下颌骨放射性骨坏死临床诊疗专家共识

Expert consensus statement on diagnosis and clinical management of osteoradionecrosis of mandible

下颌骨放射性骨坏死(osteoradionecrosis,ORN)是头颈部大剂量放疗后的一种严重并发症,常以慢性坏死及感染为主要特征,临床表现为局部红肿、疼痛、吞咽困难、开口受限、咀嚼及语言障碍、面部软组织瘘管经久不愈、死骨暴露,严重者甚至造成病理性骨折,给患者的身心带来巨大痛苦,已成为口腔颌面外科及头颈外科领域棘手的临床难题。迄今为止,国内外对于下颌骨ORN缺乏统一的分类、分期及相关治疗共识或指南,不同单位对于下颌骨ORN的诊治水平参差不齐,缺乏统一科学的诊疗标准与规范,对该疾病的处理仍以个人或单位经验作为治疗依据,同时也缺乏客观有效的下颌骨ORN治疗后评价体系。为进一步统一和规范下颌骨ORN的诊疗标准,减少医疗资源的浪费,提高治疗效果,中华口腔医学会口腔颌面外科专业委员会召集国内颌骨放射性骨坏死研究领域的专家进行反复讨论,汇集全国17家著名医学院校及附属医院专家的诊治意见,同时借鉴和参考国内外近年来对下颌骨ORN的研究成果与诊治经验,最终制订"下颌骨放射性骨坏死临床诊疗专家共识",供临床医师参考。

Osteoradionecrosis （ORN） of mandible is one of the most devastating complications caused by radiation therapy in the head and neck region. It is characterized by infection and chronic necrosis of mandible as the main manifestation. Clinically, ORN of mandible related symptoms include swelling, pain, dysphagia, trismus, masticatory or speech disorder, refractory orocutaneous fistula, bone exposure, and even pathological fracture. ORN of mandible has become a challenging clinical problem for oral and maxillofacial surgeons to deal with. But so far, this problem has not been solved due to the lack of widely accepted treatment algorithms or guidelines. Since the nonexistence of standardized treatment criteria, most clinical treatment against ORN of mandible nowadays is largely based on controversial empirical understandings, while recommendations on post-therapeutic evaluations are scarce. Therefore, to further unify and standardize the standard of diagnosis and treatment of mandibular ORN, to decrease the huge waste of medical resources, and ultimately, to improve the wellbeing of the patients, the Chinese Society of Oral and Maxillofacial Surgery （CSOMS） convened an expert panel specialized in ORN of mandible from 17 famous domestic medical colleges and affiliated hospitals to discuss and formulate about the spectrum of diagnosis and treatment. In addition, consensus recommendations were also revised with a comprehensive literature review of the previous treatment experiences and research pearls. This ＂expert consensus statement on diagnosis and clinical management of osteoradionecrosis of mandible＂ is for clinical references.