Friedlander A H, Eichstaedt R M, Friedlander I K, Lambert P M
Dental Service, Veterans Affairs Medical Center, Sepulveda, CA 91343, USA.
J Oral Maxillofac Surg. 1998 Apr;56(4):455-9. doi: 10.1016/s0278-2391(98)90712-1.
Osteoradionecrosis (ORN) of the mandible has long been considered the most destructive complication of head and neck irradiation. Recently, therapeutic irradiation has been implicated as the cause of induced/accelerated atherosclerosis of the cervical carotid artery and subsequent stroke. Panoramic radiography, previously shown to be capable of identifying carotid artery atherosclerosis in nonirradiated individuals, was used to assess the carotid vasculature of patients being treated for ORN.
The panoramic radiographs of 61 men (mean age, 60.5 years; range, 41 to 77 years) who received therapeutic irradiation to the neck 36 months or more previously were assessed for the presence of carotid artery atherosclerotic lesions. Sixty-one control subjects who never received therapeutic irradiation, but who were similarly susceptible to atherosclerosis by virtue of age, were assessed in a like manner.
The irradiated individuals sustained a dose of 40 to 72 Gy to the area of the carotid bifurcation. Seventeen individuals (27.9%) with an irradiation dosage to the carotid bifurcation that averaged 59.2 Gy had a panoramic radiograph with a carotid atheroma (11 with unilateral lesions and six with bilateral lesions). The radiographs of the control subjects showed that three individuals (4.9%) had calcified carotid lesions. The mean age of these subjects was 66.1 years; two had unilateral lesions, and one had bilateral lesions. The difference in the proportion of individuals with ORN who manifested carotid artery atherosclerosis on their panoramic radiographs was statistically significant (P = .001) when compared with the nonirradiated control subjects. The lesions seen in both populations had a similar morphologic appearance and were radiographically located within the soft tissues of the neck 1.5 to 4.0 cm inferior-posterior to the angle of the mandible.
Individuals with radiation doses sufficient to cause osteoradionecrosis of the mandible are at significantly higher risk of developing carotid artery atherosclerotic lesions than age-matched, nonirradiated controls.
下颌骨放射性骨坏死（ORN）长期以来一直被认为是头颈部放疗最具破坏性的并发症。最近，治疗性放疗被认为是导致/加速颈总动脉动脉粥样硬化及随后中风的原因。全景X线摄影先前已被证明能够识别未接受放疗个体的颈动脉粥样硬化，本研究用其评估接受ORN治疗患者的颈动脉血管系统。
对61名男性（平均年龄60.5岁；范围41至77岁）的全景X线片进行评估，这些男性在36个月或更早之前接受过颈部治疗性放疗，以检查是否存在颈动脉粥样硬化病变。61名从未接受过治疗性放疗但因年龄因素同样易患动脉粥样硬化的对照者也以同样方式进行评估。
接受放疗者的颈动脉分叉区域接受了40至72 Gy的剂量。17名（27.9%）颈动脉分叉处平均照射剂量为59.2 Gy的个体，其全景X线片显示有颈动脉粥样瘤（11例为单侧病变，6例为双侧病变）。对照者的X线片显示3名个体（4.9%）有钙化的颈动脉病变。这些受试者的平均年龄为66.1岁；2例为单侧病变，1例为双侧病变。与未接受放疗的对照者相比，ORN患者全景X线片上显示颈动脉粥样硬化的个体比例差异具有统计学意义（P = .001）。两组人群中所见病变具有相似的形态外观，且在X线片上位于下颌角下方后1.5至4.0 cm处的颈部软组织内。
与年龄匹配的未接受放疗的对照者相比，接受足以导致下颌骨放射性骨坏死剂量辐射的个体发生颈动脉粥样硬化病变的风险显著更高。
