Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with a history of head and neck radiotherapy (RT) [dose: ___ Gy] completed on [date]. Chief complaint of persistent intraoral pain, non-healing mucosal ulceration, and exposed necrotic bone in the [mandibular segment] for [duration]. Associated symptoms include halitosis, trismus, and occasional purulent discharge. No history of recent dental extractions or trauma to the site.
Clinical Examination Findings
Intraoral examination reveals an area of exposed, non-vital, necrotic bone measuring [___ x ___ cm] in the [mandibular region]. Surrounding mucosa appears erythematous, friable, and inflamed with evidence of secondary infection. Probing reveals deep periodontal pockets or sinus tracts. Extraoral exam shows [presence/absence] of cutaneous fistulae, mandibular swelling, or pathological fracture. Cranial nerve assessment is [intact/impaired].
Treatment Protocol
Management plan includes: 1. Conservative debridement of necrotic bone and sequestrectomy. 2. Antibiotic therapy targeting anaerobic and aerobic flora. 3. Hyperbaric oxygen (HBO) therapy protocol [___ sessions]. 4. If refractory, surgical resection of the necrotic segment followed by microvascular free flap reconstruction (e.g., fibula free flap). 5. Optimization of oral hygiene and cessation of smoking.