需要节段性下颌骨切除术的放射性骨坏死的预测因素：一项描述性研究。

Predictive factors of osteoradionecrosis necessitating segmental mandibulectomy: A descriptive study.

机构信息

Attending Staff, Division of Maxillofacial Surgery & Hospital Dentistry, Harbor-UCLA Medical Center, Torrance, CA, USA; Lecturer, UCLA School of Dentistry, Los Angeles, CA, USA.

Professor, Department of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.

出版信息

Oral Surg Oral Med Oral Pathol Oral Radiol. 2022 Jul;134(1):e8-e13. doi: 10.1016/j.oooo.2021.08.024. Epub 2021 Sep 3.

DOI:10.1016/j.oooo.2021.08.024

PMID:34758937

Abstract

OBJECTIVE

The objective of this study was to assess characteristics of patients with mandibular osteoradionecrosis (ORN) of severity necessitating segmental mandibulectomy and osteocutaneous free flap reconstruction.

STUDY DESIGN

This study is a retrospective review of patients who underwent free flap reconstruction of the mandible at the UCLA Medical Center between January 2016 and February 2020 secondary to ORN.

RESULTS

Twenty-nine charts with detailed dental and medical records were identified. Hypertension was reported in 14 of 29 patients, diabetes in 2 of 29, osteoporosis in 2 of 29, antiresorptive use in 3 of 29, tobacco use in 15 of 29, and alcohol use in 19 of 29. Twenty-three patients initially had stage III-IV cancer. The median radiation dose was 68 Gy and median time to ORN was 5.2 years. Chemotherapy was given in 21 patients and 4 had previous mandibular surgery. Twelve of 29 patients had surgical procedures identified as the causative factor and 17 of 29 occurred spontaneously. Median decayed, missing, and filled teeth score was 17 and 17 of 29 patients had grade II-IV periodontitis. Periodontitis was present in 8 of 17 of spontaneous and 1 of 12 of surgery cases. Twenty-five of 29 cases occurred in the same oral sextant as the tumor.

CONCLUSION

Severe ORN occurred at doses >60 Gy in most cases. Location of the primary tumor was predictive of site of ORN and only molars were involved when precipitated by tooth extraction. Risk of ORN persists indefinitely.

摘要

目的

本研究旨在评估需要进行下颌骨节段性切除术和骨皮瓣游离重建的下颌骨放射性骨坏死（ORN）患者的特征。

研究设计

本研究回顾性分析了 2016 年 1 月至 2020 年 2 月期间在加利福尼亚大学洛杉矶分校医疗中心因 ORN 接受游离皮瓣重建下颌骨的患者。

结果

共确定了 29 份有详细牙科和病历记录的图表。29 例患者中，14 例有高血压，2 例有糖尿病，2 例有骨质疏松症，3 例使用抗吸收药物，15 例有吸烟史，19 例有饮酒史。23 例患者最初患有 III-IV 期癌症。中位放射剂量为 68Gy，中位 ORN 发生时间为 5.2 年。21 例患者接受了化疗，4 例患者有先前的下颌骨手术史。29 例患者中有 12 例手术被认为是致病因素，17 例是自发性的。29 例患者的平均龋齿、缺失和补牙数为 17，29 例患者中有 17 例患有 II-IV 级牙周炎。自发性病例中有 8 例（17 例中的 8 例）和手术病例中有 1 例（12 例中的 1 例）存在牙周炎。29 例中有 25 例发生在与肿瘤相同的口腔六区。