放射性颌骨坏死的防治

Prevention and treatment of osteoradionecrosis of the jaws

放射性颌骨坏死是头颈部放疗后的一种严重并发症,主要特征为颌骨慢性坏死及感染,临床表现为局部疼痛、张口受限、语言障碍、吞咽困难、死骨暴露、面颈部软组织瘘管经久不愈,严重者甚至出现颌骨病理性骨折,给患者的身心带来巨大的痛苦,成为颌面外科及头颈外科领域的临床难题。放射性颌骨坏死其发病机理尚不明确,但放疗高剂量、放疗后拔牙及手术创伤等是公认的高危风险因素;确诊放射性颌骨坏死需结合患者放疗病史、临床症状和体症以及影像学检查;治疗主要根据其临床分类分期选择相应的保守或手术治疗;放射性颌骨坏死的预防重点在于放疗前拔除龋齿、残根、残冠,提高放疗技术,针对其高危因素采取预防措施。近年来,放射性颌骨坏死的诊治逐步走向规范化、个体化,本文将从放射性颌骨坏死的定义、病因学及危险因素、诊断和治疗、预防等方面,对目前国内外放射性颌骨坏死的治疗和研究进展作一评述,以期对临床治疗提供参考。

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 restriction,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 radiotherapy 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 surgical treatment should be selected according to its clinical classification and stages,and the prevention of radiation-induced 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 treatment.