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

Introduction: Osteoradionecrosis (ORN) of the jaws is a late complication of radiotherapy (RT) of the head and neck, with higher prevalence in the mandible. Treatment of the condition is controversial, ranging from conservative non-surgical management to extensive surgical resections with reconstruction. Drug therapy with pentoxifylline and tocopherol (PENTO) associated with adjuvant therapies has shown satisfactory clinical results, also in advanced stages of ORN. The present case report aims to describe the conservative management of an advanced mandibular ORN by medication with PENTO and other adjuvant therapies. Case Report: A 62-year-old Afro-descendent woman, with a history of oral squamous cell carcinoma in the left floor of the mouth, who was submitted to surgical resection, RT, and concomitant chemotherapy 17 years ago, complained of toothache in tooth 47, and need for rehabilitation of the mandibular residual alveolar ridge (RAR) on the left side. On intraoral clinical examination, the left RAR mucosa was intact and normal in appearance, with slightly purulent drainage associated with tooth 33, without bone exposure. Computed tomography examination showed evidence of extensive destruction. Advanced ORN was diagnosed, and treatment with PENTO was initiated, with subsequent surgical debridement, perioperative antimicrobial photodynamic therapy, and photobiomodulation sessions, resulting in regression of lesion 12 months after initial treatment. Conclusion: Pentoxifylline and tocopherol protocol can be considered an efficient alternative in the treatment of advanced ORN. Adjuvant therapies contribute to healing and improving local conditions. Prospective studies should be conducted to further clarify the role of PENTO and adjuvant therapies in the complete or partial resolution of this condition.