Pentoxifylline and tocopherol for prevention of osteoradionecrosis in patients who underwent oral surgery: A clinical audit

Abstract

Purpose Osteoradionecrosis (ORN) of the jaw is a severe and debilitating complication of the head and neck radiotherapy which frequently occurrs after oral surgery. This clinical audit aims aevaluate the effectiveness of combined use of pentoxifylline and tocopherol (PENTO) in prevention ORN onset in patient who underwent oral surgery after head and neck radiotherapy (RT). Material method In this clinical audit Pentoxifylline 400 mg, twice a day, and Tocopherol 800 IU once a day (PENTO protocol) have been prescribed. Patients started the protocol 1 week before the surgical procedure and continued for 8 weeks after. Results Twenty‐nine patients were included. They received 75 surgical interventions under PENTO protocol: 71 surgical procedures of dental extraction (single or multiple dental extractions in each session) and four implant placements. A total of 152 dental extractions were carried out: 64 surgical extractions which required the raising of mucoperiosteal flap, and 88 simple extractions. Four out of 29 patients developed ORN after surgical procedures: four cases of ORN occurred after dental extractions (5.6%) and one case of ORN after implant placement (25%). Conclusion PENTO is a useful ORN preventive protocol, low‐cost and clinically feasible, safe and well tolerated by patients. Further studies should focus on better defining the effectiveness PENTO, independently from the antibiotic therapy.

Reply to the letter to the editor by Somay et al: “In regard to recent published study of Lombardi et al. titled ‘Pentoxifylline and tocopherol for prevention of osteoradionecrosis in patients who underwent oral surgery: A clinical audit”

“…We appreciate the interest aroused by our recent clinical audit published in Special Care in Dentistry on the use of pentoxifylline and tocopherol (PENTO) for osteoradionecrosis (ORN) prevention in patients who received head and neck radiotherapy and underwent oral surgery. 1 We appreciated, in particular, the Letter from Somay and colleagues commenting on our clinical audit, which emphasizes the importance of this topic.…”

“…To conclude, we strongly agree with Somay et al about "the need for larger studies focusing on specific tumor groups staged and treated in comparable ways to achieve more reliable results about the efficacy of particular treatment protocol". Niccolò Lombardi 1,2 Elena Varoni 1,2 Giulio Villa 1 Annalisa Salis 1 Giovanni Lodi…”

Outcomes of a Pharmacological Protocol with Pentoxifylline and Tocopherol for the Management of Medication-Related Osteonecrosis of the Jaws (MRONJ): A Randomized Study on 202 Osteoporosis Patients

“…Pentoxifylline in combination with tocopherol is described as "PENTO protocol" for the management of osteoradionecrosis with beneficial antioxidant and antifibrotic properties [17]. Currently, these drugs are considered as having a positive synergistic therapeutic efficacy in treating chronic ischemic pathological conditions, such as diabetic microangiopathy, osteoradionecrosis, MRONJ, and osteomyelitis; however, the evidence is still limited and the mechanism of action remains unclear [17,18,[21][22][23][24][25].…”

Oral infections in oral cancer survivors: A mini-review

“…Cancer of the mouth and its treatments can affect a number of structures involved in key functions, such as speaking, eating, swallowing, breathing, as well having a central role in identity and communication of the individual. Thus, oncological surgery of the oral and perioral structures, chemotherapy with both traditional and biological drugs, and radiotherapy of the head and neck can significantly affect the quality of life of oral cancer patients (6). In addition, the high proportion of subjects over the age of 65 among them (59%), makes comorbidities highly common, further complicating the follow-up of this special group of cancer survivors (5).…”