Journal of Prevention and Treatment for Stomatological Diseases ›› 2019, Vol. 27 ›› Issue (7): 409-416.DOI: 10.12016/j.issn.2096-1456.2019.07.001

• Expert Forum • Previous Articles     Next Articles

Difficulties and prevention and management of serious complications in surgical treatment of osteoradionecrosis of jaw

HOU Jinsong(),ZHANG Yadong   

  1. Department of Oral and Maxillofacial Surgery, Guanghua School of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou 510055, China
  • Received:2019-01-02 Revised:2019-03-06 Online:2019-07-20 Published:2019-07-24
  • Contact: Jinsong HOU

放射性颌骨坏死手术难点与严重并发症的预防和处理

侯劲松(),张亚东   

  1. 中山大学附属口腔医院口腔颌面外科·光华口腔医学院·广东省口腔医学重点实验室,广东 广州 (510055)
  • 通讯作者: 侯劲松
  • 基金资助:
    国家自然科学基金项目(81572660);广东省自然科学基金项目(2015A03031303);中山大学5010计划项目(067009)

Abstract:

Osteoradionecrosis of the jaw (ORNJ) is a common complication after radiotherapy for head and neck malignant tumors. Surgery is the main treatment method for ORNJ with large lesions. In the case of serious maxillofacial and cervical soft and hard tissue damage caused by radiation, surgical treatment may have some difficulties and risks. In this paper, we discuss the main points for indication selection and treatment as well as surgical difficulties and their causes, including local inflammation and radiation injury during the operation, timing of bone defect reconstruction, condylar preservation, selection of recipient vessels, implant bed treatment, common complications of ORNJ operations (i.e., wound healing and nerve injury), severe complications (i.e., vascular crisis and tissue flap necrosis), pulmonary infection, cerebral pulmonary embolism, important vascular rupture, and severe psychological trauma, including its prevention and treatment. This information will enable clinicians to fully understand the various difficulties and risks that may be encountered during the ORNJ operation and will minimize serious complications, ensure the life, health and safety of the patients, and provide a reference for improvement of the clinical efficacy of ORNJ treatment.

Key words: osteoradionecrosis of the jaw, reconstruction of bone defect, vascularized fibular myocutaneous flap, microsurgery, CAD/CAM, soft tissue fibrosis, condyle, complications

摘要:

放射性颌骨坏死(osteoradionecrosis of the jaw,ORNJ)是头颈部恶性肿瘤放射治疗后的常见并发症,手术是治疗病变范围较大ORNJ的主要手段。在放射线对颌面部及颈部软硬组织损伤较为严重的情况下,ORNJ的手术处理存在一些特殊的困难和风险。本文对治疗ORNJ的不同术式适应证的选择和治疗要点;手术难点及其原因,包括局部炎症和放射线损伤对手术造成的困难、骨缺损重建时机、髁突是否保留、受区血管选择、受植床处理;ORNJ术后常见并发症如创口不愈和神经损伤,ORNJ术后严重并发症如缺损修复重建时的血管危象和组织瓣坏死、肺部感染、脑肺栓塞、重要血管破裂、以及严重心理创伤的预防和处理进行初步介绍,以便临床医生对ORNJ手术可能遇到的各种困难和风险有充分认识,从而最大限度地减少严重并发症,保障患者生命健康和安全,为提高ORNJ临床疗效提供参考。

关键词: 放射性颌骨坏死, 骨缺损重建, 血管化腓骨肌皮瓣, 显微外科, CAD/CAM, 软组织纤维化, 髁突, 并发症

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