Prevenção e manejo terapêutico da osteorradionecrose dos maxilares: uma revisão de literatura.

Abstract

Radiation therapy (RT) is an effective and widely used treatment for malignant head and neck neoplasms, however, this local irradiation brings with it some consequences or injuries and among them, osteoarthionecrosis (ORN) is one of the most serious. This manifests as an area of exposed necrotic bone in the jaw or jaw that does not heal for at least three months. In most cases, osteoarthionecrosis progresses gradually, becoming more extensive and painful, and its late manifestations include infection and pathological fracture. This serious complication appears late to the radiotherapy treatment and is usually associated with invasive procedures, like dental extractions. In the last decades, several therapeutic options have been considered in the treatment of maxillary ORN, including supportive measures, hyperbaric oxygen, prophylactic use of pentoxifylline and tocopherol or pentacolol, surgical resection with reconstruction and, more recently, drugs capable of reversing the fibroatrophic process. The search for articles for this review, which aimed to emphasize important aspects related to the preventive and therapeutic management of osteorradionecrosis of maxillary bones, used the online search bases: Scielo, Medline and Pubmed and as search strategies were used the keywords: osteoradionecrosis, jaw, prevention and control and therapy, being limited to the period from 1980 to 2018. Thus, this work emphasized the important role of the dental surgeon in face of this pathological condition and concluded that the adequacy of the buccal environment and oral surgeries before initiating RT can prevent the onset of ORN. Therefore, prevention is the best practice and even with the existence of several therapeutic options for the management of this condition, further studies still need to be performed to substantiate these treatments.