| Abstract | Osteoradionekroza čeljusti (ORN) rijetka je komplikacija koja nastaje nakon zračenja glave i vrata. Postoji nekoliko rizičnih čimbenika, no najvažniji uključuju invazivnezahvate u području čeljusti, doze zračenja koje su više od 60 Gy, lošu oralnu higijenu i nepodesne navike. Incidencija ORN-a u donjoj čeljusti je 24 puta veća nego u gornjoj te je veća nego u bilo kojoj drugoj kosti u tijelu. Definicija prema Harissu, koja se danas najčešće upotrebljava, govori da ozračena kost postaje devitalizirana i eksponirana kroz priležeću kožu ili mukozu, bez cijeljenja tri mjeseca u odsutnosti povratka tumora. Do danas nije razjašnjena patofiziologija ORN-a, no prihvaćena je teorija radijacijom induciranog fibroatrofičnog procesa u kojoj se smatra da su reaktivni metaboliti kisika
zaslužni za oštećenje na endotelnim stanicama. Klinički ORN prezentira se kao ulceracija ili nekroza sluznice, prisutan je neugodan miris, ekspozicija kosti, a moguće su i patološke frakture te fistule i ulceracije kože. Najčešće se pojavljuje u stražnjim regijama donje čeljusti. ORN i medikamentozna osteonekroza slični su entiteti, međutim histološki i patofiziološki se razlikuju. Kako bi se spriječio nastanak ORN-a, prije početka zračenja potrebno je odraditi detaljnu stomatološku obradu te ako je to potrebno, odraditi ekstrakcije deset do četrnaest dana prije radioterapije ili, ako to nije moguće, unutar prvih četiri mjeseca nakon zračenja. Pacijenta treba motivirati za održavanje dobre oralne higijene s preporukom upotrebe zubnih pasta s visokim udjelom fluorida te izbjegavanja nepodesnih navika poput pušenja. Postoji nekoliko pristupa liječenju ORN-a, ovisno o stadiju, lokalizaciji i općem stanju pacijenta. U ranijim stadijima liječenje je najčešće konzervativno, dok se u višim stadijima preporučuje kirurška terapija. |
| Abstract (english) | Osteoradionecrosis (ORN) is a rare complication of radiation to the head and neck. It occurs as a chronic side effect, and the risk after radiation is lifelong. There are several risk factors, but the most important ones include surgery in the area of radiation, a radiation dose higher than 60 Gy, smoking, alcohol consumption, and impaired oral health. The incidence of ORN in the jaw is 24 times higher than in the maxilla and is higher than in any other bone in the body. The definition that is most often used today, the Hariss' definition, says that irradiated bone becomes devitalised and exposed through the overlying skin or mucosa, persisting without healing for 3 months in the absence of tumour recurrence. To date, the pathophysiology of ORN has not been clarified, but the theory of radiation-induced fibroatrophic process is accepted, in which it is considered that reactive oxygen species is responsible for the damage to endothelial cells. Clinically, ORN is presented as ulceration or necrosis of the mucous membrane, there is an unpleasant odor, exposure of the adjacent bone, and pathological fractures, fistulas and ulcerations of the adjacent skin are also possible. It most often appears in the body of the mandible, but it can also appear in the angle and ramus and symphysis of the mandible. ORN and medication-related osteonecrosis of the jaw are similar entities, however, they are difficult to distinguish clinically and radiologically, they
differ histologically, and their pathophysiology is also different. In order to prevent the occurrence of ORN, before the start of radiation, it is necessary to perform a detailed oral exam and, if necessary, perform extractions 10 to 14 days before radiotherapy or, if this is not possible, within the first 4 months after. In addition, the patient should be motivated to maintain good oral hygiene, recommend the use of toothpaste with a high fluoride content, and avoid smoking. There are several approaches to the treatment of ORN, depending on the theory of pathophysiology. In most cases, conservative treatment is attempted in the earlier stages, while more serious cases require surgical therapy. |
