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Toker M, Karaduman ZO, Arıcan M, Turhan Y, Coşkun SK, Dalaslan RE, Çelik M, Uludağ V. Investigation of the effects of pentoxifylline and alpha tocopherol treatment on recovery in rats with Achilles tendon rupture. J Orthop Res 2024; 42:1907-1915. [PMID: 38564283 DOI: 10.1002/jor.25844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 02/16/2024] [Accepted: 03/20/2024] [Indexed: 04/04/2024]
Abstract
Although the Achilles tendon is the largest and strongest tendon in the body, healing of the Achilles tendon is the most common injury, and this process is difficult due to poor tendon circulation; moreover, the underlying mechanism has not been fully elucidated. In our study, we aimed to investigate the effects of pentoxifylline and alpha-tocopherol administered separately or in combination on rats with Achilles tendon injury. Forty-eight male Wistar rats weighing 230 ± 30 g were used in the study. The rats were randomly divided into eight groups of six animals each. Tendons were evaluated histopathologically and biomechanically. According to the statistical analysis, the vascularity density in the pentoxifylline group on day 14 was significantly greater than that in the other groups (p < 0.05). The collagen arrangement in the pentoxifylline and alpha-tocopherol groups on day 14 was found to be firmer and smoother than that in the control group (p < 0.05). The collagen arrangement in the pentoxifylline group on day 28 was greater than that in the other groups (p < 0.05). The biomechanical results were significantly greater in all groups (p < 0.05). Pentoxifylline contributed to tendon healing both through neovascularization in the early period and by improving collagen orientation in the late period, while alpha-tocopherol had a positive effect on collagen orientation in the early period. No beneficial effects were observed when pentoxifylline and alpha-tocopherol were used together. We believe that further research is needed to understand the effects of this combination therapy on tendon healing.
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Affiliation(s)
- Mustafa Toker
- Department of Orthopedics and Traumatology, Medical Faculty, Duzce University, Düzce, Turkey
| | - Zekeriya Okan Karaduman
- Department of Orthopedics and Traumatology, Medical Faculty, Duzce University, Düzce, Turkey
| | - Mehmet Arıcan
- Department of Orthopedics and Traumatology, Medical Faculty, Duzce University, Düzce, Turkey
| | - Yalçın Turhan
- Department of Orthopedics and Traumatology, Medical Faculty, Duzce University, Düzce, Turkey
| | | | - Raşit Emin Dalaslan
- Department of Orthopedics and Traumatology, Medical Faculty, Duzce University, Düzce, Turkey
| | - Mücahit Çelik
- Department of Orthopedics and Traumatology, Medical Faculty, Duzce University, Düzce, Turkey
| | - Veysel Uludağ
- Department of Orthopedics and Traumatology, Medical Faculty, Duzce University, Düzce, Turkey
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Tan W, Rossi NA, Haroun KB, Conner GR, McKinnon B, Ranasinghe V, Shabani S, Coblens OM. Denosumab-Induced Maxillary Osteonecrosis: A Case Study on Long-Term Complications in Multiple Myeloma Treatment. EAR, NOSE & THROAT JOURNAL 2024:1455613241263181. [PMID: 38880987 DOI: 10.1177/01455613241263181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2024] Open
Abstract
Background: Targeted therapies like denosumab have revolutionized multiple myeloma (MM) treatment, improved patient outcomes while introducing long-term complications. This study explores a rare instance of delayed maxillary osteonecrosis post-denosumab therapy, delving into its pathophysiology and management. Methods: A 40-year-old male MM patient who developed a painful palatal lesion post denosumab treatment and diagnosed of maxillary osteonecrosis by computed tomography scan and surgical biopsy is presented. Treatment history, symptom progression, and response to the PENTOCLO protocol were analyzed. Results: Post-denosumab discontinuation osteonecrosis highlights its prolonged impact on bone metabolism. PENTOCLO treatment protocol led to significant improvement. Genetic factors influencing osteonecrosis susceptibility have been discussed and considered. Conclusions: This case underscores the need for vigilance regarding long-term complications in MM survivors, preventive strategies, including regular dental evaluations and reducing invasive dental procedures, are crucial. We advocate for an interdisciplinary approach and further research into tailored prevention and management of osteonecrosis in cancer survivors.
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Affiliation(s)
- Wilhelmina Tan
- School of Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Nicholas A Rossi
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Brian McKinnon
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | - Viran Ranasinghe
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | - Sepehr Shabani
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
| | - Orly M Coblens
- Department of Otolaryngology, University of Texas Medical Branch, Galveston, TX, USA
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3
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Kutuk T, Atak E, Villa A, Kalman NS, Kaiser A. Interdisciplinary Collaboration in Head and Neck Cancer Care: Optimizing Oral Health Management for Patients Undergoing Radiation Therapy. Curr Oncol 2024; 31:2092-2108. [PMID: 38668058 PMCID: PMC11049200 DOI: 10.3390/curroncol31040155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 04/28/2024] Open
Abstract
Radiation therapy (RT) plays a crucial role in the treatment of head and neck cancers (HNCs). This paper emphasizes the importance of effective communication and collaboration between radiation oncologists and dental specialists in the HNC care pathway. It also provides an overview of the role of RT in HNC treatment and illustrates the interdisciplinary collaboration between these teams to optimize patient care, expedite treatment, and prevent post-treatment oral complications. The methods utilized include a thorough analysis of existing research articles, case reports, and clinical guidelines, with terms such as 'dental management', 'oral oncology', 'head and neck cancer', and 'radiotherapy' included for this review. The findings underscore the significance of the early involvement of dental specialists in the treatment planning phase to assess and prepare patients for RT, including strategies such as prophylactic tooth extraction to mitigate potential oral complications. Furthermore, post-treatment oral health follow-up and management by dental specialists are crucial in minimizing the incidence and severity of RT-induced oral sequelae. In conclusion, these proactive measures help minimize dental and oral complications before, during, and after treatment.
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Affiliation(s)
- Tugce Kutuk
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA; (T.K.)
| | - Ece Atak
- Department of Radiation Oncology, Akdeniz University Faculty of Medicine, Antalya 07070, Turkey;
| | - Alessandro Villa
- Oral Medicine and Oral Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA;
| | - Noah S. Kalman
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA; (T.K.)
- Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Adeel Kaiser
- Department of Radiation Oncology, Miami Cancer Institute, Baptist Health South Florida, Miami, FL 33176, USA; (T.K.)
- Department of Radiation Oncology, Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
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4
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Corrao G, Mazzola GC, Lombardi N, Marvaso G, Pispero A, Baruzzi E, Decani S, Tarozzi M, Bergamaschi L, Lorubbio C, Repetti I, Starzyńska A, Alterio D, Ansarin M, Orecchia R, D’Amore F, Franchini R, Nicali A, Castellarin P, Sardella A, Lodi G, Varoni EM, Jereczek-Fossa BA. Oral Surgery and Osteoradionecrosis in Patients Undergoing Head and Neck Radiation Therapy: An Update of the Current Literature. Biomedicines 2023; 11:3339. [PMID: 38137559 PMCID: PMC10742198 DOI: 10.3390/biomedicines11123339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Osteoradionecrosis (ORN) is a serious long-term complication of head and neck radiotherapy (RT), which is often triggered by dental extractions. It results from avascular aseptic necrosis due to irradiated bone damage. ORN is challenging to treat and can lead to severe complications. Furthermore, ORN causes pain and distress, significantly reducing the patient's quality of life. There is currently no established preventive strategy. This narrative review aims to provide an update for the clinicians on the risk of ORN associated with oral surgery in head and neck RT patients, with a focus on the timing suitable for the oral surgery and possible ORN preventive treatments. An electronic search of articles was performed by consulting the PubMed database. Intervention and observational studies were included. A multidisciplinary approach to the patient is highly recommended to mitigate the risk of RT complications. A dental visit before commencing RT is highly advised to minimize the need for future dental extractions after irradiation, and thus the risk of ORN. Post-RT preventive strategies, in case of dento-alveolar surgery, have been proposed and include antibiotics, hyperbaric oxygen (HBO), and the combined use of pentoxifylline and tocopherol ("PENTO protocol"), but currently there is a lack of established standards of care. Some limitations in the use of HBO involve the low availability of HBO facilities, its high costs, and specific clinical contraindications; the PENTO protocol, on the other hand, although promising, lacks clinical trials to support its efficacy. Due to the enduring risk of ORN, removable prostheses are preferable to dental implants in these patients, as there is no consensus on the appropriate timing for their safe placement. Overall, established standards of care and high-quality evidence are lacking concerning both preventive strategies for ORN as well as the timing of the dental surgery. There is an urgent need to improve research for more efficacious clinical decision making.
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Affiliation(s)
- Giulia Corrao
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
| | - Giovanni Carlo Mazzola
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
| | - Niccolò Lombardi
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
| | - Alberto Pispero
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Elisa Baruzzi
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Sem Decani
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Marco Tarozzi
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Luca Bergamaschi
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
| | - Chiara Lorubbio
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Ilaria Repetti
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
| | - Anna Starzyńska
- Department of Oral Surgery, Medical University of Gdańsk, 7 Dębinki Street, 80-211 Gdańsk, Poland;
| | - Daniela Alterio
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
| | - Mohseen Ansarin
- Division of Otolaryngology and Head and Neck Surgery, IEO European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Roberto Orecchia
- Scientific Directorate, IEO-European Institute of Oncology, IRCCS, 20141 Milan, Italy;
| | - Fiorella D’Amore
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Roberto Franchini
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Andrea Nicali
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Paolo Castellarin
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Andrea Sardella
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Giovanni Lodi
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Elena Maria Varoni
- Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Università degli Studi di Milano, Via Beldiletto 1, 20142 Milan, Italy; (N.L.); (A.P.); (E.B.); (S.D.); (M.T.); (F.D.); (R.F.); (A.N.); (P.C.); (A.S.); (G.L.)
- ASST Santi Paolo e Carlo, SC Odontostomatology II, San Paolo Hospital, 20142, Milan, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO—European Institute of Oncology, IRCCS, 20141 Milan, Italy; (G.C.); (G.C.M.); (G.M.); (L.B.); (C.L.); (I.R.); (D.A.); (B.A.J.-F.)
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
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Patel V, Young H, Mellor A, Sproat C, Kwok J, Cape A, Mahendran K. The use of liquid formulation pentoxifylline and vitamin E in both established and as a prophylaxis for dental extractions "at risk" of osteoradionecrosis. Oral Surg Oral Med Oral Pathol Oral Radiol 2023; 136:404-409. [PMID: 37316424 DOI: 10.1016/j.oooo.2023.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 02/08/2023] [Accepted: 02/19/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Osteoradionecrosis (ORN) of the jaws remains one of the most debilitating complications of radiotherapy (RT) in patients with head and neck cancer (HNC). Liquid pentoxifylline and vitamin E (PVe) presents an alternative formulation to tablets for patients with dysphagia or enteric feeding. OBJECTIVE This study aimed to assess the clinical outcomes of using a liquid formulation of PVe for both established ORN and as a prophylaxis to avoid its occurrence after dental extractions. A secondary objective was to determine patient-reported side effects in relation to the liquid formulation of PVe. STUDY DESIGN The clinical records of 111 patients with HNC who were prescribed liquid PVe were reviewed retrospectively (66 with established ORN and 45 as prophylaxis before an invasive dental procedure). RESULTS In established ORN, 44% healed, and 41% were stable. In the prophylaxis group, 96% of surgical sites healed completely, with 4% (n = 2) developing ORN. Most patients (89%) were able to tolerate liquid PVe. Of the 11% (n = 12) who could not tolerate this regime, the most commonly reported side effect was gastric irritation (n = 5/12), whereas no more than 1 patient reported dizziness, malaise, and bleeding. CONCLUSIONS This retrospective review suggests that liquid PVe is efficacious for both established ORN and as a prophylaxis. Side effects reported were similar to those recognized for the tablet formulation.
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Affiliation(s)
- Vinod Patel
- Oral Surgery Department, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom.
| | - Helen Young
- Oral Surgery Department, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Amy Mellor
- Oral Surgery Department, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Chris Sproat
- Oral Surgery Department, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Jerry Kwok
- Oral Surgery Department, Guy's & St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Angela Cape
- King's College London, London, United Kingdom
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Colapinto G, Goker F, Nocini R, Albanese M, Nocini PF, Sembronio S, Argenta F, Robiony M, Del Fabbro M. 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. J Clin Med 2023; 12:4662. [PMID: 37510777 PMCID: PMC10380687 DOI: 10.3390/jcm12144662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 06/28/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Medication-related osteonecrosis of the jaws (MRONJ) is a challenging situation in clinics. Previous studies have shown that pentoxifylline combined with tocopherol proved to be beneficial in patients with osteoradionecrosis, due to their antioxidant and antifibrotic properties. The aim of this randomized study was to evaluate the effect of pentoxifylline and tocopherol in patients that had developed MRONJ after tooth extractions. The study population consisted of 202 Stage I MRONJ female patients with an average age of 66.4 ± 8.3 years, who were divided into two groups. The test group (n = 108) received a pharmacological protocol with pentoxifylline and tocopherol (2 months pre-operatively and 6 months post-operatively). The control group (n = 94) had sequestrectomy operations without any pharmacological preparation. The main outcomes were clinical healing of the mucosa after 1 month, and clinical and radiographic healing of the bone lesion at 6 months. In the test group all patients had mucosal healing and there was only one relapse within 6 months. In the control group, in 17% of the patients the mucosa did not heal, 71% of the patients relapsed within two months, and 7% developed infectious complications (such as abscess or phlegmon). After 6 months, the control group patients with persisting issues were prescribed pentoxifylline and tocopherol, as in the test group. At a subsequent follow-up, all those patients healed completely. Patients were monitored for a period of 7.8 ± 0.3 years, during which no relapse or additional problems were reported. As a conclusion, pentoxifylline and tocopherol protocol seems to be beneficial in the management of MRONJ patients.
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Affiliation(s)
- Gianluca Colapinto
- Indipendent Researcher, Chief Medical Officer, Oral Med Care srl, 70032 Bitonto, BA, Italy
| | - Funda Goker
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20122 Milan, Italy
- Dental and Maxillo-Facial Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy
| | - Riccardo Nocini
- Dipartimento Scienze Chirurgiche Odontostomatologiche e Materno-Infantili, Università degli Studi di Verona, 37134 Verona, Italy
| | - Massimo Albanese
- Dipartimento Scienze Chirurgiche Odontostomatologiche e Materno-Infantili, Università degli Studi di Verona, 37134 Verona, Italy
| | | | | | - Francesca Argenta
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20122 Milan, Italy
| | - Massimo Robiony
- Department of Medical Area, University of Udine, 33100 Udine, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20122 Milan, Italy
- Dental and Maxillo-Facial Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, 20122 Milan, Italy
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Abed H. Dental considerations for head and neck cancer: A clinical review. Saudi Dent J 2023; 35:476-486. [PMID: 37520601 PMCID: PMC10373080 DOI: 10.1016/j.sdentj.2023.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/10/2023] [Accepted: 05/14/2023] [Indexed: 08/01/2023] Open
Abstract
Introduction Radiotherapy is one of the treatment modalities for the treatment of head and neck cancer (HNC). However, it leads to the development of chronic and acute side effects. These side effects impact negatively on the patient's quality of life and oral functioning. This clinical review aims to provide basic information about HNC, understand the impact of radiotherapy on oral health, and explain the role of dental care providers for HNC patients during the pre-and post-radiotherapy time. Materials and Methods Electronic databases (i.e., PubMed, Scopus, and Google Scholar) were searched using defined keywords. The main inclusion criteria were any studies describing "dental management of patients with head and neck cancer" and "dental management of patients treated with radiotherapy." Results Thematic analysis was used to summaries the findings of the included studies (n = 102) into main headings and subheadings. All studies were published between 1970 and 2023. Conclusion The number of HNC patients is increasing. This necessitates the need for raising the awareness of dental care providers to the side-effects of HNC therapy which includes treatment with radiotherapy, chemotherapy, and/or surgery. Dental care providers should understand the common side-effects and their treatments besides their role in the pre- (i.e., dental extraction of teeth with poor prognosis and maintaining good oral hygiene) and post- (i.e., oral rehabilitation and post-HNC dental care) radiotherapy dental care.
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The Progress in Reconstruction of Mandibular Defect Caused by Osteoradionecrosis. JOURNAL OF ONCOLOGY 2023; 2023:1440889. [PMID: 36968640 PMCID: PMC10033216 DOI: 10.1155/2023/1440889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/18/2023] [Accepted: 02/22/2023] [Indexed: 03/17/2023]
Abstract
Osteoradionecrosis (ORN) is described as a disease with exposed, nonviable bone that fails to heal spontaneously or by means of conservative treatment after radiotherapy in at least 3 months. Though traditional theories in the early stage including hypoxic-hypocellular-hypovascular and fibro-atrophic in addition to new findings such as ferroptosis were put forward to explain the mechanisms of the osteoradionecrosis, the etiology of ORN is still unclear. With the high rate of occurrence in the head and neck area, especially in the mandible, this disease can disrupt the shape and function of the irradiated area, leading to a clinical presentation ranging from stable small areas of asymptomatic exposed bone to severe progressive necrosis. In severe cases, patients may experience pain, xerostomia, dysphagia, facial fistulas, and even a jaw defect. Consequently, sequence therapy and sometimes extensive surgery and reconstructions are needed to manage these sequelae. Treatment options may include pain medication, antibiotics, the removal of sequesters, hyperbaric oxygen therapy, segmental resection of the mandible, and free flap reconstruction. Microanastomosed free-flaps are considered to be promising choice for ORN reconstruction in recent researches, and new methods including three-dimensional (3-D) printing, pentoxifylline, and amifostine are used nowadays in trying increase the success rates and improve quality of the reconstruction. This review summarizes the main research progress in osteoradionecrosis and reconstruction treatment of osteoradionecrosis with mandibular defect.
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Lombardi N, Varoni E, Villa G, Salis A, Lodi G. Pentoxifylline and tocopherol for prevention of osteoradionecrosis in patients who underwent oral surgery: A clinical audit. SPECIAL CARE IN DENTISTRY 2023; 43:136-143. [PMID: 35895902 DOI: 10.1111/scd.12759] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 11/29/2022]
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.
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Affiliation(s)
- Niccolò Lombardi
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Milan, Italy
- ASST Santi paolo e Carlo, Ospedale San Paolo, Milan, Italy
| | - Elena Varoni
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Milan, Italy
- ASST Santi paolo e Carlo, Ospedale San Paolo, Milan, Italy
| | - Giulio Villa
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Milan, Italy
| | - Annalisa Salis
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Milan, Italy
| | - Giovanni Lodi
- Università degli Studi di Milano, Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Milan, Italy
- ASST Santi paolo e Carlo, Ospedale San Paolo, Milan, Italy
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