下颌骨放射性骨坏死临床诊疗专家共识

doi:10.19438/j.cjoms.2017.05.015

中国口腔颌面外科杂志 ›› 2017, Vol. 15 ›› Issue (5): 445-456.doi: 10.19438/j.cjoms.2017.05.015

下颌骨放射性骨坏死临床诊疗专家共识

何悦^1*#，侯劲松^2*，李晓光^1#，马春跃¹，彭歆³，王慧明⁴，王松灵⁵，刘磊⁶，刘冰⁷，田磊⁸，刘忠龙¹，刘习强²，徐昕⁹，张东升¹⁰，蒋灿华¹¹，王军¹²，姚原¹³ ，朱国培¹³，白永瑞¹⁴，王胜资¹⁵，孙长伏¹⁶，李劲松¹⁷，何三纲⁷，王成²，Nabil Samman¹⁸，孙坚¹，张陈平¹，张志愿¹，邱蔚六¹

1.上海交通大学医学院附属第九人民医院·口腔医学院口腔颌面-头颈肿瘤科，上海 200011;
2.中山大学光华口腔医学院附属口腔医院口腔颌面外科，广东广州 510055;
3.北京大学口腔医学院口腔颌面外科，北京 100081;
4.浙江大学口腔医学院·浙江大学医学院附属第一医院口腔颌面外科，浙江杭州 310006;
5.首都医科大学附属北京口腔医院口腔颌面外科，北京 100050;
6.四川大学华西口腔医院口腔颌面外科，四川成都 610041;
7.武汉大学口腔医院口腔颌面外科，湖北武汉 430070;
8.第四军医大学口腔医院口腔颌面外科，陕西西安 710032;
9.浙江大学医学院附属第二医院口腔颌面外科，浙江杭州 310009;
10.山东大学附属省立医院口腔颌面外科，山东济南 250021;
11.中南大学湘雅医院口腔颌面外科，湖南长沙 410008;
12.甘肃省肿瘤医院头颈外科，甘肃兰州 730050;
13.上海交通大学医学院附属第九人民医院放疗科，上海 200011;
14.上海交通大学医学院附属仁济医院放疗科，上海 200127;
15.复旦大学附属眼耳鼻喉科医院放疗科，上海 200000;
16.中国医科大学附属口腔医院口腔颌面-头颈外科，辽宁沈阳 110002;
17.中山大学孙逸仙纪念医院口腔颌面外科，广东广州 510120;
18.香港大学牙医学院口腔颌面外科，香港 999077

收稿日期:2017-06-20 出版日期:2017-08-30 发布日期:2017-10-27
基金资助:
国家自然科学基金（81570949）；上海市申康临床创新三年行动计划（16CR2038B）；2017年上海市卫生计生系统优秀学科带头人计划（2017BR019）

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

HE Yue¹, HOU Jin-song², LI Xiao-guang¹, MA Chun-yue¹, PENG Xin³, WANG Hui-ming⁴, WANG Song-ling⁵, LIU Lei⁶, LIU Bing⁷, TIAN Lei⁸, LIU Zhong-long¹, LIU Xi-qiang², XU Xin⁹, ZHANG Dong-sheng¹0, JIANG Can-hua¹¹, WANG Jun¹², YAO Yuan¹³, ZHU Guo-pei¹³, BAI Yong-rui¹⁴, WANG Sheng-zi¹⁵, SUN Chang-fu¹⁶, LI Jin-song¹⁷, HE San-gang⁷, WANG Cheng², Nabil Samman¹⁸, SUN Jian¹, ZHANG Chen-ping¹, ZHANG Zhi-yuan¹, QIU Wei-liu¹.

1.Department of Oromaxillofacial Head and Neck Oncology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011;
2.Department of Oral ａｎｄ　Maxillofacial Surgery, Guanghua School of Stomatology, Hospital of Stomatology, Sun Yat -sen University. Guangzhou 510055;
3.Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology. Beijing 100081;
4.Department of Oral and Maxillofacial Surgery, The First Affiliated Hospital of Zhejiang University of Medicine, School of Stomatology, Zhejiang University. Hangzhou 310006, Zhejiang Province;
5. Department of Oral and Maxillofacial Surgery, Capital Medical University. Beijing 100050;
6.Department　of Oral and Maxillofacial Surgery, West China Hospital of Stomatology. Chengdu 610041, Sichuan Province;
7.Department of Oral and Maxillofacial Surgery, Hospital of Stomatology, Wuhan University. Wuhan 430070, Hubei Province;
8.Department of Oral and Maxillofacial Surgery, The Fourth Military Medical University Hospital of Stomatology. Xi'an 710032, Shaanxi Province;
9. Department of Oral and Maxillofacial Surgery, The Second Affiliated Hospital of Zhejiang University of Medicine. Hangzhou 310009, Zhejiang Province;
10.Department of Oral and Maxillofacial Surgery, Shangdong Provincial Hospital. Jinan 250021, Shandong Province;
11.Department of Oral and Maxillofacial Surgery, Xiangya Hospital Central South University. Changsha 410008, Huｎａｎ Province;
12.Department of Head and Neck Oncology, Gansu Provincial Cancer Hospital. Lanzhou 730050, Gansu Province;
13.Department of Radiotherapy, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011;
14.Department of Radiotherapy, Renji Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200127;
15.Department of Radiotherapy, Eye and ENT Hospital of Fudan University. Shanghai 200000;
16.Department of Oromaxillofacial Head and Neck Surgery, School and Hospital of Stomatology, China Medical University. Shenyang 110002, Liaoning Province;
17.Department of Oral and Maxillofacial Surgery, Sun Yat -sen Memorial Hospital, Sun Yat-sen University. Guangzhou 510120, Guangdong Province;
18.Discipline of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Hong Kong. Hong Kong 999077, China

Received:2017-06-20 Online:2017-08-30 Published:2017-10-27

摘要/Abstract

摘要： 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。

关键词: 下颌骨, 放射性骨坏死, 专家共识

Abstract: 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.

Key words: Mandible, Osteoradionecrosis, Expert consensus

中图分类号:

R782

何悦，侯劲松，李晓光，马春跃，彭歆，王慧明，王松灵，刘磊，刘冰，田磊，刘忠龙，刘习强，徐昕，张东升，蒋灿华，王军，姚原，朱国培，白永瑞，王胜资，孙长伏，李劲松，何三纲，王成，Nabil Samman，孙坚，张陈平，张志愿，邱蔚六. 下颌骨放射性骨坏死临床诊疗专家共识[J]. 中国口腔颌面外科杂志, 2017, 15(5): 445-456.

HE Yue, HOU Jin-song, LI Xiao-guang, MA Chun-yue, PENG Xin, WANG Hui-ming, WANG Song-ling, LIU Lei, LIU Bing, TIAN Lei, LIU Zhong-long, LIU Xi-qiang, XU Xin, ZHANG Dong-sheng0, JIANG Can-hua, WANG Jun, YAO Yuan, ZHU Guo-pei, BAI Yong-rui, WANG Sheng-zi, SUN Chang-fu, LI Jin-song, HE San-gang, WANG Cheng, Nabil Samman, SUN Jian, ZHANG Chen-ping, ZHANG Zhi-yuan, QIU Wei-liu.. Expert consensus statement on diagnosis and clinical management of osteoradionecrosis of mandible[J]. China J Oral Maxillofac Surg, 2017, 15(5): 445-456.

参考文献

[1] Nabil S, Samman N. Risk factors for osteoradionecrosis after head and neck radiation: a systematic review [J]. Oral Surg Oral Med Oral Pathol Oral Radiol, 2012, 113(1): 54-69.
[2] Reuther T, Schustter T, Menda U, et al. Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumor patients--a report of a thirty year retrospective review [J]. Int J Oral Maxillofac Surg, 2003, 32(3): 289-295.
[3] 刘习强, 黄洪章, 曾融生, 等. 368例放射性颌骨坏死临床分析 [J]. 中国口腔颌面外科杂志, 2007, 5(3): 176-179.
[4] Studer G, Gr?覿tz KW, Glanzmann C. Osteoradionecrosis of the mandible in patients treated with different fractionations [J]. Strahlenther Onkol, 2004, 180(4): 233-240.
[5] Regaud C. Sur la nécrose des os attente par un processus cancéreux et traits par les radiations [J]. Compt Rend SocBiol, 1922, 87: 427-429.
[6] Marx RE. Osteoradionecrosis: a new concept of its pathophysiology[J]. J Oral Maxillofac Surg, 1983, 41(5): 283-288.
[7] St?尴re G, Boysen M. Mandibular osteoradionecrosis: clinical behaviour and diagnostic aspects [J]. Clin Otolaryngol Allied Sci, 2000, 25(5): 378-384.
[8] Morton ME. Osteoradionecrosis: a study of the incidence in the North West of England[J]. Br J Oral Maxillofac Surg, 1986, 24(5): 323-331.
[9] Epstein JB, Wong FL, Stevenson-Moore P. Osteoradionecrosis: clinical experience and a proposal for classification [J]. J Oral Maxillofac Surg, 1987, 45(2): 104-110.
[10] Lyons A, Ghazali N. Osteoradionecrosis of the jaws: current understanding of its pathophysiology and treatment [J]. Br J Oral Maxillofac Surg, 2008, 46(8): 653-660.
[11] Meyer I. Infectious diseases of the jaws [J]. J Oral Surg, 1970, 28(1): 17-26.
[12] Delanian S, Lefaix JL. The radiation radiation fibroatropic process: therapeutic perspective via the antioxidant pathway [J]. Radiother Oncol, 2004, 73(2): 119-131.
[13] Zhuang Q, Zhang Z, Fu H, et al. Does radiation-induced fibrosis have an important role in pathophysiology of the osteoradionecrosis of jaw? [J]. Med Hypotheses, 2011, 77(1): 63-65.
[14] Xu J, Zheng Z, Fang D, et al. Early-stage pathogenic sequence of jaw osteoradionecrosis in vivo[J]. J Dent Res, 2012, 91(7): 702-708.
[15] 邱蔚六. 邱蔚六口腔颌面外科学 [M].上海: 上海科学技术出版社, 2008: 366-377.
[16] Nabil S, Samman N. Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review[J]. Int J Oral Maxillofac Surg, 2011, 40(3): 229-243.
[17] 王中和. 减少下颌骨放射性骨坏死的新策略 [J]. 口腔颌面外科杂志, 2009, 19(4): 229-233.
[18] Jacobson AS, Buchbinder D, Hu K, et al. Paradigm shifts in the management of osteoradionecrosis of the mandible [J]. Oral Oncol, 2010, 46(11): 795-801.
[19] Chronopoulos A, Zarra T, Trltzsch M, et al. Osteoradionecrosis of the mandible: A ten year single-center retrospective study [J]. J Craniomaxillofac Surg, 2015, 43(6): 837-846.
[20] 廖湘凌, 潘剑, 张艳, 等. 颌骨放射性骨坏死的危险因素分析 [J]. 临床肿瘤学杂志, 2002, 7(5): 336-338.
[21] 宋治锋, 李劲松. 鼻咽癌放疗后并发放射性颌骨骨髓炎的临床总结 [J].实用医学杂志, 1998, 14(5): 349-350.
[22] Chong J, Hinckley LK, Ginsberg LE. Masticator space abnormalities associated with mandibular osteoradionecrosis: MR and CT findings in five patients [J]. AJNR Am J Neuroadiol, 2000, 21(1): 175-178.
[23] Bachmann G, Rｓｓler R, Klett R, et al. The role of magnetic resonance imaging and scintigraphy in the diagnosis of pathologic changes of the mandible after radiation therapy [J]. Int J Oral Maxillofac Surg, 1996, 25(3): 189-195.
[24] Mansberg VJ, Frater CJ. Development of osteoradionecrosis demonstrated on bone scintigraphy [J]. Clin Nucl Med, 2003, 28(7): 587-588.
[25] Gavaldá C, Bagán JV. Concept, diagnosis and classification of bisphosphonate-associated osteonecrosis of the jaws. A review of the literature [J]. Med Oral Patol Oral Cir Bucal, 2016, 21(3): e260-270.
[26] Marx RE, Tursun R. Suppurative osteomyelitis, bisphosphonate induced osteonecrosis, osteoradionecrosis: a blinded histopathologic comparison and its implications for the mechanism of each disease [J]. Int J Oral Maxillofac Surg, 2012, 41(3): 283-289.
[27] Marx RE. A new concept in the treatment of osteoradionecrosis [J]. J Oral Maxillofac Surg, 1983, 41(6): 351-357.
[28] Schwartz HC, Kagan AR. Osteoradionecrosis of the mandible: scientific basis for clinical staging [J]. Am J Clin Oncol, 2002, 25(2): 168-171.
[29] Karagozoglu KH, Dekker HA, Rietveld D, et al. Proposal for a new staging system for osteoradionecrosis of the mandible [J]. Med Oral Patol Oral Cir Bucal, 2014, 19(5): e433-437.
[30] Lyons A, Osher J, Warner E, et al. Osteoradionecrosis-a review of current concepts in defining the extent of the disease and a new classification proposal [J]. Br J Oral Maxillofac Surg, 2014, 52(5): 392-395.
[31] 陈伟良, 任材年, 陈光晔, 等. 颌骨骨髓炎的临床分类分期与治疗 [J]. 临床口腔医学杂志, 1995, 11(1): 32-34.
[32] 侯劲松, 黄洪章, 潘朝斌, 等. 放射性颌骨坏死临床分期及疗效分析 [J]. 临床口腔医学杂志, 2003, 19(4): 224-225.
[33] Cierny G 3rd, Mader JT, Penninck JJ. A clinical staging system for adult osteomyelitis [J]. Clin Orthop Relat Res, 2003, (414): 7-24.
[34] 何悦, 代天国, 田卓炜, 等. 一种新的放射性颌骨坏死的临床分类分期-120例临床分析 [J]. 中国口腔颌面外科杂志, 2014, 12(3): 215-222.
[35] He Y, Liu Z, Tian Z, et al. Retrospective analysis of osteoradionecrosis of the mandible: proposing a novel clinical classification and staging system [J]. Int J Oral Maxillofac Surg, 2015, 44(12): 1547-1557.
[36] 刘舒畅, 胡静, 侯劲松,等. 507例放射性颌骨坏死回顾性分析及临床新分期的建立:单一中心20年经验 [J]. 中华口腔医学研究杂志:电子版, 2016, 10(5): 337-342.
[37] Mainous EG, Boyne PJ, Hart GB. Elimination of sequestrum and healing of osteoradionecrosis of the mandible after hyperbaric oxygen therapy: report of case[J]. J Oral Surg, 1973, 31(5): 336-339.
[38] Tompach PC, Lew D, Stoll JL. Cell response to hyperbaric oxygen treatment [J]. Int J Oral Maxillofac Surg, 1997, 26(2): 82-86.
[39] Mader JT, Brown GL, Guckian JC, et al. A mechanism for the amelioration by hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits [J]. J Infect Dis, 1980, 142(6): 915-922.
[40] Van Merkesteyn JP, Bakker DJ, Borgmeijer-Hoelen AM. Hyperbaric oxygen treatment of osteoradionecrosis of the mandible. Experience in 29 patients [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 1995, 80(1): 12-16.
[41] Freiberger JJ, Yoo DS, de Lisle Dear G, et al. MultiModality surgical and hyperbaric management of mandibular osteoradionecrosis [J]. Int J Radiat Oncol Biol Phys, 2009, 75(3): 717-724.
[42] Feldmeier JJ. Hyperbaric oxygen for delayed radiation injuries [J]. Undersea Hyperb Med, 2004, 31(1): 133-145.
[43] Curi MM, Dib LL. Osteoradionecrosis of the jaws: a retrospective study of the background factors and treatment in 104 cases [J]. J Oral Maxillofac Surg, 1997, 55(6): 540-544.
[44] D'Souza J, Goru J, Goru S, et al. The influence of hyperbaric oxygen on the outcome of patients treated for osteoradionecrosis: 8 year study[J]. Int J Oral Maxillofac Surg, 2007, 36(9): 783-787.
[45] Notani K, Yamazaki Y, Kitada H, et al. Management of mandibular osteoradionecrosis corresponding to the severity of osteoradionecrosis and the method of radiotherapy [J]. Head Neck, 2003, 25(3): 181-186.
[46] Maier A, Gaggl A, Klemen H, et al. Review of severe osteoradionecrosis treated by surgery alone or surgery with postoperative hyperbaric oxygenation [J]. Br J Oral Maxillofac Surg, 2000, 38(3): 173-176.
[47] Annane D, Depondt JP, Villart M, et al. Hyperbaric oxygen therapy for radionecrosis of the jaw: a randomized, placebo-controlled, double-blind trial from the ORN96 study group [J]. J Clin Oncol, 2004, 22(24): 4893-4900.
[48] Bennett MH, Feldmeier J, Hampson N, et al. Hyperbaric oxygen therapy for late radiation tissue injury [J]. Cochrane Database Syst Rev, 2005, 3: CD005005.
[49] Wang TH, Liu CJ, Chao TF, et al. Risk factors for and the role of dental extractions in osteoradionecrosis of the jaws: A national-based cohort study [J]. Head Neck, 2017, 39(7): 1313-1321.
[50] Marx RE, Johnson RP, Kline SN. Prevention of osteoradionecrosis: a randomized prospective clinical trial of hyperbaric oxygen versus penicillin [J]. J Am Dent Assoc, 1985, 111(1): 49-54.
[51] 张辉, 王成, 翁军权, 等. 放射性颌骨坏死局部病灶菌群分析及药物敏感性研究[J]. 中华口腔医学研究杂志：电子版, 2016, 10(3): 198-201.
[52] Delanian S, Lefaix JL. Complete healing of severe osteoradionecrosis with treatment combining pentoxifylline, tocopherol and clodronate [J]. Br J Radiol, 2002, 75(893): 467-469.
[53] Delanian S, Depondt J, Lefaix JL. Major healing of refractory mandible osteoradionecrosis after treatment combining pentoxifylline and tocopherol: a phase Ⅱ trial [J]. Head Neck, 2005, 27(2): 114-123.
[54] Diel IJ, Solomayer EF, Costa SD, et al. Reduction in new metastases in breast cancer with adjuvant clodronate treatment [J]. New Engl J Med, 1998, 339(6): 357-363.
[55] Carano A, Teitelbaum SL, Konsek JD, et al. Bisphosphonates directly inhibit the bone resorption activity of isolated avian osteoclasts in vitro [J]. J Clin Invest, 1990, 85(2): 456-461.
[56] Delanian S, Chatel C, Porcher R, et al. Complete restoration of refractory mandibular osteoradionecrosis by prolonged treatment with a pentoxifylline-tocopherol-clodronate combination (PENTOCLO): a phase Ⅱ trial [J]. Int J Radiat Oncol Biol Phys, 2011, 80(3): 832-839.
[57] Harris M. The conservative management of osteoradionecrosis of the mandible with ultrasound therapy [J]. Br J Oral Maxillofac Surg, 1992, 30(5): 313-318.
[58] Dyson M, Franks C, Suckling J. Stimulation of healing of varicose ulcers by ultrasound [J]. Ultrasonics, 1976, 14(5): 232-236.
[59] Young SR, Dyson M. The effect of therapeutic ultrasound on angiogenesis [J]. Ultrasound Med Biol, 1990, 16(3): 261-269.
[60] Hogan RD, Burke KM, Franklin TD. The effect of ultrasound on microvascular hemodynamics in skeletal muscle: effects during ischemia [J]. Microvasc Res, 1982, 23(3): 370-379.
[61] Schortinghuis J, Ruben JL, Raghoebar GM, et al. Ultrasound to stimulate mandibular bone defect healing: a placebo-controlled single-blind study in rats[J]. J Oral Maxillofac Surg, 2004, 62(2): 194-201.
[62] Pitak-Arnnop P, Sader R, Dhanuthai K, et al. Management of osteoradionecrosis of the jaws: an analysis of evidence [J]. Eur J Surg Oncol, 2008, 34(10): 1123-1134.
[63] Bayati S, Russell RC, Roth AC. Stimulation of angiogenesis to improve the viability of prefabricated flaps [J]. Plast Reconstr Surg, 1998, 101(5): 1290-1295.
[64] Zou D, Zhang Z, Ye D, et al. Repair of critical-sized rat calvarial defects using genetically engineered bone marrow -derived mesenchymal stem cells overexpressing hypoxia-induciblefactor-1α [J]. Stem Cells, 2011, 29(9): 1380-1390.
[65] Sefcik LS, Petrie Aronin CE, Wieghaus KA, et al. Sustained release of sphingosine 1-phosphate for therapeutic arteriogenesis and bone tissue engineering [J]. Biomaterials, 2008, 29(19): 2869-2877.
[66] Ang E, Black C, Irish J, et al. Reconstructive options in the treatment of osteoradionecrosis of the craniomaxillofacial skeleton [J]. Br J Plast Surg, 2003, 56(2): 92-99.
[67] Dai T, Tian Z, Wang Z, et al. Surgical management of osteoradionecrosis of the jaws [J]. J Craniofac Surg, 2015, 26(2): e175-179.
[68] 毛驰, 俞光岩, 彭歆, 等. 游离组织瓣移植同期修复下颌骨放射性骨坏死术后缺损 [J]. 华西口腔医学杂志, 2004, 22(4): 305-308.
[69] 侯劲松, 廖贵清, 黄洪章, 等. 放射性下颌骨坏死术后缺损的游离腓骨肌皮瓣重建 [J]. 中华显微外科杂志, 2006, 29(5): 341-343.
[70] Kim JW, Hwang JH, Ahn KM. Fibular flap for mandible reconstruction in osteoradionecrosis of the jaw: selection criteria of fibula flap[J]. Maxillofac Plast Reconstr Surg, 2016, 38(1): 46.
[71] Nadella KR, Kodali RM. Osteoradionecrosis of the jaws: clinico-therapeutic management: a literature review and update [J]. J Maxillofac Oral Surg, 2015, 14(4): 891-901.
[72] Shaha AR, Cordeiro PG, Hidalgo DA, et al. Resection and immediate microvascular reconstruction in the management of osteoradionecrosis of the mandible[J]. Head Neck, 1997, 19(5): 406-411.
[73] 李儒煌, 蔡志刚. 颌骨放射性骨坏死诊疗进展 [J]. 现代口腔医学杂志, 2011, 25(4): 301-305.
[74] 邹多宏, 蒋欣泉, 张志愿. 颌骨放射性骨坏死治疗进展 [J]. 中国口腔颌面外科杂志, 2012, 10(5): 423-427.
[75] Lagier JP, Blanc JL, Lachard A, et al. Current treatment of osteoradionecrosis [J]. Rev Stomatol Chir Maxillofac, 1986, 87(5): 311-314.
[76] 何悦,张志愿,竺涵光,等. 钛重建板联合胸大肌肌皮瓣同期修复下颌骨放射性骨坏死切除术后缺损 [J]. 上海口腔医学, 2008, 17(6): 565-568.
[77] Baumann DP, Yu P, Hanasono MM, et al. Free flap reconstruction of osteoradionecrosis of the mandible: a 10-year review and defect classification [J]. Head Neck, 2011, 33(6): 800-807.
[78] Curi MM, Oliveira dos Santos M, Feher O, et al. Management of extensive osteoradionecrosis of the mandible with radical resection and immediate microvascular reconstruction [J]. J Oral Maxillofac Surg, 2007, 65(3): 434-438.
[79] 何悦, 代天国, 孙坚, 等. 血管化骨组织瓣在下颌骨放射性骨坏死临床治疗中的应用研究[J]. 中国肿瘤临床, 2015, 42(16): 827-833.
[80] 何悦, 刘忠龙, 代天国, 等. 放射性下颌骨坏死的BS临床分类及治疗策略[J]. 中国肿瘤临床, 2015, 42(16): 817-826.
[81] Katsura K, Sasai K, Sato K, et al. Relationship between oral health status and development of osteoradionecrosis of the mandible: a retrospective longitudinal study [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2008, 105(6): 731-738.
[82] Koga DH, Salvajoli JV, Alves FA. Dental extractions and radiotherapy in head and neck oncology: review of the literature [J]. Oral Dis, 2008, 14(1): 40-44.
[83] Obinata K, Ohmori K, Tuchiya K, et al. Clinical study of a spacer to help prevent osteoradionecrosis resulting from brachytherapy for tongue cancer [J]. Oral Surg Oral Med Oral Pathol Oral Radiol Endod, 2003, 95(2): 246-250.
[84] 王中和, 涂文勇. 口腔颌面-头颈肿瘤放射治疗学[M]. 上海: 世界图书出版公司, 2013: 502.
[85] Reuther T, Schuster T, Mende U, et al. Osteoradionecrosis of the jaws as a side effect of radiotherapy of head and neck tumour patients-a report of a thirty-year retrospective review [J]. Int J Oral Maxillofac Surg, 2003, 32(3): 289-295.
[86] Xu J, Zheng Z, Fang D, et al. Mesenchymal stromal cell-based treatment of jaw osteoradionecrosis in Swine [J]. Cell Transplant, 2012, 21(8): 1679-1686.

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

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