Radiation jaw osteomyelitis
Introduction
Introduction to radioactive jaw osteomyelitis Radioactive jaw osteomyelitis is a common disease caused by high-dose radiation therapy for nasopharyngeal carcinoma or oral and maxillofacial cancer, which causes radioactive jaw osteonecrosis and secondary infection to form osteomyelitis. Radioactive bone marrow is currently considered to be the sum of the three factors of radiation + trauma + infection. Mainly based on prevention. basic knowledge The proportion of illness: 0.001% Susceptible people: no special people Mode of infection: non-infectious Complications: Traumatic osteomyelitis
Cause
Radioactive jaw osteomyelitis
Radioactive osteomyelitis is the sum of three factors: radiation, injury, and infection. When radiotherapy is used to treat cancer, the jaw bone is simultaneously irradiated, and the blood vessels in the jaw bone gradually develop aseptic endocarditis. When the irradiation dose exceeds 50 Gy, the intima of the blood vessel is swollen, thickened, and the lumen is narrow. Vessel embolism occurs several months or years after the irradiation, the bone is not nutritious and necrosis occurs, and the periosteum has no new bone regeneration. At this time, once a dental infection occurs or is damaged by tooth extraction, the local wound is not healed for a long time, and the bacteria invade and cause radioactive osteomyelitis. At present, it is believed that high-dose irradiation causes spontaneous necrosis of the jaw bone, and the irradiated bone tissue exhibits "three low" characteristics, namely low cell, low blood vessel and hypoxia. The tissue sections showed that the bone cells were shrinking, the bone sag was empty, the osteoblasts disappeared, the periosteum and the marrow cavity were fibrotic, and the blood vessels were embolized. Due to the lack of blood nutrition, in the case of hypoxia and low energy, the bone tissue has no repair compensatory ability, the wound does not heal for a long time, and the dead bone is not easy to be separated, showing aseptic necrosis.
Prevention
Radioactive jaw osteomyelitis prevention
safety warning
1. In order to prevent the occurrence of radioactive jaw osteonecrosis and osteomyelitis, corresponding preventive measures should be taken. Select the appropriate radiation type, dose, and radiation based on the nature of the tumor.
2, before radiotherapy, to eliminate all infections inside and outside the mouth. Full-mouth cleansing, removal of incurable sick teeth, treatment of dental caries, periodontitis and other sick teeth that can still be preserved, removal of the original metal dentures in the oral cavity, active dentures must be worn again after the end of radiotherapy, Prevent mucosal damage.
Complication
Radioactive jaw osteomyelitis complications Complications Traumatic osteomyelitis
In the later stage, the pus can be worn in the nose, nose and mouth.
Symptom
Radioactive jaw bone marrow inflammation symptoms Common symptoms Zhangkou difficult wound infection soft tissue infection
The general course of disease is longer and the lesions develop slowly. In the half year to several years after radiation therapy, the saliva secretion is reduced in most patients, the teeth are prone to severe convulsions, secondary odontogenic infections, or long-term unhealed wounds due to tooth extraction and other injuries, the formation of the sinus but less purulent secretions , persistent pain, bad breath. Sometimes soft tissue can be ulcerated and necrotic, dead bones are exposed without loosening, and chronic inflammation is a long time. If the periarticular cellulitis is secondary, different degrees of mouth opening may occur. The jaw bone can form a large dead bone, which is separated for a long time, and the soft tissue of the corresponding area becomes hard and the scar is formed. The patient suffered from generalized weakness, weight loss, and anemia, and was chronically wasting.
Examine
Examination of radioactive jaw osteomyelitis
Detailed medical history, local examination, and feasible X-ray examination to confirm the diagnosis.
The total number of white blood cells increased and the proportion of neutrophils increased. When an abscess has formed, pus can be withdrawn from the center of the abscess.
Diagnosis
Diagnosis and diagnosis of radioactive jaw osteomyelitis
Mainly based on the history of radiotherapy, clinical manifestations and X-ray films, but should be differentiated from cancer recurrence.
