RETRACTED: The effect of combined application of pentoxifylline and vitamin E for the treatment of osteoradionecrosis of the jaws: A meta-analysis

Conservative management of advanced mandibular osteoradionecrosis with mild clinical presentation after 17 years of oncological treatment: A case report

“…Kolokythas et al (2019) [10], in a recent systematic review and meta-analysis, demonstrated that in the treatment of refractory, moderate, and advanced ORN lesions, the PENTO therapy has a success rate of 62.7% (SD 3.4%, 95% CI, 55, 8-69.1%), avoiding the need for further surgical or medication approaches. However, the role of PENTO used alone continues to be controversial with respect to complete resolution of the disease itself, since some studies have shown associations of this therapy with other drugs, surgical techniques, and adjuvant therapies and these have produced different results [4]. In this case, there was a significant improvement in the advanced ORN lesion with the use of PENTO, with an initial dosage for three months after diagnosis was established, based on the clinical and imaging assessment.…”

“…Advanced or refractory cases of ORN are treated radically, with extensive surgical resections followed by reconstructions with different microvascularized free flaps such as the osteomyocutaneous or musculocutaneous grafts, which have become the most effective alternatives for stabilizing and decreasing progression of the condition [6]. Whereas the PENTO protocol, based on its antifibrotic, angiogenic, and potent antioxidant properties, has shown satisfactory clinical results and when used in conjunction with other adjuvant techniques, favoring the healing process with stabilization of and improvement in the initial clinical condition [4].…”

“…PENTO protocol is well tolerated by the majority of patients, although in some cases treatment must be adequate due to its acute toxicity. The dosage of the PENTO protocol recommended is based on 400 mg of pentoxifylline twice per day and 1000,000 IU of tocopherol whose undesirable secondary effects related were nausea or vomiting [4,9] Recent studies have demonstrated the ability of PENTO, either associated with clodronate (PENTOCLO), or not, for obtaining complete resolution of cases in early to advanced stages of ORN. Kolokythas et al (2019) [10], in a recent systematic review and meta-analysis, demonstrated that in the treatment of refractory, moderate, and advanced ORN lesions, the PENTO therapy has a success rate of 62.7% (SD 3.4%, 95% CI, 55, 8-69.1%), avoiding the need for further surgical or medication approaches.…”

“…Osteoradionecrosis (ORN) of the jaws is a late complication of RT in head and neck cancer, with an approximate incidence of 4-7%, which has been described in recent studies [1,2]. Moreover, there is a higher prevalence of ORN in the mandible, commonly manifested in the first three years after treatment [3,4]. At clinical assessment, ORN is found to be a painful exposure of necrotic bone in the irradiated region, which does not heal spontaneously within 3-6 months, and may be associated with purulent drainage, orocutaneous fistulae, and pathological fracture [3,5].…”

“…Advanced lesions are commonly treated by performing extensive surgical resections, associated with subsequent reconstruction with microvascularized free flaps [6]. It has being reported that isolated therapies are unable to promote total regression of lesions, and require the combination of adjuvant techniques in order to obtain better results [4].…”