Osteoradionecrosis of the jaws: Clinical characteristics and relation to the field of irradiation
Osteoradionecrosis of the jaws: Clinical characteristics and relation to the field of irradiation
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DOI：
10.1053/joms.2000.9562
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发表时间：
2000-10-01
影响因子：
1.9
通讯作者：
Bastholt, L
中科院分区：
文献类型：
--
作者：
Thorn, JJ;Hansen, HS;Bastholt, L
目的：研究颌骨放射性骨坏死(ORN)患者的临床特点，探讨ORN的范围与照射野的关系。临床研究人员根据全景X线片绘制了ORN范围图，并与肿瘤学家绘制的照射野图进行了比较。还记录了病变的诊断、分期、位置、治疗计划以及放射治疗的时间和剂量。结果：ORN患者的吸烟习惯与其他头颈癌患者相似。在ORN时，10%的患者被诊断为新的原发肿瘤或复发。只有3例患者的累积剂量低于60Gy.超过一半的病例是由拔牙引发的；然而，三分之一是自发发生的。74%的ORN发生在最初的3年内；但ORN可以在放射治疗后的无限年数内创伤性地出现。广泛性的ORN除了口腔粘膜的离散性裂开外，可能没有任何症状。ORN的好发部位为下颌磨牙区。结论：由于许多ORN病例无症状，应在放射治疗后的随访中更多地关注黏膜裂开，以便早期发现ORN。几乎所有的ORN病例都位于照射范围内，再加上经常拔牙是引发因素，这应该会导致在照射范围内对牙科病理学采取更积极的照射前治疗方法。(C)2000年美国口腔和颌面外科医生协会。
Purpose: This study focuses on the clinical characteristics of patients with osteoradionecrosis (ORN) of the jaws and on the relation between the extent of the ORN and the field of irradiation.Patients and Methods: The study group consisted of 80 patients referred for treatment of ORN. Charts of the extent of ORN, based on panoramic radiographs, were drawn by the clinical investigator and compared with charts of the field of irradiation drawn by the oncologists. Also recorded was diagnosis of the lesion, stage, location, treatment schedule, and period and dose of irradiation. Also documented were various potential initiating factors for ORN.Results: Smoking habits of ORN patients were similar to those of other patients with head and neck cancer. A new primary tumor or a recurrence was diagnosed in 10% of the patients at the time of ORN. Only 3 patients had received accumulated doses of less than 60 Gy. More than half of the cases were initiated by removal of teeth; however, one third occurred spontaneously. ORN developed within the first 3 years in 74%; but ORN can emerge on a traumatic basis for an infinite number of years after radiation therapy. Widespread ORN may be symptomless apart from a discrete dehiscense of the oral mucosa. The predilection site for ORN is the mandibular molar region. All cases of ORN but 1 were found in the field of radiation.Conclusion: Because many ORN case are symptomless, more focus on mucosal dehiscence in the follow-up after radiation therapy is advocated in an effort to detect ORN at an early stage. The consequence of practically all ORN cases being located in the field of irradiation, together with tooth removal frequently being the initiating factor, should lead to a more aggressive preirradiation approach to dental pathology located within the field of radiation. (C) 2000 American Association of Oral and Maxillofacial Surgeons.