Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
Department of Oral & Maxillofacial - Head & Neck Oncology, 9th People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Key Laboratory of Stomatology, Shanghai, China.
Int J Oral Maxillofac Surg. 2020 Mar;49(3):411-419. doi: 10.1016/j.ijom.2019.06.015. Epub 2019 Jul 26.
Osteoradionecrosis of the mandible (MORN) is one of the most devastating complications caused by radiation therapy in the head and neck region. It is characterized by infection and chronic necrosis of the mandible as the main manifestation. Clinically, MORN-related symptoms include swelling, pain, dysphagia, trismus, masticatory or speech disorders, refractory orocutaneous fistula, bone exposure, and even pathological fracture. MORN has become a challenging clinical problem for oral and maxillofacial surgeons to deal with, but thus far, this problem has not been solved due to the lack of widely accepted treatment algorithms or guidelines. Because of the nonexistence of standardized treatment criteria, most clinical treatment against MORN nowadays is largely based on controversial empirical understandings, while recommendations on post-therapeutic evaluations are scarce. Therefore, to further unify and standardize the diagnosis and treatment of MORN, to decrease the huge waste of medical resources, and ultimately, to improve the wellbeing of the patients, the Chinese Society of Oral and Maxillofacial Surgery (CSOMS) convened an expert panel specialized in MORN from 16 domestic medical colleges and affiliated hospitals to discuss the spectrum of diagnosis and and formulate treatment. In addition, consensus recommendations were also revised with a comprehensive literature review of the previous treatment experiences and research pearls. This 'expert consensus statement on diagnosis and clinical management of MORN' is for clinical reference.
下颌骨放射性骨坏死(MORN)是头颈部放射治疗后最严重的并发症之一。其特征为感染和慢性下颌骨坏死,主要临床表现为肿胀、疼痛、吞咽困难、牙关紧闭、咀嚼或言语障碍、难治性口皮瘘、骨暴露,甚至病理性骨折。MORN 已成为口腔颌面外科医生面临的一个具有挑战性的临床问题,但迄今为止,由于缺乏广泛接受的治疗方案或指南,这个问题尚未得到解决。由于缺乏标准化的治疗标准,目前大多数针对 MORN 的临床治疗在很大程度上基于有争议的经验性认识,而关于治疗后评估的建议则很少。因此,为了进一步统一和规范 MORN 的诊断和治疗,减少医疗资源的巨大浪费,最终提高患者的生活质量,中华口腔医学会(CSOMS)召集了来自国内 16 所医学院校及其附属医院的 MORN 专家小组,专门针对 MORN 的诊断和治疗进行了讨论。此外,还结合以往的治疗经验和研究成果,对共识建议进行了修订和完善。本“下颌骨放射性骨坏死诊断及临床治疗专家共识”仅供临床参考。