PP176: Osteoradionecrosis of the mandible and its resolution with protocol: Pentoxifylline–tocopherol associated with antibiotic therapy

Abstract

Introduction One of the worst concerns of a dentist is to ORN (osteoradionecrosis) of the mandible and maxilla. Various treatment techniques are used, but with little chance of success. Examples include various combinations of antibiotics, antiseptic irrigation, hyperbaric oxygenation therapy, Ultrasound, Sequestrectomias, resection + reconstruction with buccal fat pad flap. As the present case, many attempts have been used. One patient in the Hospital Erastus Gaertner Curitiba-PR-Brazil arrived for treatment after exposure of mandibular bone and underwent treatment with pentoxifylline, and Tocoferal with antibiotics Amoxicillin and Metronidazole. Objective Treatment of osteonecrosis of the jaw after radiotherapy protocol pentoxifylline–tocopherol. Methods Patient LSB, male, 64 years old, Caucasian, former smoker and drinker, submitted in 2005 to glossectomy with resection of the floor of the mouth and neck dissection right due to squamous cell carcinoma of the tongue (T3n0m0) and on edge radiotherapy . After 7 years showed exposed bone in bilateral mandibular body involving cortical and medullary areas of the alveolar bone on the left side, the right side had diffuse involvement in the total thickness of the jawbone, including lower border with pathological fracture. Patient underwent dental extractions for 6 months, with exposure of the bone marrow 2x2cm intraoral left. The right side showed pathological fracture with 3x2cm exposure of intra-oral and extra-oral fistula. The proposed treatment consists in removing the bone sequestration, by using 4 weeks of Amoxicillin and metronidazole 500mg, protocol associated with the use of pentoxifylline and tocopherol 400mg 2x/day 1000IU per day for 3 months may extend 6 months. Still was instructed to consume a diet liquid-pasty. Result In August of 2012 began with antibiotics and protocol Petoxifilina and Tocopherol, with three-month program and bone sequestration were removed under local anesthesia. The patient returned to the head and neck clinic to search for possible recurrent tumor in the oral cavity and biopsy was performed on buccal floor, in the area of bone exposure with negative results for malignancy, but confirming ORN. After 3 months back and it was noted epidermalization exposures bone. Conclusion It is believed that the protocol associated with antibiotic therapy and removal of bone sequestration showed positive results and opened a new technique for treatment of ORN, which needs further research.