed.

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Head and neck soft tissue sarcomas

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This review of the distribution of histological subtypes, treatment and overall survival (OS) rates of head and neck sacomas included 8 studies from 6 countries. Meta-analysis (5 studies) found the 5-year OS = 74%(95%CI; 63 to 84%)

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Osteoradionecrosis incidence and the timing of dental extractions

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This review of whether the incidence of osteoradionecrosis differed between patients who have dental extractions before or after radiotherapy (RT) included 24 studies (19 retrospective 5 prospective). While the findings suggest that the incidence is similar if extractions are undertaken before or after RT the quality of the evidence is limited.

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Low-level laser therapy in the prevention and treatment of oral mucositis

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Manas Dave takes a look at this review evaluating the prophylactic and therapeutic effects of low-level laser therapy (LLLT) in patients who might or have developed oral mucositis during chemotherapy or radiotherapy.

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Osteoradionecrosis and denture use in head and neck cancer patients

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This review assessing the evidence of the impact of replacing missing teeth with dentures on the development of osteoradionecrosis in patients who have radiotherapy for head and neck cancer only identified 3 case-controlled studies of very low quality.

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Osteoradionecrosis of the jaws: Prevention in adult patients with head and neck cancer

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This Cochrane review of interventions for preventing osteoradionecrosis of the jaws in adults with head and neck cancer undergoing curative or adjuvant (i.e. non-palliative) radiotherapy included 4 RCTs. The limited quality of the available studies means evidence regarding the interventions evaluated in this review is uncertain.

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