:—Stepwise surgical treatment before wide resection—
スポンサーリンク
概要
- 論文の詳細を見る
A method corresponding to the state of progress of necrosis is necessary for the treatment of mandibular osteoradionecrosis considering the healing conditions of the original focus. We devised a three-step treatment method that combined active application of platelet rich plasma (PRP) with particulate cancellous bone marrow (PCBM) with resolutive treatment using external skeletal fixation, as a step preceding wide segmental mandibulectomy and vascularized free combination flap graft when bone necrosis progressed.<BR>Patients and method<BR>From January 2002 until December 2004, 14 patients (12 patients of oral cancer and 2 patients of mesopharygeal cancer) in whom mandibular osteoradionecrosis developed after radiation therapy, were treated. First step: when only alveolectomy is done, the wound is closed with a mucosal flap after PRP is applied to the bone surface as there is little sequestration. Second step: when sequestrectomy spreads to the central part of the mandible, PCBM is transplanted in addition to PRP, and the wound is closed by a local skin flap. Third step: when bone defect is segmental, any issue with soft tissue is first resolved and bone grafting is performed after that, while holding the remaining bone in position by using an external skeletal fixation device.<BR>Results<BR>A decrease in exposure of bone surface and alleviation of pain symptoms were achieved in all cases by treatment with the first step. However, outer cortical bone necrosis relapsed. The outcome of the second and third step treatment was good, and bone regeneration was achieved in 8 cases where PRP and transplantation of PCBM were done. Two cases suffered an infection, and curettage or retransplantation of PCBM was necessary.<BR>Discussion<BR>It is suggested that improvement of blood circulation and resolution of soft tissue are important for treatment of osteoradionecrosis. Therefore, waiting for resolution of the soft tissue using external skeletal fixation was effective, and PRP was useful in the healing process.
- 一般社団法人 日本口腔腫瘍学会の論文
一般社団法人 日本口腔腫瘍学会 | 論文
- 進行口腔癌に対する逆行性超選択的動注化学療法, 放射線同時併用療法後の救済手術
- TS-1による化学療法と温熱放射線療法が著効した後発頸部リンパ節転移の1例
- 手術シミュレーションに基づく腫瘍分割摘出により顎骨を保存した得た下顎骨骨形成線維腫の1例
- 口腔癌における化学・放射線療法後の再発・二次再建に関する外科療法の検討
- 下顎骨再建 : 血管柄付遊離骨移植と遊離軟部組織移植の比較