Bilateral diffuse temporal bone osteoradionecrosis: a diagnostic and therapeutic challenge
Keywords:Temporal bone, Osteoradionecrosis, Necrosis, Radiotherapy, Mastoidectomy
Temporal bone osteoradionecrosis (TBORN) is a rare complication of head and neck radiotherapy. It usually presents as a unilateral disorder with a long latency between the exposition to radiation and the symptoms onset, which might overlap with other clinical entities, making it difficult to establish the diagnosis. It can be classified as localized, when confined to the tympanic bone; or diffuse, when extended to other portions of the temporal bone, with the inherent implication in treatment selection and prognosis. The authors present a case of a 53 years old patient with multiple comorbidities, including an immunosuppressive state, who presented an infected massive diffuse TBORN bilaterally. The diagnosis was challenging and the patient was initially treated for a malignant otitis externa, but after established diagnosis of TBORN, the patient was treated resorting to surgery, topical treatment and hyperbaric oxygenotherapy, with consequent symptoms resolution. This case illustrates the difficulty in establishing the diagnosing and treatment of TBORN and highlights the importance of a low suspicion threshold for this rare complication of radiotherapy, for which there is still no consensus regarding the best treatment.
Lambert EM, Gunn GB, Gidley PW. Effects of radiation on the temporal bone in patients with head and neck cancer. Head Neck. 2016;38(9):1428-35.
Yuhan BT, Nguyen BK, Svider PF. Osteoradionecrosis of the temporal bone: An evidence-based approach. Otol Neurotol. 2018;39(9):1172-83.
Ramsden RT, Bulman CH, Lorigan BP. Osteoradionecrosis of the temporal bone. J Laryngol Otol. 1975;89(9):941-55.
Olusanya BO, Davis AC, Hoffmanc HJ. Hearing loss grades and the International classification of functioning, disability and health. Bull World Heal Organ. 2019;90(10):725-8.
Ewing J. Radiation osteitis. Acta radiol. 1926;6(1-6):399-412.
E. B. Radiation injury of the temporal bone. Z Hals Nas Ohrenheilkd. 1952;3:45-6.
Morrissey D, Grigg R. Incidence of osteoradionecrosis of the temporal bone. ANZ J Surg. 2011;81(12):876-9.
Herr MW, Vincent AG, Skotnicki MA, Ducic Y, Manolidis S. Radiation Necrosis of the Lateral Skull Base and Temporal Bone. Semin Plast Surg. 2020;34(4):265-71.
Nason R, Chole RA. Bacterial biofilms may explain chronicity in osteoradionecrosis of the temporal bone. Otol Neurotol. 2007;28(8):1026-8.
Sharon JD, Khwaja SS, Drescher A, Gay H, Chole RA. Osteoradionecrosis of the temporal bone: A case series. Otol Neurotol. 2014;35(7):1207-17.
Lovin BD, Hernandez M, Elms H. Temporal Bone Osteoradionecrosis: An 18-year, Single-Institution Experience. Laryngoscope. 2021;131(11):2578-85.
Glicksman JT, Khalili S, Fung K, Parnes LS, Agrawal SK. Pentoxifylline-tocopherol-clodronate combination: A novel treatment for osteoradionecrosis of the temporal bone. Head Neck. 2015;37(12):E191-3.