Evre III MRONJ Tedavisinde Pentoksifilin ve Tokoferol Protokolü: Bir Olgu Sunumu

Abstract

Pentoksifilin ve tokoferol rejiminin osteoradyonekrozun önlenmesi ve tedavisinde olumlu sonuçları bildirilmekle beraber, MRONJ tedavisindeki rolü ile ilgili çalışmaların sayısı limitlidir. Bu vaka raporunda, patolojik mandibula fraktürü gelişmiş ve cerrahi tedavi uygulanamayan bir evre III MRONJ olgusunda PENTO protokolü ile elde edilen sonuçlar sunulacaktır. 68 yaşında prostat kanseri ve üç yıllık intravenöz zoledronik asit kullanım öyküsü bulunan erkek hasta, 2018 yılında kliniğimize iyileşmeyen çekim bölgesi şikâyeti ile başvurmuştur. Takip ve kontrol bakımından kooperasyon kurulamayan hastada, iki yıl sonra patolojik mandibula fraktürü gözlenmiştir. Hastanın devam eden kemoterapisi göz önünde bulundurularak, PENTO protokolüne başlanmış, yedi aylık sürenin sonunda hastada spontan sekestrasyon, kırık hattında iyileşme ve yumuşak dokuda kapanma izlenmiştir. Bu vakadan elde edilen bulgular ve mevcut literatür değerlendirildiğinde, PENTO protokolü MRONJ yönetiminde umut vaat eden bir tedavi yaklaşımı olarak düşünülebilir. Bununla birlikte, bu rejimin MRONJ tedavisindeki yerinin daha net bir biçimde aydınlatılması için, daha geniş hasta gruplarını içeren ileri klinik ve deneysel araştırmalara ihtiyaç vardır.

Keywords

• MRONJ
• patolojik fraktür
• PENTO
• pentoksifilin
• tokoferol

Pentoxifylline and Tocopherol in the Management of Stage III Medication-Related Osteonecrosis of the Jaw: A Case Report

Abstract

Regimen of pentoxifylline and tocopherol (PENTO) has been widely recommended in prevention and treatment of osteoradionecrosis, however, limited data has been found regarding the efficacy of this protocol in management of MRONJ. This report aims to present the outcomes of PENTO protocol in a stage III MRONJ case with pathologic mandible fracture who was not convenient for surgery. A 68-year-old male patient with prostate cancer and a three-year history of intravenous zoledronic acid was referred to our clinic for impaired healing of extraction site in mandible in 2018. He was non-cooperated for follow-up and control appointments and two years later from the first visit, it was observed that a pathologic fracture occured in the region. Due to the ongoing chemotherapy of the patient, PENTO protocol was initiated. At the end of a seven-month period, spontaneous sequestration, healing of the fracture and healing of the mucosa was observed. Findings of the presented case and current literature suggest that PENTO protocol may be a promising treatment modality in MRONJ management. However, further clinical and experimental research involving larger sample size is necessary to clarify the role of this regimen in the treatment of MRONJ.

Keywords

• MRONJ
• pathologic fracture
• PENTO
• pentoxifylline
• tocopherol

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