Sialadenitis May Be Associated with an Increased Risk for Osteoradionecrosis: A Nationwide Population-Based Cohort Study

Publication date: Available online 5 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): Yi-Fang Huang, Shih-Ping Liu, Chih-Hsin Muo, Chung-Ta Chang, Chun-Hao Tsai, Donald E. Morisky

Abstract

Purpose

The impact of sialadenitis on osteoradionecrosis is controversial. The aim of this study was to determine the association between sialadenitis and osteoradionecrosis.

Materials and Methods

The participants were derived from Taiwan's Longitudinal Health Insurance Database. From 2000/01/01 to 2008/12/31, sialadenitis (ICD-9-CM 527.2, 527.3, 527.5-527.7, 527.9, and 710.2) and osteoradionecrosis (ICD-9-CM 526.89, 526.5, 730.0, and 730.1) were identified. Variable treatment modalities including surgery or medicine were used to distinguish the severity of sialadenitis. The primary predictor variable was sialadenitis. The secondary predictor variable was severity of sialadenitis. The primary outcome variable was time to developing ORN. Other study variables were grouped into the following sets of age, gender, risk factor, and medical treatment. Cox proportional hazard regression was used to investigate the associations between sialadenitis and osteoradionecrosis after adjusting confounders in statistics.

Results

The sample was composed of 47,385 subjects with a mean age of 46.6 years (standard deviation = 19.9) and 37.2% were male. 20.0% had a diagnosis of sialadenitis. 1.13% had a diagnosis of osteoradionecrosis. Sialadenitis was associated with an increased risk of osteoradionecrosis [hazard ratio (HR) = 1.93, 95% confidence interval (CI) = 1.61–2.31, p <0.0001). After adjusted for confounders, sialadenitis was associated with osteoradionecrosis (multivariable HR = 1.83, 95% CI = 1.52–2.19, p <0.0001). Severity of sialadenitis was associated with an increased risk of osteoradionecrosis; the osteoradionecrosis risk was 1.79 and 3.52 in mild and serious sialadenitis patients (95% CI = 1.49–2.16 and 1.67–7.44, p <0.0001 and <0.001, respectively) compared with non-sialadenitis cohort. In the joint effect for ORN between sialadenitis and malignancy type, the sialadenitis patients had 11.6-fold osteoradionecrosis risk (95% CI = 5.58–23.9) compared to comparisons without malignancy.

Conclusions

Sialadenitis significantly raised the risk to develop osteoradionecrosis. The severity of sialadenitis was positively correlated with the incidence of osteoradionecrosis.

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