一种新的放射性颌骨坏死的临床分类分期—120例临床分析

目的:探讨颌骨放射性骨坏死的临床特征、治疗方法、分类及分期。方法:采用BS分类及分期,对我院口腔颌面-头颈肿瘤科2003年1月—2013年1月10 a间收治的120例放射性颌骨坏死患者临床资料进行回顾分析。结果:下颌骨发生骨坏死的病例明显多于上颌骨及上、下颌骨,分别为99例、14例及7例。累计放疗剂量区间为35～148 Gy,中位剂量为68.1 Gy, 69(57.5%)例患者剂量大于60 Gy。大多数患者骨坏死发生在放疗后1～2 a内(64.2%),少数发生在放疗5 a以后(20.0%)。按BS分类,Stage Ⅰ期患者为0例;Stage Ⅱ期患者16(13.3%)例,主要采用单纯死骨刮治及单纯死骨扩大切除术(14例);Stage Ⅲ期患者92(76.7%)例,71例患者采用死骨扩大切除术,其中47例同期行血管化组织瓣修复;Stage Ⅳ期患者12(10.0%)例,主要采用死骨扩大切除联合同期血管化组织瓣修复(10例)。结论:放射性颌骨坏死以单侧下颌骨最多见,并以体部及部分下颌支最为好发,大多数患者骨坏死发生在放疗后1～2 a。死骨扩大切除联合同期血管化组织瓣修复是目前最好的治疗方法。     

放射性颌骨坏死局部病灶菌群分析及药物敏感性研究

目的研究放射性颌骨坏死（ORN）局部病灶的细菌类型及药物敏感性,为临床合理使用抗菌药物提供客观依据。 方法收集2012年11月5日至2015年9月10日于中山大学附属口腔医院口腔颌面外科就诊的ORN患者局部病灶渗出液标本共106份,送检进行细菌培养和抗菌药物敏感性试验,分析检出菌群的类型和药敏试验结果。 结果106份送检标本中31份（29.2%）无细菌生长,75份（70.8%）分离培养出细菌。培养出细菌的标本中,双重和多重感染14份（13.2%）,单菌种感染61份（57.5%）;所有有菌标本共分离出病原菌36种（95株）,其中需氧菌25种（78株）、厌氧菌11种（17株）,分别占比69.4%和30.6%。药敏试验发现,细菌对利奈唑胺、万古霉素、亚胺培南、美罗培南、阿米卡星、哌拉西林+他唑巴坦最敏感。对红霉素、克林霉素、氨苄西林、头孢唑林、阿奇霉素、克拉霉素等耐药比例较高。 结论ORN局部病灶细菌谱分布广泛,呈现出菌群多样性,且部分患者为无菌性坏死,因此临床上有必要根据细菌培养和药敏试验结果指导用药,避免抗菌药物的盲目使用。     

Radiation necrosis of the mandible: A 10 year study. Part I. Factors influencing the onset of necrosis

Of 404 patients who were irradiated for cancer in the oral region between 1971 and 1975, 19.1 % developed radiation necrosis of the mandible. Three main effects, anatomic tumor site, tumor dose, and dental status, were found to have a statistically significant effect on incidence of necrosis. Necrosis was also found to occur more frequently in association with an implant than with treatment administered by an external radiation source alone. The T-stage of the tumor did not appear to affect the incidence of necrosis. Necrosis incidence was also studied over two time periods- 1966-1%9 (study I) and 1971–1975 (study II). Differences between the two periods were found in the primary etiological groupings. Necrosis attributed to spontaneous or unknown cause increased in the second study, while that associated with dental extractions before irradiation decreased. Fewer teeth were extracted before radiation therapy in study If than in study 1. Less necrosis followed mandibular surgery for recurrent disease in study II than study 1.     

颌骨放射性骨坏死的临床病理分析

目的：研究近年来颌骨放射性骨坏死（ＯＲＮＪ）病例的临床和病理特点，为进一步提高防治水平提供参考。方法：对１９９１年以来我科收治的２６例ＯＲＮＪ病例就临床表现和病理特点诸方面进行总结分析。结果：半数以上病例照射总剂量超过８０Ｇｙ，２３例（８８．４％）有明确创伤感染史。组织病理学检查反映出ＯＲＮＪ病变时期下牙槽动脉并未闭塞，病变四周的骨髓腔内仍可见活跃的新骨生成，毛细血管增殖。结论：高剂量放射是当前临床ＯＲＮＪ发病的显著特点，创伤与感染仍是ＯＲＮＪ发病的重要因素。组织病理学检查结果进一步解释了一些诸如Ｘ线检查、核素骨显像上ＯＲＮＪ病灶及周围密度增高影、放射线浓聚等重要临床征象。     

Lateralized lesions of the oral cavity and oropharynx treated in part with the electron beam.

This review analyzes the results of electron beam treatment of suitable lesions of the oral cavity and oropharynx in 125 patients. A high percentage of control is achieved in lateralized squamous cell carcinomas of the oral cavity and oropharynx by using the electron beam combined with high energy photons or with interstitial therapy. The ultimate failure rates were 5.2% for anterior faucial pillar and retromolar trigone lesions, 11% for buccal mucosa lesions, and 13.3% for gingival lesions. The ultimate failure rates were 17% for patients treated with the electron beam alone and 6.8% for patients treated with the mixed beam. A surgical procedure provided salvage in 25 of 35 patients who had recurrences.     

Osteoradionecrosis after treatment of head and neck cancer: a comprehensive analysis of risk factors with a particular focus on role of dental extractions

In head and neck cancer (HNC), osteoradionecrosis (ORN) is one of the most significant complications of radiotherapy (RT). With an absence of effective non-surgical treatment, prevention of the development of ORN is the best approach. The purpose of this study was to identify the risk factors for the development of ORN in HNC. Records of 1,118 patients with HNC treated with radical RT (≥55Gy) from January 2010 to December 2019 were reviewed. After applying the exclusion criteria, 935 patients were included in the final analysis. In patients with confirmed ORN, exact RT doses were mapped. In total, 91 patients were found (9.7%) with a median (range) time of eight (3-89) months to the development of ORN. Smoking, having a primary site in the oropharynx, bone surgery before adjuvant RT, the addition of concurrent chemotherapy, the presence of xerostomia, dental extraction pre-RT, the time ≤20 days between dental extraction and start of RT, and receiving >55Gy RT dose were significant factors for its development. This comprehensive analysis including the precise RT dose mapping has shown the risk factors for the development of ORN. In practice, every effort should be made to avoid these risk factors without compromising the oncology treatment. The findings of this analysis may provide a basis for future prospective research on this topic.     

National and international guidelines on the replacement of missing teeth with dentures for head and neck cancer patients post-radiotherapy: A rapid review

BackgroundReplacement of missing teeth is not a straightforward task in head and neck cancer (HNC) patients post-radiotherapy. There is debate regarding the best way to care for these patients as it has been reported that using dentures by HNC patients after receiving treatment with radiotherapy might initiate the development of osteoradionecrosis.AimThis rapid review aimed to collate and compare the national and international guidelines for the use of dentures following radiotherapy for HNC patients.Materials and methodsThree steps were included in data collection of this rapid review (first step; identification of dental and relevant non-dental associations/societies, second step, identification of national and international guidelines regarding the dental management of HNC patients, and third step; identification of recommendations about the replacement of missing teeth in HNC patients).ResultsIn the 193 countries recognized by the United Nations, there were 238 relevant societies found, from those 175 confirmed that they do not have clear guidelines. Only 32 associations/societies (all in either Europe and North America) recommend guidelines for their dentists (N = 12 guidelines) about the dental management of HNC patients and show their position regarding the use of dentures for HNC patients after receiving treatment with radiotherapy.ConclusionsThere are very few guidelines and those that do exist differ, lack detail, and rarely go beyond routine advice. Accordingly, clear, detailed, and evidence-based guidelines are required to inform the management of patients with missing teeth following radiotherapy for HNC patients.     

Radiation-induced osteoradionecrosis of the ribs in a patient with breast cancer: A case report

Osteoradionecrosis of the chest wall after radiation therapy for breast cancer is rare; however, it is one of the most severe complications of radiation treatment. Radiologically, osteoradionecrosis can manifest as a focal lucent area in bone, periostitis, sclerosis, and cortical irregularity of bones on X-ray or computed tomography; therefore, differentiation from bone metastasis can be challenging. Associated insufficiency fractures, ulceration, and skin necrosis may also occur. We encountered a patient with osteoradionecrosis in the left anterior ribs after radiation therapy for breast cancer. Chest computed tomography revealed cortical irregularity with severe sclerotic changes of the anterior arc of the left fist to the fourth ribs. The patient''s skin on the left chest wall exhibited ulceration with purulent discharge. Ultrasonography of the left chest wall revealed diffuse skin thickening with hyperechoic changes in the subcutaneous fat layer of the left chest wall with calcifications. The patient underwent rib resection and chest wall reconstruction. Recognizing characteristic imaging features of osteoradionecrosis is important for radiologists to differentiate it from bone metastasis and plan appropriate treatment.