Wongmanee Sombat, Chotipanich Adit
Department of Otolaryngology, Head and Neck Surgery, Chonburi Cancer Hospital, Chonburi, THA.
Cureus. 2023 Jan 10;15(1):e33628. doi: 10.7759/cureus.33628. eCollection 2023 Jan.
Objectives Osteoradionecrosis is one of the most severe complications in patients with head and neck cancer, which is characterized by persistent exposed and devitalized bone without proper healing after radiation. The extent to which mandibulotomy and marginal mandibulectomy influence the occurrence of osteoradionecrosis remains unclear. This study evaluated the incidence and risk factors for developing osteoradionecrosis of the mandible after oral cancer treatments. Methods A retrospective study was performed to analyze medical records of patients who underwent surgery and postoperative radiotherapy for oral cancers from 2009 to 2019 at a tertiary care hospital. Patient characteristics, incidence, and risk factors for developing osteoradionecrosis were reviewed. Comparisons between continuous and categorical data were performed using t-test and Chi-squared test. Cox regression analysis was used to assess the association between factors and the development of osteoradionecrosis. Results Among the 61 patients included in the study, osteoradionecrosis of the mandible occurred in 9 of 32 (28.1%) patients who underwent mandibular surgery during oral cancer resection (marginal mandibulectomy and/or mandibulotomy) and 2 of 29 (6.9%) patients without mandibular surgery. The development of osteoradionecrosis was significantly associated with performing mandibular surgery (hazard ratio 4.64, 95% confidence interval: 1.002, 21.5) and HIV infection (hazard ratio 8.53, 95% confidence interval: 2.2, 33.3). In the subgroup analysis of mandibular surgery, the development of osteoradionecrosis significantly increased in patients undergoing mandibulotomy (hazard ratio 6.62, 95% confidence interval: 1.3, 34.8) but not in patients undergoing marginal mandibulectomy (hazard ratio 3.56, 95% confidence interval: 0.6, 22.0). The analysis also showed that concurrent chemoradiation, radiation doses ≥ 60 Gy, and smoking were potential risk factors for the development of osteoradionecrosis, but none of these factors were statistically significant. Conclusion Our findings suggest that mandibular surgery is a significant risk factor for the development of osteoradionecrosis in patients with oral cancer. Further studies including larger population sizes are required to verify these findings.
目的 放射性骨坏死是头颈癌患者最严重的并发症之一，其特征为放疗后持续存在暴露且无活力的骨组织，无法正常愈合。下颌骨切开术和下颌骨边缘切除术对放射性骨坏死发生的影响程度尚不清楚。本研究评估了口腔癌治疗后下颌骨放射性骨坏死的发生率及危险因素。方法 进行一项回顾性研究，分析2009年至2019年在一家三级护理医院接受口腔癌手术及术后放疗患者的病历。回顾患者的特征、放射性骨坏死的发生率及危险因素。连续数据和分类数据的比较分别采用t检验和卡方检验。采用Cox回归分析评估各因素与放射性骨坏死发生之间的关联。结果 在纳入研究的61例患者中，32例在口腔癌切除术中接受下颌骨手术（下颌骨边缘切除术和/或下颌骨切开术）的患者中有9例（28.1%）发生下颌骨放射性骨坏死，29例未接受下颌骨手术的患者中有2例（6.9%）发生。放射性骨坏死的发生与进行下颌骨手术（风险比4.64，95%置信区间：1.002，21.5）及HIV感染（风险比8.53，95%置信区间：2.2，33.3）显著相关。在下颌骨手术的亚组分析中，接受下颌骨切开术的患者放射性骨坏死的发生率显著增加（风险比6.62，95%置信区间：1.3，34.8），而接受下颌骨边缘切除术的患者则未增加（风险比3.56，95%置信区间：0.6，22.0）。分析还表明，同步放化疗、放疗剂量≥60 Gy及吸烟是放射性骨坏死发生的潜在危险因素，但这些因素均无统计学意义。结论 我们的研究结果表明，下颌骨手术是口腔癌患者发生放射性骨坏死的一个重要危险因素。需要开展包括更大样本量的进一步研究来验证这些发现。
