Lombardi Niccolò, Varoni Elena, Villa Giulio, Salis Annalisa, Lodi Giovanni
Università degli Studi di Milano, Dipartimento di Scienze Biomediche Chirurgiche e Odontoiatriche, Milan, Italy.
ASST Santi paolo e Carlo, Ospedale San Paolo, Milan, Italy.
Spec Care Dentist. 2023 Mar;43(2):136-143. doi: 10.1111/scd.12759. Epub 2022 Jul 27.
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).
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.
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%).
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.
颌骨放射性骨坏死（ORN）是头颈部放疗的一种严重且使人衰弱的并发症，常在口腔手术后频繁发生。本临床审计旨在评估己酮可可碱与生育酚联合使用（PENTO）对预防头颈部放疗（RT）后接受口腔手术患者ORN发病的有效性。
在本临床审计中，已开具了己酮可可碱400毫克，每日两次，以及生育酚800国际单位，每日一次（PENTO方案）的处方。患者在手术前1周开始该方案，并在术后持续8周。
纳入29例患者。他们在PENTO方案下接受了75次手术干预：71次拔牙手术（每次手术进行单颗或多颗牙齿拔除）和4次种植体植入。总共进行了152次拔牙：64次外科拔牙需要掀起粘骨膜瓣，88次简单拔牙。29例患者中有4例在手术后发生ORN：4例ORN发生在拔牙后（5.6%），1例ORN发生在种植体植入后（25%）。
PENTO是一种有用的ORN预防方案，成本低且临床可行，安全且患者耐受性良好。进一步的研究应集中在更好地确定PENTO的有效性，独立于抗生素治疗。
