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Abstract：
Objectives Osteoradionecrosis is one of the most severe complications in patients with head and neck cancer, which is characterized by persistent exposed and devitalized bone without proper healing after radiation. The extent to which mandibulotomy and marginal mandibulectomy influence the occurrence of osteoradionecrosis remains unclear. This study evaluated the incidence and risk factors for developing osteoradionecrosis of the mandible after oral cancer treatments. Methods A retrospective study was performed to analyze medical records of patients who underwent surgery and postoperative radiotherapy for oral cancers from 2009 to 2019 at a tertiary care hospital. Patient characteristics, incidence, and risk factors for developing osteoradionecrosis were reviewed. Comparisons between continuous and categorical data were performed using t-test and Chi-squared test. Cox regression analysis was used to assess the association between factors and the development of osteoradionecrosis. Results Among the 61 patients included in the study, osteoradionecrosis of the mandible occurred in 9 of 32 (28.1%) patients who underwent mandibular surgery during oral cancer resection (marginal mandibulectomy and/or mandibulotomy) and 2 of 29 (6.9%) patients without mandibular surgery. The development of osteoradionecrosis was significantly associated with performing mandibular surgery (hazard ratio 4.64, 95% confidence interval: 1.002, 21.5) and HIV infection (hazard ratio 8.53, 95% confidence interval: 2.2, 33.3). In the subgroup analysis of mandibular surgery, the development of osteoradionecrosis significantly increased in patients undergoing mandibulotomy (hazard ratio 6.62, 95% confidence interval: 1.3, 34.8) but not in patients undergoing marginal mandibulectomy (hazard ratio 3.56, 95% confidence interval: 0.6, 22.0). The analysis also showed that concurrent chemoradiation, radiation doses ≥ 60 Gy, and smoking were potential risk factors for the development of osteoradionecrosis, but none of these factors were statistically significant. Conclusion Our findings suggest that mandibular surgery is a significant risk factor for the development of osteoradionecrosis in patients with oral cancer. Further studies including larger population sizes are required to verify these findings.
摘要：
目的放射性骨坏死是头颈部肿瘤患者最严重的并发症之一。其特征是辐射后持续暴露和失活的骨骼没有适当的愈合。下颌骨切开术和下颌骨边缘切除术对放射性骨坏死的影响程度尚不清楚。这项研究评估了口腔癌治疗后发生下颌骨放射性骨坏死的发生率和危险因素。方法回顾性分析2009-2019年某三级医院口腔癌手术及术后放疗患者的病历资料。患者特征,发病率,并对发生放射性骨坏死的危险因素进行了综述。使用t检验和卡方检验对连续数据和分类数据进行比较。Cox回归分析用于评估因素与放射性骨坏死发展之间的关系。结果纳入研究的61例患者中,在口腔癌切除术(下颌骨边缘切除术和/或下颌骨切开术)期间接受下颌骨手术的32例患者中,有9例(28.1%)发生下颌骨放射性坏死,在没有下颌骨手术的29例患者中,有2例(6.9%)发生放射性骨坏死.放射性骨坏死的发展与进行下颌骨手术（风险比4.64，95％置信区间：1.002，21.5）和HIV感染（风险比8.53，95％置信区间：2.2，33.3）显着相关。在下颌手术的亚组分析中，在接受下颌骨切开术的患者中,放射性骨坏死的发展显著增加(风险比6.62,95%置信区间:1.3,34.8),但在接受边缘下颌骨切开术的患者中没有增加(风险比3.56,95%置信区间:0.6,22.0).分析还表明，同步放化疗，辐射剂量≥60Gy，吸烟是放射性骨坏死发展的潜在危险因素，但这些因素均无统计学意义.结论下颌骨手术是口腔癌患者发生放射性骨坏死的重要危险因素。需要进一步的研究，包括更大的人口规模来验证这些发现。
