Martín L Pingarrón, Gallo L J Arias, Pons M Chamorro, Soto M J Morán, Carretero J L Cebrián, García M Burgueño
Department of Oral and Maxillofacial Surgery, La Paz University Hospital, Madrid, Spain.
Craniomaxillofac Trauma Reconstr. 2010 Jun;3(2):91-5. doi: 10.1055/s-0030-1254380.
Mandibular osteoradionecrosis is a serious complication of radiotherapy that often leads to severe facial deformity, intolerable pain, fracture, sequestration of devitalized bone and fistulas. The prophylaxis of this severe complication is a major goal in modern combined tumor therapy, but once the pathology is established, conservative treatment modalities are used in almost all patients in an effort to control progression. Radical surgery should only be instituted when conservative methods fail or when severe bone and soft-tissue necrosis prevails. Pathologic fractures and chronic fistulae are clear indicators for radical surgical management. This paper document a case report of severe bilateral mandibular osteoradionecrosis reconstructed with two sequencial osteocutaneous fibular free flap. The authors discuss the different alternatives of treatment and the most important steps for a successful management of this challenge.
下颌骨放射性骨坏死是放疗的一种严重并发症，常导致严重的面部畸形、难以忍受的疼痛、骨折、坏死骨分离和瘘管形成。预防这种严重并发症是现代肿瘤综合治疗的主要目标，但一旦病理情况确定，几乎所有患者都会采用保守治疗方法以控制病情进展。只有在保守方法失败或出现严重骨和软组织坏死时才应进行根治性手术。病理性骨折和慢性瘘管是根治性手术治疗的明确指征。本文记录了一例采用连续两个游离腓骨骨皮瓣修复严重双侧下颌骨放射性骨坏死的病例报告。作者讨论了不同的治疗方案以及成功应对这一挑战的最重要步骤。
