title: New perspectives on the conservative management of osteoradionecrosis of the mandible: A literature review.
abstract: Over the last decades, several therapeutic options were considered in the treatment of the osteoradionecrosis (ORN) of the mandible, including supportive measures, ultrasound therapy, corticosteroids, hyperbaric oxygen, surgical resection with reconstruction, and, more recently, drugs capable of reversing the fibroatrophic process. Once established, the ORN does not spontaneously disappear and a standard treatment has not yet been defined. The clear clinical effectiveness of hyperbaric oxygen therapy (HBOT) varies according to the literature and there are some economic/logistic issues to be considered; the triplet tocopherol/pentoxifylline/clodronate demands greater evidence from randomized clinical trials and also resilience from the patient, given the long treatment duration and its possible side effects. Controversy around the ideal treatment of the initial stage ORN of the mandible persists. More rigorous randomized prospective trials are essential. The purpose of this article was to review the relevant literature on the physiopathology of ORN of the mandible and discuss the new perspectives of its conservative treatment. © 2016 Wiley Periodicals, Inc. Head Neck 38: 1708-1716, 2016.
authors.affiliation: Medical Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal. diogoalpuimcosta@gmail.com.|Underwater and Hyperbaric Medicine Center, Portuguese Navy, Lisbon, Portugal. diogoalpuimcosta@gmail.com.|Naval Research Center, Almada, Portugal. diogoalpuimcosta@gmail.com.|Nova Medical School, Lisbon, Portugal. diogoalpuimcosta@gmail.com.
authors.forename: Diogo Alpuim
authors.initials: DA
authors.lastname: Costa
authors.affiliation: Otorhinolaryngology Department, Centro Hospitalar de Lisboa Norte, Hospital de Santa Maria, E.P.E., Lisbon, Portugal.|Underwater and Hyperbaric Medicine Center, Portuguese Navy, Lisbon, Portugal.
authors.forename: Tiago Porfírio
authors.initials: TP
authors.lastname: Costa
authors.affiliation: Radiation Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal.
authors.forename: Eduardo Carlinhos
authors.initials: EC
authors.lastname: Netto
authors.affiliation: Biomedical Sciences and Medicine Department, Universidade do Algarve, Faro, Portugal.
authors.forename: Natércia
authors.initials: N
authors.lastname: Joaquim
authors.affiliation: Stomatology Department, Hospital do Espírito Santo, E.P.E., Évora, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: Ventura
authors.affiliation: Maxillofacial Surgery Department, Centro Hospitalar de Lisboa Central, Hospital de São José, E.P.E., Lisbon, Portugal.|Underwater and Hyperbaric Medicine Center, Portuguese Navy, Lisbon, Portugal.|Naval Research Center, Almada, Portugal.
authors.forename: Ana Cristina
authors.initials: AC
authors.lastname: Pratas
authors.affiliation: Medical Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal.
authors.forename: Patrícia
authors.initials: P
authors.lastname: Winckler
authors.affiliation: Medical Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal.
authors.forename: Inês Pires
authors.initials: IP
authors.lastname: Silva
authors.affiliation: General Surgery Department, Centro Hospitalar de Lisboa Central, Hospital de São José, E.P.E., Lisbon, Portugal.
authors.forename: Ana Catarina
authors.initials: AC
authors.lastname: Pinho
authors.affiliation: Medical Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal.
authors.forename: Isabel Goulão
authors.initials: IG
authors.lastname: Sargento
authors.affiliation: Underwater and Hyperbaric Medicine Center, Portuguese Navy, Lisbon, Portugal.|Naval Research Center, Almada, Portugal.
authors.forename: Francisco Gamito
authors.initials: FG
authors.lastname: Guerreiro
authors.affiliation: Medical Oncology Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal.|Clinical Trials Department, Instituto Português de Oncologia de Lisboa Francisco Gentil, E.P.E., Lisbon, Portugal.
authors.forename: António Rita
authors.initials: AR
authors.lastname: Moreira
mesh_terms: D000975:Antioxidants / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D004002:Clodronic Acid / Q000627:therapeutic use; D000072700:Conservative Treatment; D004359:Drug Therapy, Combination; D006801:Humans; D006931:Hyperbaric Oxygenation; D008336:Mandibular Diseases / Q000628:therapy*; D010025:Osteoradionecrosis / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D010431:Pentoxifylline / Q000627:therapeutic use; D024505:Tocopherols / Q000627:therapeutic use
chemical_list: D000975:Antioxidants; D050071:Bone Density Conservation Agents; D004002:Clodronic Acid; D024505:Tocopherols; D010431:Pentoxifylline
keywords: conservative management; mandible; osteoradionecrosis; physiopathology; radiation-induced fibrosis