Ristow Oliver, Birgel Jan Lukas, Rückschloß Thomas, Held Thomas, Lang Kristin, Smielowski Maximilian, Zittel Sven, Moratin Julius, Pilz Maximilian, Engel Michael, Hoffmann Jürgen, Semmelmayer Karl
Department of Oral and Cranio-Maxillofacial Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany.
Department of Radiation Oncology, Heidelberg University Hospital, Im Neuenheimer Feld 400, D-69120 Heidelberg, Germany.
Diagnostics (Basel). 2023 Jan 18;13(3):366. doi: 10.3390/diagnostics13030366.
Surgical therapy of osteoradionecrosis of the jaw (ORN) is challenging and requires treatment of the affected hard and soft tissue. To understand how tissue injury after irradiation influences surgical outcomes, the objective of this study was to find out whether (a) bone-related, (b) soft tissue-related, and (c) treatment-related parameters influence the surgical success of patients with ORN. A total of 175 patients (324 lesions) were included in this retrospective, single-center study. All patients were diagnosed with ORN and underwent surgical therapy. The primary outcome was complete soft tissue recovery (mucosa/skin) and the absence of symptoms 3 months after surgery. At the time of follow-up, 58% of patients (189 of 324 lesions) had intact intraoral or extraoral soft tissue. The extent of bone destruction had no effect on treatment success, whereas soft tissue injury due to fibrosis (OR: 0.344; CI 0.142-0.834; = 0.01818) and xerostomia (OR: 0.163; CI 0.064-0.419; = 0.00016) increased the probability of treatment failure. Soft tissue reconstruction with a microvascular graft improved therapeutic success compared to local wound closure (OR: 2.998; CI 1.371-6.555; = 0.006). Thus, for the treatment of ORN, it is extremely important to pay attention not only to the extent of bone destruction but especially to soft tissue defects. Because the extent of soft tissue injury is a predictor for therapeutic success, it should influence the choice of surgical treatment.
颌骨放射性骨坏死（ORN）的手术治疗具有挑战性，需要对受影响的硬组织和软组织进行治疗。为了解放疗后组织损伤如何影响手术效果，本研究的目的是确定（a）与骨相关的、（b）与软组织相关的以及（c）与治疗相关的参数是否会影响ORN患者的手术成功率。本项回顾性单中心研究共纳入了175例患者（324个病灶）。所有患者均被诊断为ORN并接受了手术治疗。主要结局是术后3个月软组织完全恢复（黏膜/皮肤）且无症状。在随访时，58%的患者（324个病灶中的189个）口腔内或口腔外软组织完整。骨破坏程度对治疗成功没有影响，而纤维化导致的软组织损伤（OR：0.344；CI 0.142 - 0.834；P = 0.01818）和口干（OR：0.163；CI 0.064 - 0.419；P = 0.00016）增加了治疗失败的可能性。与局部伤口缝合相比，采用微血管移植进行软组织重建可提高治疗成功率（OR：2.998；CI 1.371 - 6.555；P = 0.006）。因此，对于ORN的治疗，不仅要关注骨破坏程度，尤其要关注软组织缺损，这极为重要。由于软组织损伤程度是治疗成功的预测指标，它应影响手术治疗的选择。
