Ma Chunyue, Gao Weijin, Liu Zhonglong, Zhu Dan, Zhu Fengshuo, Li Xiaoguang, He Yue
Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Oral and Maxillofacial Surgery, First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
Front Oncol. 2021 Apr 28;11:641061. doi: 10.3389/fonc.2021.641061. eCollection 2021.
Radiation-induced soft-tissue injuries (STIs) in mandibular osteoradionecrosis (ORN) are not well studied regarding their correlations with nearby bone lesions. The aim of this study is to investigate the severity of radiation-induced STIs in advanced mandibular ORN and its relationship with hard-tissue damage and postoperative outcomes.
A retrospective study was performed in our institution from January 2017 to December 2019. Aside from demographic factors, the associations between the triad ORN variables (irradiation doses, ORN stages, ORN sizes) and radiation-related STI factors, vascular characteristics, and postoperative functional recovery were assessed. In addition, the severity of STI was also compared with treatment outcomes. Such correlations were established both univariate and multivariable analyses.
A total number of 47 patients were included. The median follow-up reached 27 months. Nasopharyngeal cancer was the histology type among most patients (n = 21, 44.7%). The median irradiation doses reached 62 Gy (range, 40-110 Gy). For STI, the symptom scoring equaled an average of 5.4 (range from 1 to 12), indicative of the severity of STI problems. During preoperative MRI examinations, signs of hypertrophy or edema (n = 41, 87.2%) were frequently discerned. Most patients (n = 23, 48.9%) also had extensive muscular fibrosis and infection, which required further debridement and scar release. Surprisingly, most STI factors, except cervical fibrosis (p = 0.02), were not in parallel with the ORN levels. Even the intraoperative soft-tissue defect changes could not be extrapolated by the extent of ORN damage (p = 0.096). Regarding the outcomes, a low recurrence rate (n = 3, 6.9%) was reported. In terms of soft tissue-related factors, we found a strong correlation (p = 0.004) between symptom scores and recurrence. In addition, when taking trismus into consideration, both improvements in mouth-opening distance (p < 0.001) and facial contour changes (p = 0.004) were adversely affected. Correlations were also observed between the intraoperative soft-tissue defect changes and complications (p = 0.024), indicative of the importance of STI evaluation and management.
The coexistence of hard- and soft-tissue damage in radiation-induced advanced mandibular ORN patients reminds surgeons of the significance in assessing both aspects. It is necessary to take the same active measures to evaluate and repair both severe STIs and ORN bone lesions.
关于下颌骨放射性骨坏死（ORN）中辐射诱导的软组织损伤（STIs）与附近骨病变的相关性，目前尚未得到充分研究。本研究旨在调查晚期下颌骨ORN中辐射诱导的STIs的严重程度及其与硬组织损伤和术后结果的关系。
2017年1月至2019年12月在本机构进行了一项回顾性研究。除人口统计学因素外，评估了ORN三联征变量（照射剂量、ORN分期、ORN大小）与辐射相关的STI因素、血管特征和术后功能恢复之间的关联。此外，还将STI的严重程度与治疗结果进行了比较。通过单变量和多变量分析建立了此类相关性。
共纳入47例患者。中位随访时间达27个月。大多数患者（n = 21，44.7%）的组织学类型为鼻咽癌。中位照射剂量达62 Gy（范围40 - 110 Gy）。对于STI，症状评分平均为5.4（范围1至12），表明STI问题的严重程度。术前MRI检查时，肥大或水肿迹象（n = 41，87.2%）经常被发现。大多数患者（n = 23，48.9%）还存在广泛的肌肉纤维化和感染，需要进一步清创和松解瘢痕。令人惊讶的是，除颈部纤维化外（p = 0.02），大多数STI因素与ORN水平并不平行。即使术中软组织缺损变化也不能通过ORN损伤程度推断（p = 0.096）。关于结果，报告的复发率较低（n = 3，6.9%）。在软组织相关因素方面，我们发现症状评分与复发之间存在强相关性（p = 0.004）。此外，考虑到牙关紧闭时，开口距离的改善（p < 0.001）和面部轮廓变化（p = 0.004）均受到不利影响。术中软组织缺损变化与并发症之间也存在相关性（p = 0.024），表明STI评估和管理的重要性。
辐射诱导的晚期下颌骨ORN患者硬组织和软组织损伤并存，提醒外科医生评估这两个方面的重要性。对严重的STIs和ORN骨病变采取同样积极的评估和修复措施是必要的。
