Manzano Brena Rodrigues, Santaella Natália Garcia, Oliveira Marco Aurélio, Rubira Cássia Maria Fischer, Santos Paulo Sérgio da Silva
Departament of Surgery, Stomatology, Pathology and Radiology, Bauru School of Dentistry, University of São Paulo, Bauru, Brazil.
J Korean Assoc Oral Maxillofac Surg. 2019 Feb;45(1):21-28. doi: 10.5125/jkaoms.2019.45.1.21. Epub 2019 Feb 26.
Osteoradionecrosis (ORN) is one of the most severe complications resulting from radiotherapy (RT) in patients with head and neck cancer (HNC). It is characterized by persistent exposed and devitalized bone without proper healing for greater than 6 months after a high dose of radiation in the area. To describe the profile and dental management of ORN in HNC patients undergoing RT in an oncological clinical research center.
A retrospective descriptive study was performed to analyze dental records from HNC patients with ORN treated at an oncological clinical research center from 2013 to 2017. A total of 158 dental records for HNC patients were selected from a total of 583 records. Afterwards, this number was distributed to three examiners for manual assessments. Each examiner was responsible for selecting dental records that contained an ORN description, resulting in 20 dental records.
Mean patient age was 60.3 years with males being the most affected sex (80.0%). The most affected area was the posterior region of the mandible (60.0%) followed by the anterior region of the mandible (20.0%) and the posterior region of the maxilla (10.0%). The factors most associated with ORN were dental conditions (70.0%) followed by isolated systemic factors (10.0%) and tumor resection (5.0%). There was total exposed bone closure in 50.0% of cases. The predominant treatment was curettage associated with chlorhexidine 0.12% irrigation (36.0%).
Poor dental conditions were related to ORN occurrence. ORN management through less invasive therapies was effective for the closure of exposed bone areas and avoidance of infection.
放射性骨坏死（ORN）是头颈部癌（HNC）患者放疗（RT）后最严重的并发症之一。其特征是在高剂量放疗区域持续出现暴露且无活力的骨组织，超过6个月仍未正常愈合。描述在肿瘤临床研究中心接受放疗的HNC患者ORN的情况及牙科处理。
进行一项回顾性描述性研究，分析2013年至2017年在肿瘤临床研究中心接受治疗的患有ORN的HNC患者的牙科记录。从总共583份记录中选取了158份HNC患者的牙科记录。之后，将这个数字分配给三名检查人员进行人工评估。每位检查人员负责选择包含ORN描述的牙科记录，最终得到20份牙科记录。
患者平均年龄为60.3岁，男性受影响最大（80.0%）。受影响最严重的区域是下颌骨后部（60.0%），其次是下颌骨前部（20.0%）和上颌骨后部（10.0%）。与ORN最相关的因素是牙齿状况（70.0%），其次是孤立的全身因素（10.0%）和肿瘤切除（5.0%）。50.0%的病例实现了完全暴露骨闭合。主要治疗方法是刮除术联合0.12%氯己定冲洗（36.0%）。
牙齿状况不佳与ORN的发生有关。通过侵入性较小的疗法进行ORN管理对于闭合暴露骨区域和避免感染是有效的。
