Manimaran K, Sankaranarayanan S, Ravi V R, Elangovan S, Chandramohan M, Perumal S Mahendra
Department of Oral and Maxillofacial Surgery, K.S.R. Institute of Dental Science and Research, Tiruchengode, India.
Director, Mothercell Regenerative Centre, Trichy, Tamil Nadu, India.
Ann Maxillofac Surg. 2014 Jul-Dec;4(2):189-92. doi: 10.4103/2231-0746.147130.
Osteoradionecrosis (ORN) is a noninfectious, necrotic condition of the bone occurring as a complication of radiotherapy. Most cases occur following trauma or surgical manipulation of the irradiated site. Mandible is the most common bone to be affected following head and neck irradiation. The aim was to develop a successful therapeutic approach for ORN. A spectrum of treatment modalities is practiced for ORN with variable success rate that includes simple irrigation of the affected bone to the partial or complete resection of the jaw bone. In this paper, we present two cases which had successful therapeutic approach for ORN of mandible with autologous bone marrow concentrate stem cells and allogeneic dental pulp stem cells (DPSC) with platelet rich plasma (PRP) following failure of conventional methods. Autologous bone marrow aspirate concentrate (BMAC) was injected around the socket and into the periosteum for one case, and DPSC were mixed with tricalcium phosphate and inserted at the site of the defect in one case. The patient treated with BMAC remained asymptomatic and complete bone remodeling was noticed after 1 year. The extraoral sinus was excised, and healing was uneventful without recurrence in the patient treated with allogeneic DPSC and PRP. Periodic panoramic radiographs revealed an appreciable bone formation from the 2(nd) month onward. We have successfully treated two cases of ORN with BMAC and DPSC, respectively.
放射性骨坏死（ORN）是一种非感染性的骨坏死疾病，是放疗的并发症。大多数病例发生在受照射部位受到创伤或进行手术操作之后。下颌骨是头颈部放疗后最常受影响的骨骼。目的是开发一种成功治疗ORN的方法。针对ORN采用了一系列治疗方式，成功率各不相同，包括对受影响骨骼进行简单冲洗到颌骨的部分或完全切除。在本文中，我们介绍了两例下颌骨ORN患者，在传统方法治疗失败后，分别采用自体骨髓浓缩干细胞和异体牙髓干细胞（DPSC）联合富血小板血浆（PRP）成功治疗。其中一例将自体骨髓抽吸浓缩物（BMAC）注射到牙槽窝周围和骨膜内，另一例将DPSC与磷酸三钙混合后植入缺损部位。接受BMAC治疗的患者无症状，1年后观察到完全的骨重塑。接受异体DPSC和PRP治疗的患者，切除口外窦道后愈合顺利，无复发。定期全景X线片显示从第2个月起有明显的骨形成。我们分别用BMAC和DPSC成功治疗了两例ORN患者。
