Lim A A, Karakla D W, Watkins D V
Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center, Portsmouth, VA 23708, USA.
Am J Otolaryngol. 1999 Nov-Dec;20(6):408-11. doi: 10.1016/s0196-0709(99)90083-2.
Osteoradionecrosis (ORN) is a common complication of radiation therapy. We present the first case reported in the literature of ORN involving the first and second cervical vertebrae and occipital bone in a patient who was treated with surgery and radiation therapy 9 years prior for a TxN3M0 squamous cell carcinoma of the left neck arising from an unknown primary origin. A brief review of the pathophysiology and treatment of this pathological process is also presented. Although the mandible is the most commonly affected site in the head and neck, ORN may develop in an unusual location without any preceding trauma and display an insidious but rapidly progressive course. The pathophysiology of ORN is believed to be a complex metabolic and homeostatic deficiency created by radiation-induced cellular injury and fibrosis, which is characterized by the formation of hypoxic, hypovascular, and hypocellular tissue. The irradiated bone loses its capability to increase the metabolic requirements and nutrient supply required to replace normal collagen and cellular components lost through routine wear. This results in tissue breakdown and the formation of a chronic nonhealing wound. Infection plays only a contaminant role, with trauma being a possible initiating factor. Diagnosis of ORN begins with a complete physical examination, including fiberoptic examination and biopsy of any suspicious lesion to eliminate the possibility of recurrent tumor. Treatment of ORN commonly requires the debridement of necrotic bone and hyperbaric oxygen therapy. The head and neck surgeon must possess a high degree of suspicion to promptly diagnose ORN and initiate early treatment. Because of similarities in clinical presentation, the most important step in the initial management of suspected ORN is to eliminate the possibility of tumor recurrence or a new primary.
放射性骨坏死（ORN）是放射治疗的常见并发症。我们报告了文献中首例ORN累及第一和第二颈椎及枕骨的病例，该患者9年前因原发灶不明的左颈部TxN3M0鳞状细胞癌接受了手术和放射治疗。本文还简要回顾了这一病理过程的病理生理学及治疗方法。虽然下颌骨是头颈部最常受累的部位，但ORN也可能在无任何先前创伤的情况下于不寻常部位发生，并呈现隐匿但进展迅速的病程。ORN的病理生理学被认为是由辐射诱导的细胞损伤和纤维化导致的复杂代谢和内环境稳态缺陷，其特征是形成缺氧、低血运和细胞减少的组织。受照射的骨骼失去了增加代谢需求以及提供替换因日常磨损而丢失的正常胶原蛋白和细胞成分所需营养供应的能力。这导致组织分解并形成慢性不愈合伤口。感染仅起污染作用，创伤可能是起始因素。ORN的诊断始于全面的体格检查，包括纤维光学检查及对任何可疑病变进行活检，以排除肿瘤复发的可能性。ORN的治疗通常需要清除坏死骨并进行高压氧治疗。头颈外科医生必须高度怀疑，以便及时诊断ORN并尽早开始治疗。由于临床表现相似，疑似ORN初始管理中最重要的步骤是排除肿瘤复发或新发原发性肿瘤的可能性。
