Journal of the Korean Association of Oral and Maxillofacial Surgeons

The Korean Association of Oral and Maxillofacial Surgeons (대한구강악안면외과학회)
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OSTEORADIONECROSIS ON MANDIBLE : A CASE REPORT AND LITERATURE REVIEW

하악골에 발생한 방사선골괴사증 증례보고 및 문헌고찰

  • Park, Jin-Hyuk (Department of Oral & Maxillofacial Surgery, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Shin, Sun-Ho (Department of Oral & Maxillofacial Surgery, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Lee, Su-Woon (Department of Oral & Maxillofacial Surgery, Pusan Paik Hospital, College of Medicine, Inje University) ;
  • Kim, Woo-Hyung (Department of Oral & Maxillofacial Surgery, Pusan Paik Hospital, College of Medicine, Inje University)
  • 박진혁 (인제대학교 부속 부산백병원 구강악안면외과학교실) ;
  • 신선호 (인제대학교 부속 부산백병원 구강악안면외과학교실) ;
  • 이수운 (인제대학교 부속 부산백병원 구강악안면외과학교실) ;
  • 김우형 (인제대학교 부속 부산백병원 구강악안면외과학교실)
  • Published : 2006.10.30
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Abstract

The osteoradionecrosis of the mandible can be a serious complication of radiotherapy for malignancies of the head and neck. The cause and pathogenesis of osteoradionecrosis are unclear and anecdotal. There are various treatment-, patient- and tumor-related risk factors on development of osteoradionecrosis. The treatment of osteoradionecrosis relies on conservative measures (antibiotics, debridement, irrigation and HBO) and surgical measures (sequestrectomy, marginal resection and segmental resection with or without reconstruction). But the indications are not defined. We present the two cases of patients who were not controlled by conservative treatment but good-resulted by surgical treatment.

방사선골괴사증은 발병율이 낮아지고는 있으나 발병시 여전히 치료가 힘든 합병증이다. 방사선골괴사증의 병인 및 치료에 대해서는 논쟁이 계속되고 있으나 그 과정에서 새로운 시도와 개발이 진행되고 있어 고무적이라 할 수 있다. 방사선골괴사증은 치유기전의 문제이며 임의적으로 발병할 수 있어 완전한 예방은 불가능하다. 그러나 앞서 언급한 위험요소들을 주의깊게 인지하고 방사선 치료 전 예방적인 치과치료, 조심스런 발치 및 발치 후 충분한 치유기간, 구강 위생 교육, 예방적 항생제의 사용 등을 철저히 함으로써 발병 위험을 줄일 수 있다. 이 질환은 발병시 자발적으로 치유되지 않으며 보존적 치료로 개선이 되지 않을 시에는 적절한 외과적 개입이 필수적이다. 외과적 개입시에는 방사선골괴사 병소뿐 아니라 환자의 나이, 건강상태 및 환자의 바램, 암종의 예후등도 함께 고려해야 한다. 본 교실에서는 2명의 방사선골괴사증 환자에 대해 비록 장기간의 치료가 시행되었지만 비교적 양호한 치유결과를 얻을 수 있었기에 문헌고찰과 함께 보고하는 바이다.

Keywords

References

  1. Ewing J: Radiation osteitis. Acta Radiol 1926;6:399-412 https://doi.org/10.3109/00016922609139503
  2. Teng MS, Futran ND: Osteoradionecrosis of the mandible. Curr Opin Otolaryngol Head Neck Surg 2005;13(4):217-221 https://doi.org/10.1097/01.moo.0000170527.59017.ff
  3. Schwartz HC, Kagan RK: Osteoradionecrosis of the mandible: scientific basis for clinical staging. Am J Clin Oncol 2002;25:168-171 https://doi.org/10.1097/00000421-200204000-00013
  4. Marx RE: Osteoradionecrosis: A new concept of its pathophysiology. J Oral Maxillofac Surg 1983;41:283-288 https://doi.org/10.1016/0278-2391(83)90294-X
  5. Clayman L: Clinical controversies in oral and maxillofacial surgery: part two. Management of dental extractions in irradiated jaws: a protocol without hyperbaric oxygen therapy. J Oral Maxillofac Surg 1997;55:275-281 https://doi.org/10.1016/S0278-2391(97)90542-5
  6. Annane D, Depondt J, Aubert P, et al: Hyperbaric oxygen therapy for radionecrosis of the jaw: a randomized, placebo-controlled, doubleblind trial from the ORN96 study group. J Clin Oncol 2004;22:4893-4900 https://doi.org/10.1200/JCO.2004.09.006
  7. Maier A, Gaggl A, Klemen H, et al: Review of severe osteoradionecrosis treated by surgery alone or surgery with postoperative hyperbaric oxygenation. Br J Oral Maxillofac Surg 2000;38:173-176 https://doi.org/10.1054/bjom.1999.0285
  8. Delanian S, Lefaix JL: The radiation-induced fibroatrophic process: therapeutic perspective via the antioxidant pathway. Radiother Oncol 2004;73:119-131 https://doi.org/10.1016/j.radonc.2004.08.021
  9. Reuther T, Schuster T, Mende U, Kubler A: Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumor patients: a report of a thirty year retrospective review. Int J Oral Maxillofac Surg 2003;32:289-295 https://doi.org/10.1054/ijom.2002.0332
  10. Mendenhall WM: Mandibular osteoradionecrosis. J Clin Oncol 2004;22:4867-4868 https://doi.org/10.1200/JCO.2004.09.959
  11. Studer G, Gratz KW, Glanzmann C: Osteoradionecrosis of the mandibula in patients treated with different fractionations. Strahlenther Onkol 2004;180:233-240 https://doi.org/10.1007/s00066-004-1171-z
  12. 김용각, 유현석, 곽재근, 김규영: 악골 방사선골괴사증에 관한 임상적 연구. 대구외지 1993;19(2):177-184
  13. Jereczek-Fossa BA, Orecchia R: Radiotherapy-induced mandibular bone complications. Cancer Treat Rev 2002;28:65-74 https://doi.org/10.1053/ctrv.2002.0254
  14. Curi MM, Dib LL: Osteoradionecrosis of the jaws: a retrospective study of the background factors and treatment in 104 cases. J Oral Maxillofac Surg 1997;55(6):540-544 https://doi.org/10.1016/S0278-2391(97)90478-X
  15. Notani K, Omori K, Nakamura M, et al: Management of mandibular osteoradionecrosis corresponding to the severity of osteoradionecrosis and the method of radiotherapy. Head Neck 2003;25:181-186 https://doi.org/10.1002/hed.10171
  16. Glanzmann C, Gratz KW: Radionecrosis of the mandible: a retrospective analysis of the incidence and risk factors. Radiother Oncol 1995;36:94-100 https://doi.org/10.1016/0167-8140(95)01583-3
  17. Fujita M, Hirokawa Y, Kashiwado K, et al: An analysis of mandibular bone complications in radiotherapy for T1 and T2 carcinoma of the oral tongue. Int J Radiat Oncol Biol Phys 1996;34:333-339 https://doi.org/10.1016/0360-3016(95)02066-7
  18. Beumer J, Harrison R, Sanders B, et al: Osteoradionecrosis: predisposing factors and outcomes of therapy. Head Neck Surg 1984;6:819 https://doi.org/10.1002/hed.2890060404
  19. Oh HK, Chambers MS, Garden AS, et al: Risk of osteoradionecrosis after extraction of impacted third molars in irradiated head and neck cancer patients. J Oral Maxillofac Surg 2004;62:139-144 https://doi.org/10.1016/j.joms.2003.08.009
  20. Marx RE, Ehler WJ, Tayapongsak P, Pierce LW: Relationship of oxygen dose to angiogenesis induction in irradiated tissue. Am J Surg 1990;160(5):519-524 https://doi.org/10.1016/S0002-9610(05)81019-0
  21. Bui QC, Lieber M, Withers HR, et al: The efficacy of hyperbaric oxygen therapy in the treatment of radiation-induced late side effects. Int J Radiat Oncol Biol Phys 2004;60:871-878 https://doi.org/10.1016/j.ijrobp.2004.04.019
  22. Marx RE, Johnson RP, Kline SN: Prevention of osteoradionecrosis: a randomized prospective clinical trial of hyperbaric oxygen versus penicillin. J Am Dent Assoc 1985;111:49-54 https://doi.org/10.14219/jada.archive.1985.0074
  23. Sulaiman F, Huryn JM, Slotolow IM: Dental extractions in the irradiated head and neck patient: a retrospective analysis of the Memorial Sloan-Kettering Cancer Center protocols, criteria, and end results. J Oral Maxillofac Surg 2003;61:1123-1131 https://doi.org/10.1016/S0278-2391(03)00669-4
  24. Al-Nawas B, Duschner H, Grotz KA: Early cellular alterations in bone after radiation therapy and its relation to osteoradionecrosis. J Oral Maxillofac Surg 2004;62(8):1045 https://doi.org/10.1016/j.joms.2004.05.204
  25. Mumyakmaz K, Mumyakmaz F, Altundag K, Altundag O: Incidence of mandibular osteoradionecrosis may be low in head and neck cancer patients treated with concurrent radiation and weekly paclitaxel. Med Hypotheses 2005;65(5):994-995 https://doi.org/10.1016/j.mehy.2005.05.029
  26. Chang DW, Robb GL, Miller MJ, et al: Management of advanced mandibular osteoradionecrosis with free flap reconstruction. Head Neck 1002;23:830-835 https://doi.org/10.1002/hed.1121
  27. Shaha AR, Huryn J, Shah JP, et al: Resection and immediate microvascular reconstruction in the management of osteoradionecrosis of the mandible. Head Neck 1997;19:406-411 https://doi.org/10.1002/(SICI)1097-0347(199708)19:5<406::AID-HED7>3.0.CO;2-3