RESUMEN
Osteoradionecrosis (ORN) of the jaw is a complication of radiation therapy for head and neck cancers. We report a case of ORN of the posterior maxilla treated with Er: YAG laser and a pedicled buccal fat pad (bichat bulla adipose) flap. A 69-year-old man presented complaining of pain on left maxilla. He had received high-dose radiotherapy (90 Gy) for squamous cell carcinoma of the left soft palate 2 years earlier. Clinical and radiographic examinations revealed ORN of the left maxillary molar region and maxillary sinusitis. Daily home care consisted of 0.9% saline irrigation and 0.8% H2O2 gel application. Sequestrectomy and tooth extraction were followed by debridement with Er: YAG laser and repair with a pedicled buccal fat pad flap. Complete resolution of ORN and maxillary sinusitis was established one year postsurgically. The excellent clinical outcome suggests that Er: YAG laser debridement and pedicled buccal fat pad flap are a viable option to treat ORN of the posterior maxilla.
Asunto(s)
Tejido Adiposo/trasplante , Láseres de Estado Sólido/uso terapéutico , Enfermedades Maxilares/cirugía , Osteorradionecrosis/cirugía , Colgajos Quirúrgicos/trasplante , Anciano , Autoinjertos/trasplante , Carcinoma de Células Escamosas/radioterapia , Desbridamiento/métodos , Estudios de Seguimiento , Humanos , Peróxido de Hidrógeno/uso terapéutico , Masculino , Enfermedades Maxilares/tratamiento farmacológico , Sinusitis Maxilar/tratamiento farmacológico , Sinusitis Maxilar/cirugía , Osteorradionecrosis/tratamiento farmacológico , Neoplasias Palatinas/radioterapia , Irrigación Terapéutica/métodos , Extracción Dental/métodos , Resultado del TratamientoRESUMEN
Laser therapy and fluorescence-guided surgery are highly reliable and predictable methods, but their combination has not been found to yield useful outcomes. We present a new therapeutic approach combining fluorescence-guided Er:YAG laser ablation with Nd:YAG/diode laser biostimulation for bisphosphonate-related osteonecrosis of the jaw (BRONJ). A woman was treated with zoledronic acid for bone metastasis from clear cell renal cell carcinoma and subsequently developed BRONJ in the left jaw. The management protocol included perioperative medical therapy (1% chlorhexidine gel, rifamycin, and doxycycline for 10 preoperative and 7 postoperative days), Er:YAG laser ablation guided by doxycycline fluorescence in vital bone under UV light, and Nd:YAG/diode laser biostimulation. The lesion regressed from stage 3 to stage 1 and showed nearly complete healing after laser therapy (3 and 23 cycles of ablation and biostimulation, respectively). These preliminary findings suggest the feasibility of the new approach, which is minimally invasive and biostimulative and causes very low morbidity.