Changing trends and the role of medical management on the outcome of patients treated for osteoradionecrosis of the mandible: experience from a regional head and neck unit.

This study is a retrospective review of treatment outcomes of osteoradionecrosis (ORN) of the mandible with specific reference to the evolving role of medical management with pentoxifylline, tocopherol, and doxycycline. We reviewed the presentation and management of 71 patients treated for ORN of the mandible at the regional head and neck unit during a 15-year period to January 2011, and categorised them into three grades using the Notani classification: grade I (n=28), grade II (n=16), and grade III (n=27). Twelve patients with grade I ORN, 3 with grade II, and 10 with grade III, were prescribed medical treatment. Of these, three with grade I, and two with grade II ORN were cured, and progression of the disease had halted and there was satisfactory control of symptoms in eight with grade I and four with grade III disease. Patients who failed to respond to conservative treatment were further analysed for the need for free flap reconstruction. Medical management was introduced as a standard treatment in January 2006. Of the 39 patients diagnosed before this, 20 (51%) required resection and free flap reconstruction compared with only 8/32 (25%) after it had been introduced.

The influence of hyperbaric oxygen on the outcome of patients treated for osteoradionecrosis: 8 year study.

This study was a retrospective review of treatment outcomes of osteoradionecrosis (ORN) of the mandible over an 8-year period, with specific reference to the role of hyperbaric oxygen therapy (HBOT). The presentation and management of 23 patients treated for ORN was studied by categorising them into three grades according to the severity of clinical and radiographic involvement. At presentation there were 13 patients with grade I ORN, six patients with grade II ORN and four patients with grade III ORN. HBOT was given to 10 patients in the grade I group, four patients in the grade II group and two patients in the grade III group. Overall eight patients (62%) with grade I, three patients (50%) with grade II and two patients (50%) with grade III were cured. In the patients who received HBOT the cure rate was 12.5% whilst in those without HBOT it was 86%. Although the cohort was small it seems that HBOT was of little benefit. HBOT is demanding for patients and has cost implications for the NHS; hence further clinical outcome data are urgently required with regard to its role in the management of ORN.

Effects of crude aqueous extract of Carica papaya seeds in male albino mice.

The effect of an aqueous extract of Carica papaya seeds (5 mg/kg body/day im and 20 mg/kg body wt/day oral) were investigated in male mice treated for 60 days. Reversibility studies were also carried out to elucidate if any induced effects were transient. The aqueous extract did not manifest any estrogenic effects in male mice, and LD50 studies indicated its nontoxic nature. The body weight or the weights of reproductive organs, kidney, and adrenal were not affected, indicating that the extract did not promote body weight gain through obesity or water retention. The serum SGOT, SGPT, protein, and cholesterol levels were also within the normal range in the extract-treated mice, suggesting that the extract does not influence liver function or cholesterol and protein metabolism. These data suggest that the aqueous extracts of papaya seeds is safe and could serve as an effective male contraceptive in rodents.