Journal of Prevention and Treatment for Stomatological Diseases ›› 2019, Vol. 27 ›› Issue (3): 143-152.doi: 10.12016/j.issn.2096-1456.2019.03.002

• Expert Forum • Previous Articles     Next Articles

Prevention and treatment of osteoradionecrosis of the jaws

HE Yue(),LI Xiaoguang   

  1. Department of Oral Maxillofacial-Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine; National Clinical Research Center for Oral Disease; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology,Shanghai 200011, China;
  • Received:2018-08-23 Revised:2018-09-26 Online:2019-03-20 Published:2019-03-20
  • Contact: Yue HE E-mail:william5218@126.com

Abstract:

Radioactive jaw necrosis is a serious complication of head and neck radiotherapy. This complication's main characteristics are chronic necrosis and infection, and its clinical manifestations are local pain, mouth opening re'striction, speech disorder, dysphagia, exposure of dead bone, prolonged healing of facial and neck soft tissue fistula, and even pathological fracture, which brings great pain to the patient's body and mind. Radioactive jaw necrosis has become a clinical problem in the field of medicine, specifically for maxillofacial surgery of the external head and neck. The pathogenesis of radiation-induced jaw necrosis is still unclear, but high radiotherapy dose, extraction of teeth after radio-therapy and surgical trauma are recognized as high-risk factors. The diagnosis of radiation-induced jaw necrosis needs to be combined with the patient's radiotherapy history, clinical symptoms and imaging examination. Conservative or sur-gical treatment should be selected according to its clinical classification and stages, and the prevention of radiation-in- duced jaw necrosis should be emphasized. The key points are to remove dental caries, residual roots and crowns before radiotherapy; improve radiotherapy technology; and take preventive measures against high-risk factors. In recent years, the diagnosis and treatment of radiation-induced jaw necrosis has gradually become standardized and individualized.This article reviews the progress of treatment and research on radiation-induced jaw necrosis at home and abroad in terms of its definition, etiology, risk factors, diagnosis, treatment and prevention to provide reference for clinical treat-ment.

Key words: Osteoradionecrosis, Osteoradionecrosis of the jaws, Mandible, Reconstruction, Speech disorder, Radiotherapy, Chemotherapy

CLC Number: 

  • R782

Figure 1

Clinical manifestations of ORNJ"

Figure 2

Imaging features of ORNJ"

Table 1

The BS classification and stage of ORNJ"

分类 分期
骨质破坏(Bone destruction ) B0:影像学上仅有轻微骨密度改变 Stage 0 B0S0
B1:影像学上骨坏死病变区 ≤ 2.0 cm StageⅠ B1S0,B1S1,B1S2
B2:影像学上骨坏死病变区 > 2.0 cm StageⅡ B2S0,B2S1,B2S2
B3:病理性骨折 Stage Ⅲ B3S0,B3S1,B3S2
软组织损伤(Soft tissue injury ) S0:皮肤黏膜放疗后改变,但无破损
S1:黏膜或皮肤破损
S2:黏膜和皮肤破损

Table 2

The BS classification-stage and corresponding treatments"

分期 BS分类 治疗策略
Stage 0 B0S0 保守治疗
Stage Ⅰ B1S0,B1S1,B1S2 病灶刮除术/边缘性切除术
Stage Ⅱ B2S0,B2S1,B2S2 边缘性切除术/截骨+血管化骨瓣
Stage Ⅲ
B3S0,B3S1,B3S2
截骨+血管化骨瓣/截骨+软组织瓣/截骨后不修复
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