Pentoxifylline, tocopherol, and sequestrectomy are effective for the management of advanced osteoradionecrosis of the jaws—a case series

Abstract

Background The aim of the present study was to evaluate the efficacy of pentoxifylline and tocopherol for the management of osteoradionecrosis of the jaws. Methods Twenty-five patients diagnosed with osteoradionecrosis of the jaws treated with pentoxifylline 400 mg + tocopherol 400 mg three times daily (tid) were evaluated. Clinical records and image tests were reviewed. All patients were previously submitted to head and neck radiation therapy and presented with a clinical and radiographic diagnosis of osteoradionecrosis of the jaws.Results Following therapy with pentoxifylline and tocopherol, 76% (19/25) of the patients showed complete mucosal healing, in which 47.3% (9/19) did not undergo sequestrectomy. From this particular group, 77.7% (7/9) were in stage I and 33.3% (3/9) used the protocol for up to 3 months. Among those who underwent to sequestrectomy, complete mucosal healing was observed in 52.7% (10/19). Among these, 60% (6/10) were in stage I and 100% of the patients were using the protocol for more than 3 months. In all other patients, partial healing of the mucosa was observed since they presented advanced disease. These represented 24% of the sample (6/25), 66.6% (4/6) were in stage III, and 60% (4/6) used the protocol for over 6 months. Conclusion Pentoxifylline and tocopherol may provide effective management of osteoradionecrosis of the jaws, and the association with sequestrectomy may avoid major surgical procedures.

Oral health related-quality of life before and during the COVID-19 pandemic in patients with non-alcoholic fatty liver disease

“…However, differences as great as those found in our “During - Before” mean scores for Role functioning/physical (-32.8 points) and Role functioning/emotional (-18.9 points) and in OHIP14 (3.6 points) were remarkable and leave no doubt about the magnitude of these decreases after the advent of the COVID-19 pandemic. Further, it must be kept in mind that the MCID for the group-level is necessarily smaller than for the individual patient-level, because of greater measurement errors inherent to patient quality of life scores ( 26 ).…”

Prevention and Management of Osteoradionecrosis in Patients With Head and Neck Cancer Treated With Radiation Therapy: ISOO-MASCC-ASCO Guideline

“…Eighty publications were identified on the basis of the search strategy described in the Methods section. Of these, six were RCTs, [10][11][12][13][14][15] 14 were prospective studies, 3,[16][17][18][19][20][21][22][23][24][25][26][27][28][29] and 60 were retrospective studies. The identified trials were published between 2004 and 2023.…”

“…Nine studies of pentoxifylline and potentiation by clodronate (PENTOCLO) were identified. 19,20,26,44,59,60,69,75,77 In one controlled study, pentoxifylline was used in combination with surgery and doxycycline, which led to inconclusive results regarding the effect of pentoxifylline in mild, moderate, and severe ORN cases. 69 The remaining two prospective 19,26 and six retrospective studies 20,44,59,60,75,77 of pentoxifylline in mild, moderate, and severe ORN cases reported healing rates of 60%-100% in studies that also administered clodronate, ciprofloxacin, amoxicillin and/or prednisolone.…”