Koga D H, Salvajoli J V, Alves F A
Department of Stomatology, Cancer Hospital A.C. Camargo, São Paulo, Brazil.
Oral Dis. 2008 Jan;14(1):40-4. doi: 10.1111/j.1601-0825.2006.01351.x.
Management of irradiated patients with cancer in the head and neck region represents a challenge for multidisciplinary teams. Radiotherapy promotes cellular and vascular decrease that results in a low response rate in the healing. Consequently, surgical procedures in irradiated tissues present high rates of complication. Osteoradionecrosis (ORN) is the most severe sequelae caused by radiotherapy. It is associated with previous extractions especially those carried out post-irradiation. The management of this side effect is difficult and can result in bone or soft tissue loss, affecting the quality of life. The literature regarding dental extractions performed before and after head and neck radiotherapy was evaluated, focusing on indications, criteria, surgical techniques and adjunctive therapies such as antibiotics and hyperbaric oxygen. Osteoradionecrosis can be minimized by oral evaluation and care prior to irradiation and healing time which allows tissue repair until the commencement of radiotherapy. In dental extractions realized after irradiation, minimal trauma, alveolectomy, primary alveolar closure and adjunctive therapies are recommended. Patients must be evaluated before radiation therapy and at that time all unrestorable teeth and/or teeth with periodontal problems must be extracted to reduce the post-radiotherapy exodontias that contribute to ORN. Once dental extractions become unavoidable after irradiation, additional care is needed.
对头颈部癌症放疗患者的管理对多学科团队而言是一项挑战。放射治疗会促使细胞数量减少和血管收缩，导致愈合反应率较低。因此，在接受过放疗的组织上进行外科手术会出现较高的并发症发生率。放射性骨坏死（ORN）是放疗引起的最严重后遗症。它与之前的拔牙尤其是放疗后进行的拔牙有关。这种副作用的处理很困难，可能导致骨质或软组织丧失，影响生活质量。对有关头颈部放疗前后拔牙情况的文献进行了评估，重点关注适应证、标准、手术技术以及抗生素和高压氧等辅助治疗方法。通过放疗前的口腔评估和护理以及留出组织修复的愈合时间直至放疗开始，可以将放射性骨坏死降至最低程度。对于放疗后进行的拔牙，建议采用微创、牙槽骨切除术、初期牙槽封闭以及辅助治疗。患者在放疗前必须接受评估，此时必须拔除所有无法修复的牙齿和/或有牙周问题的牙齿，以减少导致ORN的放疗后拔牙情况。一旦放疗后拔牙无法避免，则需要额外护理。
