Thorn J J, Hansen H S, Specht L, Bastholt L
Department of Oral and Maxillofacial Surgery, Rigshospitalet, University Hospital of Copenhagen, Denmark.
J Oral Maxillofac Surg. 2000 Oct;58(10):1088-93; discussion 1093-5. doi: 10.1053/joms.2000.9562.
This study focuses on the clinical characteristics of patients with osteoradionecrosis (ORN) of the jaws and on the relation between the extent of the ORN and the field of irradiation.
The study group consisted of 80 patients referred for treatment of ORN. Charts of the extent of ORN, based on panoramic radiographs, were drawn by the clinical investigator and compared with charts of the field of irradiation drawn by the oncologists. Also recorded was diagnosis of the lesion, stage, location, treatment schedule, and period and dose of irradiation. Also documented were various potential initiating factors for ORN.
Smoking habits of ORN patients were similar to those of other patients with head and neck cancer. A new primary tumor or a recurrence was diagnosed in 10% of the patients at the time of ORN. Only 3 patients had received accumulated doses of less than 60 Gy. More than half of the cases were initiated by removal of teeth; however, one third occurred spontaneously. ORN developed within the first 3 years in 74%; but ORN can emerge on a traumatic basis for an infinite number of years after radiation therapy. Widespread ORN may be symptomless apart from a discrete dehiscense of the oral mucosa. The predilection site for ORN is the mandibular molar region. All cases of ORN but 1 were found in the field of radiation.
Because many ORN case are symptomless, more focus on mucosal dehiscence in the follow-up after radiation therapy is advocated in an effort to detect ORN at an early stage. The consequence of practically all ORN cases being located in the field of irradiation, together with tooth removal frequently being the initiating factor, should lead to a more aggressive preirradiation approach to dental pathology located within the field of radiation.
本研究聚焦于颌骨放射性骨坏死（ORN）患者的临床特征，以及ORN范围与照射野之间的关系。
研究组由80例因ORN前来治疗的患者组成。临床研究者根据全景X线片绘制ORN范围图表，并与肿瘤学家绘制的照射野图表进行比较。还记录了病变的诊断、分期、位置、治疗方案以及照射时间和剂量。同时记录了ORN的各种潜在诱发因素。
ORN患者的吸烟习惯与其他头颈癌患者相似。在诊断ORN时，10%的患者被诊断出有新的原发性肿瘤或复发。只有3例患者接受的累积剂量小于60 Gy。超过一半的病例是由拔牙引发的；然而，三分之一是自发发生的。74%的病例在放疗后的前3年内发生ORN；但放疗后数年，ORN也可能因创伤而出现。除口腔黏膜有离散性裂开外，广泛的ORN可能没有症状。ORN的好发部位是下颌磨牙区。除1例之外，所有ORN病例均在照射野内发现。
由于许多ORN病例没有症状，因此提倡在放疗后的随访中更多关注黏膜裂开情况，以便早期发现ORN。几乎所有ORN病例都位于照射野内，且拔牙常为诱发因素，这一结果应促使对位于照射野内的牙科病变采取更积极的放疗前处理方法。
