a) Radiotherapy

1. Radiation mucositis

• Etiology:
  • Radiation > 3500-4000 rads
  • Usually develops in 2nd week of radiotherapy
• Clinical:
  • Reddening of oral mucosa
  • Pseudomembrane and greyish white slough
• Histology:
  • Ulceration/atrophy of surface epithelium
  • Attenuated stratum spinosum
  • Inflammation of submucosa
• Management:
  • Soothing mouth rinse
  • Pain relief

2. Osteoradionecrosis

• Etiology: High dose of radiation – impaired vascularity of jaw bones – complicated by proximity of normal oral flora
• Clinical: Gross necrotic lesion
• Histology:
  • Death of osteocytes, osteoblasts and endothelial cells within bone
  • 2ry infection – purulent discharge
• Management:
  • Prophylactic treatment
  • Resection of dead bone
• More under osteomyelitis

3. Temporary complications

1. Focal alopecia
2. Dermatitis of overlying skin
3. Pain
4. Dysgeusia (altered taste)
5. Candidiasis
6. Erythema
7. Mucositis

4. Permanent complications

1. Xerostomia
2. Cervical caries
3. Telangiectasia (dilated blood vessels)
4. Epithelial atrophy
5. Focal hyperpigmentation
6. Osteoradionecrosis

b) Chemotherapy

• Local toxicity
• Myelosuppression
• GIT toxicity
• Alopecia
• Pulmonary fibrosis
• Cardiotoxicity
• Nephrotoxicity
• Neurotoxicity

c) Surgical therapy

1. Short term:

1. Bleeding
2. P/O pain and paresthesia
3. Infection
4. Prolonged convalescence (recovery from illness)
5. Wound dehiscence

2. Long term:

1. Loss of mastication
2. Loss of speech function
3. Gross disfigurement
4. Graft rejection

Post-operative complications:

• Skin flap necrosis
• Hematoma
• Salivary fistula – due to trauma, presents as an opening in the suture line below the lobule of the ear
• Facial nerve paralysis – temporary or permanent
• Numbness of ear – injury to great auricular nerve
• Mucocele
• Xerostomia
• Frey’s syndrome

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Frey’s syndrome

Gustatory sweating syndrome – patient sweats when they see food

Etiology: Post-op growth of the interrupted preganglionic parasympathetic nerve branches to the parotid into the more superficial sweat glands

Diagnosis:

• History
• Starch iodine test:
  • Paint the affected skin with iodine, dust the skin with starch
  • Feed the patient
  • Appearance of bluish discoloration of overlying skin due to reaction between starch and iodine in the presence of moisture (sweat)

Management:

• Parasympatholytic creams such as glycopyrrolate lotion or scopolamine cream
• Apply anti-perspirant to avoid sweating
• Jacobsen’s neurectomy via tympanotomy approach

Preventive measure: Elevating skin flap and placing tissue such as fascia, dermis, or creating SCM muscle flap. For large defects use regional flaps such as pectoralis major flap