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放疗后拔牙并发颌骨放射性骨坏死的预防策略

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Author:: No author available

Journal Title:: Chinese Journal of Stomatology

Issue:: 8

DOI:: 10.3760/cma.j.issn.1002-0098.2015.08.013

Key Word:: No keyword available

Abstract：放疗是头颈部恶性肿瘤的重要治疗方法,既可作为主要的治疗手段,也可作为手术的辅助方法,或者结合化疗治疗.然而射线在杀伤肿瘤细胞的同时也损伤周围正常组织,从而引发一系列并发症,其中颌骨放射性骨坏死(osteoradionecrosis of jaws,ORNJ)是最严重的并发症之一.ORNJ可以自发形成,但更多因遭受外伤、手术或拔牙而诱发[1].目前拔牙被认为是诱发ORNJ主要的危险因素.放疗后的患者原则上应尽量避免拔牙.然而,由于射线对涎腺和牙周组织的损伤,放疗患者易发生猖獗龋及进行性的牙周附着丧失,照射区组织纤维化导致牙关紧闭,使正常的口腔护理出现障碍,常致放射区域内的牙齿需拔除[2].尽管现在通过放疗前的预防措施,如治疗龋病、拔除不能保留的患牙、牙周洁治及刮治以及放疗中、后使用氟化物并增强对放疗患者牙齿健康状况的关注,已经大大减少了放疗后需拔牙数量[3],但仍然无法完全避免上述情况的发生.因而只能选择拔除病变患牙同时采取各种措施,降低ORNJ的发生率.现就放疗后拔牙并发ORNJ的预防进行综述.

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