Therapeutic alternatives in the management of osteoradionecrosis of the jaws. Systematic review

Abstract

Background to systematically review the literature, comparing the healing of osteoradionecrosis (ORN) among the therapeutic alternatives: surgical, pharmacological and combined. Material and Methods The review was organized according to the PRISMA protocol with regards to the following PICO question: patients with ORN of the jaws (P=Patient); all interventions reported (I = intervention); between all therapies (C=Comparison); healing of lesions (O=outcome). Results Surgical treatment was the most common choice (46.3%) followed by pharmacological treatment, exclusively (25.9%) or combined (26.9%). Treatment exclusively by surgical intervention seems to be most effective option, with 51.2% of the lesions healed, OR for healing of 5.7 (CI95% 1.9-16.9, p =0.002). Only 1 case (0.9%) corresponded to low level laser therapy. Conclusions It seems clear that early intervention with conservative surgical combined with pharmacological methods improves the prognosis of ORN. Key words: Osteoradionecrosis, radiotherapy bone necrosis, hyperbaric oxygen, pentoxifylline, teriparatide, low level laser therapy.

Osteoradionecrosis of the jaw: A mini review

“…Fixation plates and screws are removed if they appear to be a contributing factor. Studies have shown that early intervention with minor surgical procedures combined with pharmacological methods may improve the prognosis of ORN [ 51 ]. Surgical management is generally employed when conservative management is unsuccessful and there is progressive (Notani III) ORN resulting in pathological fractures and draining fistulae [ 52 ].…”

The Potential Therapeutic Role of Mesenchymal Stem Cells-Derived Exosomes in Osteoradionecrosis

“…Although conservative therapies can treat some early ORN, the cure rate is only 28.6%, combined surgery is required to obtain better effects, and the recurrence is possible [ 103 ]. Therefore, it is necessary to study a new treatment.…”

Osteorradionecrose dos maxilares em pacientes portadores de câncer de cabeça e pescoço - Overview de revisões sistemáticas

“…O uso dos fármacos, como a pentoxifilina-tocoferol (PENTO) ou associada ao clodronato (PENTOCLO), (Delanian et al, 2005) e a utilização de teriparatida (Cha et al, 2018) são formas de tratamento alternativo para a ORN, assim como os estudos realizados com fotobiomodulação antimicrobiana demonstraram potencializar, a fase de cicatrização dos tecidos acometidos por ORN (Camolesi et al, 2021).…”

“…Após a revisão dos títulos e resumos e eliminação das duplicatas, 189 estudos foram selecionados, dos quais 176 artigos foram excluídos após leitura do texto na íntegra (Figura 5.1). Finalmente, 13 artigos foram considerados para análise de qualidade metodológica (Fritz et al, 2010;Samman, 2011Samman, , 2012Bennett et al, 2016;Martos-Fernández et al, 2018;El-Rabbany et al, 2019;Kolokythas et al, 2019;Raggio;Winter, 2019;Abed et al, 2020;Beaumont et al, 2020;Lajolo et al, 2020;Zhang et al, 2020;Camolesi et al, 2021). O nível de concordância entre os examinadores na fase de inclusão e de elegibilidade foi de 0.9 e 0.9 (Kappa de Cohen), respectivamente.…”

“…O fluxograma baseado no PRISMA mostra os resultados das etapas de seleção dos artigos (Figura 5.1). Samman, 2012;Abed et al, 2020;Camolesi et al, 2021).…”