Department of Otolaryngology - Head and Neck Surgery, University of Miami, Miami, Florida, USA.
Surgical Care Division, Miami Veterans Affairs Health Care System, Miami, Florida, USA.
Head Neck. 2024 Nov;46(11):2824-2833. doi: 10.1002/hed.27824. Epub 2024 Jun 7.
Head and neck osteoradionecrosis (ORN) of the midface requiring free flap (FF) reconstruction is uncommon. This multi-institutional study was designed to review outcomes for this rare patient population.
Retrospective multi-institutional review of FF reconstruction for midface ORN (2005-2022; n = 54).
The FF survival rate was 87% (n = 54). Patients were less likely to be tolerating a regular diet at 3 months postoperative if they had a preoperative history of prior head and surgery (80% vs. 95%; p = 0.02), a pathologic fracture (50% vs. 90%; p = 0.04), exposed bone intraorally (43% vs. 94%; p = 0.002), or a fistula (67% vs. 96%; p = 0.03). Mean albumin was higher in patients whose FF survived (3.6 ± 0.5 vs. 2.7 ± 1.4; p = 0.03). Patients with low prealbumin were more likely to undergo a hematoma evacuation (27% vs. 0%; p = 0.02).
In this series of midface ORN requiring FF reconstruction preoperative nutritional status impacted postoperative complications. Preoperative occurrence of a fistula, pathologic fracture, and intraoral bone exposure correlated with decreased tolerance of a regular diet following reconstruction.
需要游离皮瓣（FF）重建的头颈部颌骨放射性骨坏死（ORN）较为少见。本多机构研究旨在回顾这一罕见患者群体的治疗结果。
回顾性多机构研究 2005 年至 2022 年期间 FF 重建治疗颌骨 ORN（n=54）的病例。
FF 存活率为 87%（n=54）。如果患者术前有头颈部手术史（80% vs. 95%；p=0.02）、病理骨折（50% vs. 90%；p=0.04）、口腔内暴露骨（43% vs. 94%；p=0.002）或瘘管（67% vs. 96%；p=0.03），则患者在术后 3 个月更难以耐受常规饮食。存活的 FF 患者的平均白蛋白水平更高（3.6±0.5 vs. 2.7±1.4；p=0.03）。低前白蛋白的患者更有可能接受血肿清除术（27% vs. 0%；p=0.02）。
在本系列需要 FF 重建的颌骨 ORN 病例中，术前营养状况影响术后并发症。术前瘘管、病理骨折和口腔内骨暴露与重建后常规饮食耐受不良相关。
