Wanifuchi Satoshi, Akashi Masaya, Ejima Yasuo, Shinomiya Hirotaka, Minamikawa Tsutomu, Furudoi Shungo, Otsuki Naoki, Sasaki Ryohei, Nibu Ken-Ichi, Komori Takahide
Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-1, Chuo-ku, Kobe, 650-0017, Japan.
Department of Radiation Oncology, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-1, Chuo-ku, Kobe, 650-0017, Japan.
Oral Maxillofac Surg. 2016 Dec;20(4):337-342. doi: 10.1007/s10006-016-0570-5. Epub 2016 Jul 11.
This retrospective study aimed to analyze the relationship between tooth extraction and osteoradionecrosis (ORN) occurrence. The irradiation field, dose, and time interval between radiotherapy (RT) and ORN were reviewed. We also discuss appropriate guidelines for prophylactic tooth extraction.
A total of 33 patients treated for grade ≥2 (clinical) ORN in our department from 2002 to 2014 were enrolled. The following epidemiological data were retrospectively gathered: age, sex, histological diagnosis, primary tumor sites, radiation dose, chemotherapy, site of ORN, relationship between tooth extraction and ORN occurrence, and time interval between tooth extraction and the initiation or end of RT.
Twenty-one percent of ORN cases resulted from tooth extraction. The most common site of ORN (82 %) was the mandibular molar region. About half of ORN cases (49 %) occurred within 2 years after RT. All patients who received tooth extraction after RT developed ORN (100 %) independently of time interval between tooth extraction and the end of RT (median interval, 37.5 months; range, 27-120 months). In contrast, only 50 % of patients who received tooth extraction before RT developed ORN. There may have been an association between the irradiation field and the site of ORN development CONCLUSIONS: ORN occurrence due to tooth extraction was 21 %. Occurrence timing of ORN did not depend on time interval between tooth extraction and the end of RT. The irradiation field is certainly related to the site of ORN; therefore, prophylactic tooth extraction should be performed in consideration of the proposed radiation field and dose.
本回顾性研究旨在分析拔牙与放射性骨坏死（ORN）发生之间的关系。对放疗（RT）与ORN之间的照射野、剂量和时间间隔进行了回顾。我们还讨论了预防性拔牙的适当指导原则。
纳入2002年至2014年在我科接受治疗的33例≥2级（临床）ORN患者。回顾性收集以下流行病学数据：年龄、性别、组织学诊断、原发肿瘤部位、放射剂量、化疗、ORN部位、拔牙与ORN发生之间的关系以及拔牙与RT开始或结束之间的时间间隔。
21%的ORN病例由拔牙引起。ORN最常见的部位（82%）是下颌磨牙区。约一半的ORN病例（49%）发生在RT后2年内。所有在RT后拔牙的患者均发生ORN（100%），与拔牙和RT结束之间的时间间隔无关（中位间隔，37.5个月；范围，27 - 120个月）。相比之下，RT前拔牙的患者中只有50%发生ORN。照射野与ORN发生部位之间可能存在关联。结论：拔牙导致的ORN发生率为21%。ORN的发生时间不取决于拔牙与RT结束之间的时间间隔。照射野肯定与ORN部位有关；因此，应根据拟议的照射野和剂量进行预防性拔牙。
