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. 2018:26:e20170172.
doi: 10.1590/1678-7757-2017-0172. Epub 2018 May 21.

Osteoradionecrosis of the jaws: case series treated with adjuvant low-level laser therapy and antimicrobial photodynamic therapy

Guilherme Henrique Ribeiro  1 , Mariana Comparotto Minamisako  2 , Inês Beatriz da Silva Rath  1 , Aira Maria Bonfim Santos  1 , Alyne Simões  3 , Keila Cristina Rausch Pereira  4 , Liliane Janete Grando  1
Affiliations

Osteoradionecrosis of the jaws: case series treated with adjuvant low-level laser therapy and antimicrobial photodynamic therapy

Guilherme Henrique Ribeiro et al. J Appl Oral Sci. 2018.

Abstract

Background: Osteoradionecrosis of the jaw (ORNJ) is the most severe and complex sequel of head and neck radiotherapy (RT) because of the bone involved, it may cause pain, paresthesia, foul odor, fistulae with suppuration, need for extra oral communication and pathological fracture. We treated twenty lesions of ORNJ using low-level laser therapy (LLLT) and antimicrobial photodynamic therapy (aPDT). The objective of this study was to stimulate the affected area to homeostasis and to promote the healing of the oral mucosa.

Methods: We performed aPDT on the exposed bone, while LLLT was performed around the bone exposure (red spectrum) and on the affected jaw (infrared spectrum). Monitoring and clinical intervention occurred weekly or biweekly for 2 years.

Results: 100% of the sample presented clinical improvement, and 80% presented complete covering of the bone exposure by intact oral mucosa.

Conclusion: LLLT and aPDT showed positive results as an adjuvant therapy to treat ORNJ.

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Conflict of interest statement

Conflict of Interest

The authors declare no conflict of interest. Authors disclose all relationships or interests that could have direct or potential influence or bias on the study.

Figures

Figure 1
Figure 1. Risk factors in relation to increased susceptibility to develop ORNJ
Figure 2
Figure 2. Classification of ORNJ based on clinical and imaging parameters
Figure 3
Figure 3. Patients with ORNJ. Stage I: bone exposures < 2 cm, asymptomatic, without evidence of infection (a). Stage II: bone exposure ≥2 cm, symptomatic, with infection, erythema and pain (b). Stage III: orocutaneous fistula with purulent drainage in intraoral (c) and extraoral (d) view
Figure 4
Figure 4. Osteoradionecrosis of the jaw (ORNJ) remission with total coating of oral mucosal lining in patients treated with LLLT and aPDT. ORNJ stage I in posterior maxilla in remission after 10 months (a). ORNJ stage II in posterior mandible in remission after 7 months (b). ORNJ stage II in anterior maxilla in remission after 4 months (c). Both patients were followed-up for two years and so far there was no recurrence of the lesions
See this image and copyright information in PMC

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