多层螺旋CT对颌骨放射性骨坏死的诊断价值

目的：探讨多层螺旋CT对颌骨放射性骨坏死（ORNJ）的诊断价值。方法：回顾性分析27例经手术、病理证实为ORNJ的CT表现。结果：ORNJ在多层螺旋CT上主要表现为局限性骨质破坏和死骨形成。结论：多层螺旋CT能清楚的显示ORNJ病灶的位置、形态、病灶内的死骨形成、有无骨膜反应及软组织肿块形成等,对ORNJ的诊断及鉴别诊断有重要的价值。     

Effects of high doses of ionising radiation on bone in rats: A new model for evaluation of bone engineering

The purpose of this study was to assess the effects of high doses of ionising radiation on the histology and healing of bone in an experimental model of 12 inbred rats.     

Merits of the free periosteal femoral condyle flap in the management of advanced mandibular osteoradionecrosis

The management of advanced mandibular osteoradionecrosis (ORN) is poorly codified and requires repeated time-consuming, morbid surgical procedures. The free periosteal medial femoral condyle flap could be used for the management of extensive mandibular ORN with fracture, to avoid non-conservative surgery such as mandibulectomy. The purpose of this study was to report the authors’ experience using periosteal flaps for advanced ORN and to assess the therapeutic effectiveness of these flaps in this context. A series of 10 patients who underwent bone revascularization with a free periosteal femoral flap for the management of advanced ORN (Notani class III) is reported. The onset of bone consolidation, length of hospital stay, duration of surgery, donor site morbidity, and the option of dental rehabilitation in the event of a successful outcome were assessed. Osteogenesis was observed in 70% of cases. Thirty percent of patients benefited from dental implant rehabilitation. The mean follow-up was 73.1 months. No patient experienced any sequelae at the flap harvest site. In the authors’ opinion, the free periosteal medial femoral condyle flap appears to offer a therapeutic solution for patients with advanced stages of ORN.     

Antiseptic negative pressure instillation therapy for the treatment of septic wound healing deficits in oral and maxillofacial surgery

Introduction

Impaired wound healing, chronic wounds and extended soft tissue defects present a crucial problem in reconstructive surgery of the head and neck region, even more after radiation therapy. In such cases the standard is a prolonged open wound treatment. The negative pressure instillation therapy might present an alternative therapy option.

The value of reconstructive surgery in the management of refractory jaw osteoradionecrosis: a single-center 10-year experience

Mandibular osteoradionecrosis (mORN) is a severe complication of head and neck irradiation. International consensus on the management of mORN is currently lacking. The present study sought to evaluate the effectiveness and benefits of early reconstructive surgery (resection of the diseased bone and immediate reconstruction with a free flap) in treatment-refractory mORN. A single-center retrospective study was carried out of operations performed in a French university medical center between 2003 and 2013 inclusive. For each patient, the surgical modalities and postoperative outcomes were recorded. A total of 55 operations (19 marginal resections and 36 segmental resections) were performed, and the overall success rate was 92.3%. Relative to marginal resections, segmental resections were associated with longer operating times (440 ± 62 min vs. 531 ± 72 min, respectively; P < 0.05 in Student’s t-test), a longer length of hospital stay (16.5 ± 6.5 days vs. 25.6 ± 11.3 days, respectively; P < 0.05), and a higher complication rate (26.3% vs. 63.9%, respectively; P < 0.05 in Fisher’s test). Given the unpredictable progression of treatment-refractory mORN and the risk–benefit ratio observed here, the value of early reconstructive surgery with curative intent should be reassessed.     

Symptom distress and interference among cancer patients with osteoradionecrosis of jaw: A cross-sectional study

ObjectiveOsteoradionecrosis of the jaws (ORNJ) is among the most serious oral complications of head and neck cancer treatment with radiation therapy. This study aimed to examine the level of symptom distress and interference of ORNJ in head and neck cancer patients in China.MethodsA cross-sectional study was conducted to profile patient reported symptom severity. Ninety-five hospitalized ORNJ patients were recruited. Participants completed the MD Anderson Symptom Inventory–Head and Neck Module-Chinese version.ResultsThe percentage of participants who reported that they experienced at least one type of symptom was 97.9%, and 85.2% patients reported interference. The 10 most severe symptoms were as follows: limited mouth opening, problem with teeth/gums, difficulty swallowing/chewing, dry mouth, oral malodor, difficulty with voice/speech, dental ulcer, tinnitus/ear obstruction, skin pain/burning/rash, and difficulty hearing. The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy. The interference of patients positively correlated with core symptoms (r = 0.612), head and neck symptoms (r = 0.709), and ORNJ symptoms (r = 0.440) (P< 0.01). The longer time to the onset of ORNJ after radiotherapy was positively and significantly correlated with symptom distress (r = 0.479, P< 0.001), and mouth opening correlated negatively with symptom distress (r = −0.298, P = 0.003).ConclusionsORNJ patients suffered mainly from limited mouth opening and other maxillofacial symptoms. The problem of limited mouth opening was more severe in patients with longer time to onset of ORNJ after radiotherapy. ORNJ patients commonly had symptom distress, which influenced their quality of life.     

507例放射性颌骨坏死回顾性分析及临床新分期的建立：单一中心20年经验

目的通过回顾性分析放射性颌骨坏死（ORNJ）的临床表现,探讨建立一种可更好地指导临床治疗和预后风险评估的新分期。 方法选择中山大学附属口腔医院1993年3月至2014年10月ORNJ手术病例共507例,根据软组织和骨组织破坏程度,结合长期的临床经验以及对国内外ORNJ分期的总结,提出基于软组织（T）和骨组织（B）破坏程度的"TB"临床新分期,进一步分析不同新分期病损与患者手术情况、手术效果及预后的关系。 结果按"TB"新分期,Ⅰ期55例（10.85%）、Ⅱ期174例（34.32%）、Ⅲ期180例（35.50%）、Ⅳ期98例（19.33%）。Ⅰ、Ⅱ期病例主要采取死骨刮治术、扩大摘除或颌骨方块切除术,Ⅲ、Ⅳ期患者主要采用颌骨节段性切除,部分病例予同期组织瓣包括游离血管化腓骨肌皮瓣转移修复术。不同分期患者手术治疗后均获得较好效果。术后最常见的并发症为手术部位感染（19.92%）和伤口裂开（13.41%）。极少数出现皮瓣坏死、吸入性肺炎甚至死亡等严重并发症。按新分期划分,越严重的患者预后越差,围手术期并发症发生率越高,Ⅰ~Ⅳ期病例围手术期并发症的发生率分别为9.09%、25.86%、30.00%和53.06%。 结论成功建立了一种基于软硬组织破坏程度的"TB"新分期,该分期可更好地用于指导ORNJ临床治疗和预后风险评估。     

肌成纤维细胞与颌骨放射性骨坏死

颌骨放射性骨坏死（osteoradionecrosis of jaw,ORNJ）是口腔颌面-头颈部恶性肿瘤放疗术后严重的并发症。迄今为止,其病因机制尚未完全明确,最新学说认为ORNJ是由放射诱导纤维萎缩机制形成,即放疗区域的软硬组织经放疗后发生一系列变化,形成病理性纤维化组织,最后,这些纤维化组织坏死崩解,导致ORNJ发生。肌成纤维细胞在肝、肺、肾及硬皮病等纤维化发生过程中起着重要作用,是否也在ORNJ过程中起着同样重要的作用还有待证实。本文就ORNJ病因机制学说,肌成纤维细胞的特征、肌成纤维细胞与成纤维细胞的联系及区别,肌成纤维细胞与ORNJ做一综述。