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E107 - Dr. Thomas Schlieve: How to Prevent and Treat Osteoradionecrosis of the Jaw

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Jake Stucki

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Show notes:

Osteoradionecrosis is a condition in the field of oral surgery that seems to be shrouded in fear and confusion. To help us gain clarity on this subject, today we are joined by Dr. Thomas Schlieve to discuss this problem, as well as how to prevent and treat it when it occurs in the jaw. Dr. Schlieve is an Oral & Maxillofacial Surgeon practicing in Dallas and currently the Director of the Parkland Oral Surgery Program. As an expert on osteonecrosis, today he explains exactly what osteoradionecrosis is, how to identify it, and the importance of testing early. Tuning in you’ll hear about the factors to consider when it comes to the degree of dosage and location of radiation, how to prepare your patient for all possible outcomes of treatment, and some of the reasons why osteoradionecrosis treatment may not work. You’ll also discover the benefits of hyperbaric oxygen therapy and Pentoxifylline in treating a patient who is at high risk for osteoradionecrosis as well as Dr. Schlieve’s ‘Kitchen sink’ approach. To find out how he treats a patient that already has exposed bone, how he treats a patient with a pathologic fracture at the angle, and other important factors to consider concerning this condition, tune in today!

Key Points From This Episode:

Dr. Thomas Schlieve defines what osteoradionecrosis is.
The importance of testing early so you don’t get a lawsuit for failure to diagnose or delayed diagnosis.
The percentage of cancer patients that experience osteoradionecrosis.
Factors to consider when it comes to the degree of dosage and location of radiation.
How to find out exactly what part of the bone was radiated.
From what angles a radiation oncologist will deliver radiation to a tonsillar lesion.
What type of prep should be taken for tooth surgery on a patient who is at high risk for osteoradionecrosis.
Insight into Dr. Schlieve’s ‘Kitchen sink’ approach to surgery on a patient who is high risk for osteoradionecrosis.
The benefits of hyperbaric oxygen therapy and Pentoxifylline.
How he treats a patient that already has exposed bone.
When insurance will and will not cover hyperbaric oxygen therapy in Dr. Schlieve’s patients.
How he treats patients with a pathologic fracture at the angle.
Some of the reasons why osteoradionecrosis treatment may not work.
The importance of properly informing your patients with osteoradionecrosis of all the possible results before you begin treatment.
What tips the scale from other forms of treatment to surgery in a patient at high risk for osteoradionecrosis.
The role of infection as a risk factor for osteoradionecrosis.
Why you need to educate your staff and understand your patient’s full history prior to surgery.
Whether or not you’re more likely to have complications as the result of radiation as more time passes.
Hear about Dr. Schlieve’s favorite book and one of his favorite movies in the rapid-fire questions.