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Case Report
Conservative management of advanced mandibular osteoradionecrosis with mild clinical presentation after 17 years of oncological treatment: A case report
1 DDS, MSc., Ph.D. Student, Department of Radiation Oncology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
2 Dental Clinician, Department of Stomatology, School of Dentistry, University Center UNIFAMINAS, Muriaé, Minas Gerais, Brazil
3 DDS, Master Candidate, Department of Radiation Oncology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
4 DDS, MSc., Department of Oral and Maxillofacial Surgery, Hospital Sirio Libanes, Sao Paulo, Brazil
5 MD, Ph.D., Head of Department of Radiation Oncology, A.C. Camargo Cancer Center, Sao Paulo, Brazil
Address correspondence to:
Wilber Edison Bernaola-Paredes
DDS, MSc., Ph.D. Student, Department of Radiation Oncology, A.C. Camargo Cancer Center, Sao Paulo,
Brazil
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Article ID: 101206Z01WP2021
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Bernaola-Paredes WE, Veronese HRM, Filho VB, Martins IS, Pellizzon ACA. Conservative management of advanced mandibular osteoradionecrosis with mild clinical presentation after 17 years of oncological treatment: A case report. Int J Case Rep Images 2021;12:101206Z01WP2021.ABSTRACT
Introduction: Osteoradionecrosis (ORN) of the jaws is a late complication of radiotherapy (RT) of the head and neck, with higher prevalence in the mandible. Treatment of the condition is controversial, ranging from conservative non-surgical management to extensive surgical resections with reconstruction. Drug therapy with pentoxifylline and tocopherol (PENTO) associated with adjuvant therapies has shown satisfactory clinical results, also in advanced stages of ORN. The present case report aims to describe the conservative management of an advanced mandibular ORN by medication with PENTO and other adjuvant therapies.
Case Report: A 62-year-old Afro-descendent woman, with a history of oral squamous cell carcinoma in the left floor of the mouth, who was submitted to surgical resection, RT, and concomitant chemotherapy 17 years ago, complained of toothache in tooth 47, and need for rehabilitation of the mandibular residual alveolar ridge (RAR) on the left side. On intraoral clinical examination, the left RAR mucosa was intact and normal in appearance, with slightly purulent drainage associated with tooth 33, without bone exposure. Computed tomography examination showed evidence of extensive destruction. Advanced ORN was diagnosed, and treatment with PENTO was initiated, with subsequent surgical debridement, perioperative antimicrobial photodynamic therapy, and photobiomodulation sessions, resulting in regression of lesion 12 months after initial treatment.
Conclusion: Pentoxifylline and tocopherol protocol can be considered an efficient alternative in the treatment of advanced ORN. Adjuvant therapies contribute to healing and improving local conditions. Prospective studies should be conducted to further clarify the role of PENTO and adjuvant therapies in the complete or partial resolution of this condition.
Keywords: Alpha-tocopherol, Conservative treatment, Debridement, Osteoradionecrosis, Pentoxifylline, Photobiomodulation therapy
SUPPORTING INFORMATION
Acknowledgments
The authors thank D.M.C. Company, NUPEN Research Institute, and Professor Luciana Almeida from Sao Carlos, Sao Paulo, Brazil and their teams who supported this work with full resources for applying photobiomodulation and antimicrobial photodynamic therapy (aPDT). The author Wilber E. Bernaola-Paredes is a student fellow and supported with a scholarship provided by the National Council for Scientific and Technological Development of Brazil (CNPq), Sao Paulo, Brazil (140071/2019-9).
Author ContributionsWilber Edison Bernaola-Paredes - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Henrique Rocha Mazorchi Veronese - Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Valdener Bella Filho - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Ivan Solani Martins - Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Antônio Cássio Assis Pellizzon - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Wilber Edison Bernaola-Paredes et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
