Systematic management of osteoradionecrosis in the head and neck.

OBJECTIVES: Osteoradionecrosis is one of the most serious and devastating complications of radiotherapy. The proper management of osteoradionecrosis is currently undetermined. The objective of this study is to evaluate the treatment results of a systematic approach to osteoradionecrosis. STUDY DESIGN: A prospective study of a systematic approach to osteoradionecrosis in the head and neck area was undertaken. METHODS: From July 1993 to June 1998, 33 cases of osteoradionecrosis in the head and neck area were treated using a systematic approach that combined sequestrectomy and hyperbaric oxygen therapy. RESULTS: Seven (21%) had recurrent cancer. The control rate of the other 26 osteoradionecrosis cases was 77% (20/26). CONCLUSIONS: Persistent osteoradionecrosis, despite diligent radical treatment, raises the suspicion of recurrent cancer. Extensive osteoradionecrosis with a multiple discharging fistula, a large area of exposed necrotic bone, or a coexistent fracture should be treated primarily with radical sequestrectomy and microvascular free flap reconstruction. Surgery still plays a major role in controlling osteoradionecrosis, and hyperbaric oxygen therapy is adjuvant.

Presenile (early ageing) changes in tissues of Kaschin-Beck disease and its pathogenetic significance.

The selenium level and activity of glutathione peroxidase in blood of children living in Kaschin-Beck disease (KBD) endemic areas were lower than that in nonendemic areas. KBD children were deficient in selenium, their lipid components, structure and function of the red cell membrane and cartilage tissue were abnormal. That is, the phospholipid (PL) content in the tissues of the patient was less than that of the controls in endemic and non-endemic areas. Especially as the phosphatidylcholine (PC) content decreased significantly, but sphingomyelin (SM) increased, the molar ratio of SM/PC and cholesterol (Ch)/PL increased. Increase of acanthocyte content was seen under the electron microscope and the fragility of erythrocytes was also increased. It indicated that there were membrane defects and membrane damage in KBD. At the same time, the sulfation extent of mucopolysaccharides in cartilage of patients was lower, and the collagen content was higher than that of controls. The presenile changes in lipid composition, structure and function of biomembranes and cartilage metabolism of KBD are very significant in studies on the aetiological pathogenesis of KBD and other ageing diseases.