Osteocutaneous Free Tissue Transplantation for Mandibular Osteoradionecrosis
Osteocutaneous Free Tissue Transplantation for Mandibular Osteoradionecrosis
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DOI：
10.1055/s-0032-1326731
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发表时间：
2013-01-01
影响因子：
2.1
通讯作者：
Chepeha, Douglas B.
中科院分区：
文献类型：
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作者：
Chandarana, Shamir P.;Chanowski, Eric J. P.;Chepeha, Douglas B.
目的探讨骨皮游离组织移植治疗4级下颌骨放射性骨坏死（ORN）的成功率、并发症和功能结局。设计回顾性病例系列。设置三级保健学术医疗中心。患者12例，男8例，女4例，平均年龄57.6岁。3例（25%）患者有初次放疗史，2例（17%）患者有同期放化疗史，7例（58%）患者有术后辅助放疗史。10名患者（83%）曾接受过大消融手术治疗原发肿瘤，5名患者（50%）在ORN发病前接受过游离组织移植重建。干预措施：1999年至2006年间，所有4级下颌骨ORN患者均行骨皮游离组织移植重建。主要观察指标：下颌ORN治疗成功；主要、次要和晚期并发症；胃造口管（g管）依赖性；语言和吞咽得分。结果8例（73%）可评估患者成功治疗4级下颌ORN。1例患者（8%）在12个月评估前死于第二原发肿瘤。8例患者（67%）有严重并发症，3例（25%）有轻微并发症，9例（75%）有晚期并发症。5名依赖g管的患者中有3名在下颌骨重建之前能够停止使用g管。8名成功治疗的患者中有7名通过口腔维持营养。“液体范围”评分中位数为6/6（范围为4至6）。“固体范围”得分中位数为4/6（范围3至6）。“言语可理解性”得分中位数为4/5（范围从2到5）。结论：8例可评估患者（73%）通过骨皮游离组织移植成功治疗了4级下颌骨ORN。在成功治疗的患者中，语言/吞咽中位评分功能良好，但剩余的放射软组织导致较高的局部伤口并发症和饮食改变。
Objective To describe the success rate, complications, and functional outcomes of patients who are treated with osteocutaneous free tissue transplantation for grade 4 mandibular osteoradionecrosis (ORN).Design Retrospective case series.Setting Tertiary care academic medical center.Patients Twelve patients (8 males, 4 females; mean age, 57.6 years) with grade 4 mandibular ORN. Three patients (25%) had a history of primary radiotherapy, two (17%) had previous concurrent chemoradiation, and seven (58%) had undergone postoperative adjuvant radiotherapy. Ten patients (83%) had previous major ablative surgery to treat the primary tumor and five (50%) had been reconstructed with a free tissue transplant prior to the onset of ORN.Interventions All patients underwent reconstruction with an osteocutaneous free tissue transplant for grade 4 mandibular ORN between 1999 and 2006.Main Outcome Measures Successful treatment of mandibular ORN; major, minor, and late complications; gastrostomy tube (G-tube) dependence; speech and swallowing scores.Results Grade 4 mandibular ORN was successfully treated in eight (73%) evaluable patients. One patient (8%) died of a second primary tumor before the 12-month assessment. Eight patients (67%) had a major complication, three (25%) had a minor complication, and nine (75%) had a late complication. Three of the five G-tube-dependent patients prior to mandibular reconstruction were able to discontinue the use of their G-tube. Seven of the eight successfully treated patients maintained their nutrition by mouth. Median "range of liquids" score was 6/6 (range, 4 to 6). Median "range of solids" score was 4/6 (range, 3 to 6). Median "understandability of speech" score was 4/5 (range, 2 to 5).Conclusions Grade 4 mandibular ORN was treated successfully with an osteocutaneous free tissue transfer in eight evaluable patients (73%). In successfully treated patients, median speech/swallowing scores were highly functional, but the remaining radiated soft tissue resulted in higher local wound complications and a modified diet.