About head and neck cancer

Jaw Necrosis is a rare but serious condition in which the cells in the jawbone start to die. Osteoradionecrosis (ORN) radiation from cancer treatment makes people more susceptible to jaw necrosis. The gums are not well protected like other parts of the body from damage during treatment. Radiation causes dry mouth and tight jaw as it makes the muscles contract, which makes dental care harder and also impacts on eating.

Traditional treatment for jaw necrosis is surgery, including partial removal of the patient’s jaw or rebuilding the jaw using undamaged leg bone.

Although surgery is really good for cancer treatment it is not as effective for the treatment of jaw necrosis. Patients often have reduced quality-of-life as their jaw doesn’t feel how it did before.

Another treatment traditionally used is hyperbaric oxygen therapy. This is the same therapy used if a scuba diver had suffered a decompression injury. Essentially the patient is put into a high-pressure tank in an attempt to increase their oxygen levels. The theory is simply that higher oxygen levels in the body (and jaw) can promote better healing. However, a recent study called the Hop on Study shows this treatment doesn’t work effectively.

Pentoclo Treatment Therapy doesn’t involve invasive surgery and aims to;

1. Boost the blood supply to the jaw,
2. Reverse some of the damage done to the skin and mouth and
3. If the bone in the jaw is dead, it pushes the affected bone out.

In some cases, the jawbone has been seen to rebuild. Pentoclo Treatment Therapy has a healing rate of 56%, which is a very high figure given the alternatives can be so destructive.

We aim to make you aware of the changes that are occurring in the treatment of odontogenic diseases. Additionally, we raise awareness of minimally invasive options that may be ideal for your case.

The bones that form the jaw and face develop in a different way to the bones of the skeleton, so naturally have unique disorders. Odontogenic tumours arise from abnormalities in tooth development, such as ameloblastoma. Alternatively, disturbances in bone growth, lead to what is described as a fibro-osseous lesions or giant cell lesions. Odontogenic tumours mainly occur in the lower jaw and are locally invasive. They originate from tooth remnants so do not move outside the bone. These lesions are silent and are usually discovered by chance on dental X-rays. Lesions are usually quite large when they are found.

The traditional treatment involves surgically removing lesions from the jaw, which leads to facial disfigurement. This can be particularly distressing for the majority of patients, who are predominately adolescents or young adults. This is a major operation that can take around ten hours to perform as bone from the hip or leg has to be used to reform the jaw. Patients are in hospital for a minimum of ten days and the procedure has significant mortality rates.

A much smaller procedure, where the tumour lining is removed from the jaw and the cavity is sterilised, is being pioneered. This minimally invasive approach has been adopted by surgeons in many countries across the world and in some places in the UK.

The recurrence rate is approximately ten percent. If odontogenic tumours reform, the procedure can be repeated. With this pioneering treatment, patients only spend one to two days in hospital and there are no devastating changes to a patient’s appearance.

Giant Cell Lesions are associated with abnormalities in bone metabolism. This results in the growth of large bony swellings, which result in significant distortion of the face and jaw. Traditionally, surgeons remove the abnormal tissue and repair the defect with new bone taken from elsewhere on the body.

Over the last two decades, it has become clear that the process of bone growth can be controlled by new drugs, which slow down and direct bone growth. The lumps can then be pared down and controlled with medication. These lesions tend to burn out naturally, so the drugs are only required while the tumours are growing.

We aim to inform you of the changes that are occurring in approaches to odontogenic diseases, and most importantly, make you aware of your options. These pioneering treatments are available to you and can be discussed with your surgeon or second opinion doctor. The Montgomery Ruling means you have the right to be informed of all treatment options, which you can discuss objectively with your surgeon.

The Parotid glands are the largest of the salivary glands which are located either side of the mouth, in front of both ears. Over three quarters (80%) of major tumours in the salivary gland start in this area.

One of the major facial nerves, which allows movement in the face, runs and branches-out through the parotid gland. The nerve’s position in the salivary gland means that it is often within very close to proximity to any tumours - making surgery difficult and leaving a high risk of patient nerve damage.

It is extremely difficult to map out the path of the nerve or how involved it is with salivary gland tumours. This means that, with pre-existing approaches, there is a high risk associated with surgical treatment of tumours in this area.

With conventional scanning, the risk of long-term nerve damage is between 1-2% of surgeries, and around 10% of patients will experience temporary paralysis postoperatively. The nerve damage can result in several different issues and takes a toll on a patient’s recovery. Complications include weakness or numbness of the face, problems moving the lower lip, numbness or low sensation of the tongue or problems closing one of your eyes. These side effects can often prevent people from consenting to, or surgeons feeling comfortable to remove the tumour, due to the limited knowledge of its location on involvement with the facial nerve.

New MRI sequencing allows radiologists to identify the nerve and map its path through the parotid gland. Academic software is then applied to this data to create virtual images where the anatomy can be segmented. This creates a three-dimensional model of the parotid gland, and shows where the tumour sits in relation to the major facial nerves. The data can then be uploaded to a Microsoft Hololens, creating a three-dimensional model of the anatomy in augmented reality. This is effectively a ‘real-life’ model of the tumour, gland and nerve.

This 3D model can be studied before treatment so that surgeons can accurately locate the tumour and map its proximity to the nerve. Patients are more confident when consenting to surgery, as they are more aware of the risk associated with their procedure. Surgeons also enter the operating theatre with greater confidence as they can accurately assess the risks associated with the patient mitigate the anomalies found during surgery.

In the future, this 3D holographic model will then be projected on to the patient during their surgery. This means the oncology team can study and continue to analyse the surgical plan throughout, maximise positive patient outcomes.

No one else is using the Hololens software for this purpose. This is a completely new technological processes which is hugely beneficial to patient outcome. However, there are extensive barriers to the universal adoption of the software and use of the Hololens in this way – mainly price, accessibility and training. These factors currently limit the number of oncologists who can utilise this technology.

HNCF is working to promote access to this technology. We plan to roll this technology out to the global oncology community through our education and accessibility programme. We aim to make patients aware of developments in the treatment of Parotid gland tumours and continue to raise awareness of this new and innovative treatment.