New perspectives on the conservative management of osteoradionecrosis of the mandible: A literature review

Diogo Alpuim Costa, Tiago Porfirio Costa, Eduardo Carlinhos Netto, Natercia Joaquim, Isabel Ventura, Ana Cristina Pratas, Patricia Winckler, Ines Pires Silva, Ana Catarina Pinho, Isabel Goulao Sargento, Francisco Gamito Guerreiro, Antonio Rita Moreira

Research output: Contribution to journalReview article

20 Citations (Scopus)

Abstract

Over the last decades, several therapeutic options were considered in the treatment of the osteoradionecrosis (ORN) of the mandible, including supportive measures, ultrasound therapy, corticosteroids, hyperbaric oxygen, surgical resection with reconstruction, and, more recently, drugs capable of reversing the fibroatrophic process. Once established, the ORN does not spontaneously disappear and a standard treatment has not yet been defined. The clear clinical effectiveness of hyperbaric oxygen therapy (HBOT) varies according to the literature and there are some economic/logistic issues to be considered; the triplet tocopherol/pentoxifylline/clodronate demands greater evidence from randomized clinical trials and also resilience from the patient, given the long treatment duration and its possible side effects. Controversy around the ideal treatment of the initial stage ORN of the mandible persists. More rigorous randomized prospective trials are essential. The purpose of this article was to review the relevant literature on the physiopathology of ORN of the mandible and discuss the new perspectives of its conservative treatment. (C) 2016 Wiley Periodicals, Inc.
Original languageEnglish
Pages (from-to)1708-1716
Number of pages9
JournalHEAD AND NECK-JOURNAL FOR THE SCIENCES AND SPECIALTIES OF THE HEAD AND NECK
Volume38
Issue number11
DOIs
Publication statusPublished - Nov 2016

Keywords

  • osteoradionecrosis
  • mandible
  • physiopathology
  • conservative management
  • radiation-induced fibrosis

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