Diagnóstico Precoce, Tratamento Conservador e Remissão Completa de Osteorradionecrose de Mandíbula - Relato de Caso

Abstract

IntroductionOsteoradionecrosis (ORN) is characterized as one of radiotherapy's late adverse effects which causes great suffering and compromises patient's quality of life. The classical treatments for ORN are the hyperbaric therapy and surgery (mandibulectomy), quite expensive procedures with controversial indication. Conversely, the effectiveness of conservative treatments, such as topical chlorhexidine mouthwashes, is not well established in the literature. ObjectiveTo report the clinical case and the results in the conservative treatment and control protocols of the ORN in mandible established in a public health service. Case reporta black 45-year-old female patient was treated for squamous cell carcinoma in the past 3 years. She underwent partial glossectomy and adjuvant radiotherapy (7500Cg) on primary tumor area and neck. Patient was referred with a painful condition exhibiting multiple areas of bone exposure of about 2.5cm in its longest axis. Three-times a day mouthwashes with aqueous chlorhexidine gluconate solution 0.12% was prescribed for an indefinite period associated with rigorous oral hygiene and elimination possible oral irritants. Clinical follow was performed weekly until early response and monthly after this period. Two weeks after initial treatment there was complete remission of prodromal symptoms, and after six months sequestrectomy treatment was indicated under antibiotic prophylaxis. Total mucosa covered the bone defect 4 weeks after surgery. Discussion and ConclusionThe treatment was effective. The institution of conservative therapy avoided the necessity of hyperbaric therapy or surgical resection block (mandibulectomy). The results offered less morbidity to the patient and rationalization of the public health resources.