Buccinator Myomucosal Flap for Treatment of Osteoradionecrosis of the Mandible

The use of a myomucosal flap from the buccinator muscle is a valuable reconstruction method for intraoral defects. In this paper, we report the clinical advantages of using a buccinator myomucosal flap for the treatment of partial mandibular defects caused by osteoradionecrosis. We implemented a buccinator myomucosal flap for the reconstruction of a partial mandibular defect in a 55-year-old man with tonsil cancer and partial mandibular defects caused by osteoradionecrosis. The total operating time was 90 minutes. Twelve months after the reconstruction, the patient remains free of disease. A buccinator myomucosal flap can be used for the reconstruction of partial mandibular defects caused by osteoradionecrosis. It is a reliable method for reconstructing small mandibular defects.     

放射性骨坏死微血管铸型的动物实验

目的 观察颌骨放射性骨坏死（ＯＲＮＪ）病变时颌骨内微血管系统的病理损害,探讨ＯＲＮＪ的病理发生机制。方法 采用＾６０Ｃｏ对１０只狗右侧颌面部进行６０￣８０Ｇｙ照射,并于照射后３、６个月拔牙,通过定期局部观察、Ｘ线摄片和组织病理学方法诊断ＯＲＮＪ的发生,并对其进行颌骨的微血管铸型检测。结果 放疗后１２个月先后有７例发生了ＯＲＮＪ。血管铸型标本除１例病变广泛、波及下牙槽动脉造成其闭塞外,其余６例下牙槽     

鼻咽癌放射治疗后颅底骨坏死的诊断和治疗

目的　探讨鼻咽癌放射治疗 (简称放疗 )后颅底放射性骨坏死的诊断和治疗 ,提高本病的诊治水平。方法　对 15例确诊的鼻咽癌颅底骨坏死患者的资料、临床症状及体征、治疗方式等特点进行分析与总结。结果　颅底放射性骨坏死的常见症状为恶臭、头痛和鼻衄 ;内镜表现为鼻咽坏死 ,可见骨质裸露或死骨形成。CT特征性表现 :骨破坏广泛而对称或局限 ;骨体的表面裸露在气腔中 ;有死骨形成 ;软组织内见小气泡。 9例局限性颅底骨坏死手术治疗 ,2例死于放射性颞叶坏死 ,生存 7例 ,生存时间 2～ 7年。 5例广泛颅底骨坏死和 1例局限性颅底骨坏死保守治疗 ,3例死于鼻咽大出血 ,1例死于呼吸循环衰竭 ,生存 2例 ,生存时间 3～ 5年。结论　颅底骨坏死根据症状结合CT或磁共振成像 (magneticresonanceimaging ,MRI)及内镜特征可作出临床诊断 ,确诊须病理证实 ;手术治疗效果最佳。广泛颅底骨坏死伴放射性脑损伤或颅神经损伤者预后较差 ,鼻咽大出血及衰竭为主要死因     

Systematic Management of Osteoradionecrosis in the Head and Neck

Objectives: Osteoradionecrosis is one of the most serious and devastating complications of radiotherapy. The proper management of osteoradionecrosis is currently undetermined. The objective of this study is to evaluate the treatment results of a systematic approach to osteoradionecrosis. Study Design: A prospective study of a systematic approach to osteoradionecrosis in the head and neck area was undertaken. Methods: From July 1993 to June 1998, 33 cases of osteoradionecrosis in the head and neck area were treated using a systematic approach that combined sequestrectomy and hyperbaric oxygen therapy. Results: Seven (21%) had recurrent cancer. The control rate of the other 26 osteoradionecrosis cases was 77% (20/26). Conclusions: Persistent osteoradionecrosis, despite diligent radical treatment, raises the suspicion of recurrent cancer. Extensive osteoradionecrosis with a multiple discharging fistula, a large area of exposed necrotic bone, or a coexistent fracture should be treated primarily with radical sequestrectomy and microvascular free flap reconstruction. Surgery still plays a major role in controlling osteoradionecrosis, and hyperbaric oxygen therapy is adjuvant.     

鼻咽癌放疗后颅底骨感染坏死的治疗体会

目的 探讨鼻咽癌放疗后颅底放射性骨坏死(ORN)的临床处理策略。 方法 收集11例确诊为鼻咽癌ORN的病历资料,分析其临床表现、诊断、治疗及预后特点。 结果 7例鼻咽部放射性骨坏死(NORN)患者中(其中3例合并上颌骨坏死),2例于术后1年分别因颅内感染、肺部感染死亡,其余5例生存患者中,3例感染控制,骨质坏死未见扩大(1例随访5年,1例随访3年,1例随访1年),2例骨坏死范围均有不同程度扩大(1例随访1年,1例随访8个月)。4例颞骨放射性骨坏死(TORN),其中3例为局限性,1例术腔完全上皮化(随访3年),2例术腔间断性渗出(分别随访1年、2年),上述3例均未发现有明显的骨质坏死扩大现象。另1例为广泛性坏死,最终死于颈内动脉破裂大出血。11例中有3例行责任血管栓塞治疗。 结论 鼻咽癌放射治疗后引起的颅底骨感染坏死病情复杂,早期积极采用内镜下彻底清除坏死骨质是治疗该病的有效途径。责任血管栓塞既可避免突发大出血,降低死亡率,又能降低手术风险,彻底清理坏死灶。     

31例放射性颌骨骨坏死(ORN)回顾性研究

目的:探讨放射性颌骨骨坏死(ORN)发病诱因及治疗手段。方法:对1995~2005年南京口腔医院颌面外科收治31例放射性颌骨骨坏死患者临床资料进行回顾性分析。结果:1)31例患者中患者原发头颈肿瘤来自鼻咽癌15例、腭癌5例、颊癌3例,余为咽、舌、口底、唾液腺癌等各1例。2)31例ORN患者接受放疗剂量由4 500~8 500 cGY。3)31例ORN患者下颌骨20例,上颌骨11例,两者之比近2∶1。4)高压氧 抗生素 创面死骨刮治术18例,抗生素 病灶搔刮术6例,抗生素 死骨切除术4例,单纯抗生素治疗3例。5)随诊痊愈17例,症状改善6例,死亡3例,失访5例。结论:1)放射性颌骨骨坏死(ORN)发病诱因同放疗剂量有关,7 000 cGY为临界点,统计结果存在显著性差异。2)下颌骨ORN与颌骨骨质结构、解剖位置以及体积有关。3)高压氧辅助抗生素控制感染,对于ORN仍是较为有效的治疗手段。     

Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment

During the past 80 years a number of theories about the pathogenesis of osteoradionecrosis (ORN) have been proposed, with consequent implications for its treatment. Until recently tissue hypoxia and its consequences were accepted as the primary cause, and this led to the use of hyperbaric oxygen (HBO) for both treatment and prevention of complications of radiotherapy in the head and neck. The benefit of HBO has not been validated. A new theory for the pathogenesis of ORN has proposed that damage to bone is caused by radiation-induced fibrosis. Cells in bone are damaged as a result of acute inflammation, free radicals, and the chronic activation of fibroblasts by a series of growth factors. New treatments have therefore been devised that include pentoxifylline, a vasodilator that also inhibits fibrosis, and tocopherol (vitamin E) to reduce damage caused by free radicals. Impressive results in terms of reversing the process of ONR have been reported using these agents. It has been suggested that this theory and these agents could be the basis of future treatment and prevention of ORN.