Tratamento de necrose mandibular: relato de dois casos

Abstract

Maxillary necroses, whether medication-related osteonecrosis or osteoradionecrosis, are pathological conditions affecting patients who have undergone antiresorptive or angiogenesis-inhibiting therapy and radiation therapy in the head and neck region, respectively. Regarding medication-related osteonecrosis, the American Association of Oral and Maxillofacial Surgeons has established a staging classification based on clinical and imaging characteristics, guiding the treatment protocol. However, osteoradionecrosis does not have a single staging system; therefore, various classification methods have been reported, taking into account treatment response, disease status, and the extent of bone involvement. In light of this, the objective of this study is to report two clinical cases: the first diagnosed with stage II mandibular osteonecrosis associated with the use of denosumab, and the second with grade II mandibular osteoradionecrosis progressing to grade III, in which treatment was ineffective. Thus, this work encompasses not only the clinical and imaging aspects but also the clinical relevance of adjuvant therapies, the behavior of mandibular necroses, and the possibilities for definitive treatment.