Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia.
Sydney Head and Neck Cancer Institute, Chris O'Brien Lifehouse, Sydney, New South Wales, Australia; Sydney Medical School, Faculty of Medicine and Health Sciences, University of Sydney, Sydney, New South Wales, Australia; Department of Otolaryngology - Head and Neck Surgery, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, New South Wales, Australia.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2023 Aug;136(2):128-135. doi: 10.1016/j.oooo.2022.12.002. Epub 2022 Dec 17.
Osteoradionecrosis (ORN) of the jaw is a potentially devastating consequence of head and neck irradiation. Despite recent advances, there are patients who fail to respond to conventional therapies. Historically, free flaps were reserved for advanced cases requiring segmental resection and composite reconstruction, with early and intermediate disease treated more conservatively. We have adopted a more active surgical approach in selected intermediate cases.
A retrospective review of patients with intermediate stage ORN who received debridement and either fascio-cutaneous or fascio-periosteal free flap reconstruction was performed. Demographic data, ORN severity, treatment, and outcomes are described.
From 2019, 9 cases in 7 patients were identified. All cases were Notani grade II. There were 6 Epstein stage IIa and 3 Epstein stage IIIa. The mandible was the most common site (n = 8). Of the 7 patients, 2 had oropharyngeal primaries treated with chemoradiation, and 5 had oral cavity primaries treated with surgery and adjuvant radiation therapy. Three patients had prior hyperbaric oxygen therapy, and 2 had pentoxifylline/tocopherol therapy. After debridement, the radial forearm, ulnar artery perforator, and antero-lateral thigh fascio-cutaneous free flaps were each used in 1 case and the temporoparietal fascio-periosteal free flap was used in 6 cases. There was no recurrence or progression of ORN at the site of surgery, but 2 patients developed additional sites of ORN.
For patients with unresponsive intermediate ORN, debridement and soft tissue free flap reconstruction is an alternative to ongoing conservative management or composite resection and reconstruction.
颌骨放射性骨坏死（ORN）是头颈部放疗的一种潜在破坏性后果。尽管最近取得了进展，但仍有一些患者对常规治疗反应不佳。历史上，游离皮瓣仅保留用于需要节段切除和复合重建的晚期病例，而早期和中期疾病则采用更为保守的治疗方法。我们在选择的中期病例中采用了更为积极的手术方法。
对接受清创术和筋膜皮瓣或筋膜骨膜游离皮瓣重建的中期 ORN 患者进行回顾性研究。描述了人口统计学数据、ORN 严重程度、治疗和结果。
自 2019 年以来，共确定了 7 名患者的 9 例病例。所有病例均为 Notani Ⅱ级。有 6 例 Epstein Ⅱa 期和 3 例 Epstein Ⅲa 期。下颌骨是最常见的部位（n=8）。7 名患者中，2 例为口咽原发灶，行放化疗；5 例为口腔原发灶，行手术和辅助放疗。3 例患者曾接受高压氧治疗，2 例患者接受过己酮可可碱/生育酚治疗。清创后，桡侧前臂、尺动脉穿支、前外侧大腿筋膜皮瓣分别应用于 1 例，颞顶筋膜骨膜游离皮瓣应用于 6 例。手术部位无 ORN 复发或进展，但有 2 例患者出现了其他部位的 ORN。
对于反应不佳的中期 ORN 患者，清创术和软组织游离皮瓣重建是持续保守治疗或复合切除和重建的替代方法。
