Pitak-Arnnop P, Sader R, Dhanuthai K, Masaratana P, Bertolus C, Chaine A, Bertrand J-C, Hemprich A
Department of Maxillofacial Surgery, Faculty of Medicine, Pitié-Salpêtrière University Hospital, University Paris 6, Pierre et Marie Curie, Paris, France.
Eur J Surg Oncol. 2008 Oct;34(10):1123-34. doi: 10.1016/j.ejso.2008.03.014. Epub 2008 May 5.
To review and discuss the management of jaw bone osteoradionecrosis (JORN) based on levels of evidence.
The Medline/PUBMED and Cochrane search was performed to identify all studies on the management of JORN, published in English, French, and German during January 1975-October 2007. Only clinical researches were identified and classified into four levels of evidence before being examined. All references of the retrieved articles were analysed.
Seventy three articles and their additional 45 citations were evaluated. Most of the eligible literature provided observational evidence. Hyperbaric oxygen therapy (HBOT) is an adjunct; however, its clinical usefulness remains controversial. A conservative approach should be limited to early-onset JORN, while radical surgery is indicated for an advanced or refractory lesion. Free tissue transfer is the reconstruction of choice for large defects without the need of HBOT. Some new technologies have also been studied, including ultrasound, biological molecules, distraction osteogenesis and antioxidant agents.
Most of the reports on the treatment of JORN offer weak evidence. Current information seems insufficient for establishing the definite treatment guideline; thus, well-designed studies with long-term clinical data are encouraged.
基于证据水平对颌骨放射性骨坏死（JORN）的治疗进行综述和讨论。
检索Medline/PUBMED和Cochrane数据库，以识别1975年1月至2007年10月期间发表的所有关于JORN治疗的英文、法文和德文研究。仅纳入临床研究，并在审查前将其分为四个证据水平。对检索到的文章的所有参考文献进行分析。
评估了73篇文章及其另外45篇引用文献。大多数合格文献提供的是观察性证据。高压氧治疗（HBOT）是一种辅助治疗方法，但其临床实用性仍存在争议。保守治疗应限于早期JORN，而对于晚期或难治性病变则应进行根治性手术。游离组织移植是无需HBOT的大型缺损重建的首选方法。还研究了一些新技术，包括超声、生物分子、牵张成骨和抗氧化剂。
大多数关于JORN治疗的报告证据不足。目前的信息似乎不足以确立明确的治疗指南；因此，鼓励开展具有长期临床数据的精心设计的研究。
