Use of platelet-rich fibrin and surgical approach for combined treatment of osteoradionecrosis: a case report

Osteoradionecrosis (ORN) is a complication of radiation therapy for which several treatment options have been reported. The use of platelet‐rich fibrin (PRF), a second-generation platelet concentrate, has been promoted in refractory wounds. A 53-year-old man underwent concurrent chemoradiotherapy for squamous cell carcinoma in the right side of the tongue. Subsequently, he exhibited pus discharge around the right maxillary first molar. Intraoral examination showed mobility and probing depths of >10 mm in teeth 15 and 16. Computed tomography revealed poorly defined osteolytic changes in teeth 15 to 17, indicative of oroantral fistula. Teeth 15 to 17 were extracted and the socket was debrided. Primary closure was achieved after PRF dressing. The wound healed within 2 weeks. The patient returned because of spontaneous loss of tooth 46 and numbness over the right lower lip. Pus was present in premolar areas and in the tooth 46 socket. Radiographic examination showed moth-eaten destruction in right mandibular teeth and better trabecular quality in the right maxilla. A provisional diagnosis of ORN was made. Debridement and primary closure after PRF dressing were performed. The mucosa healed within 3 weeks. Our findings suggest that PRF combined with a surgical approach might be useful for treatment of ORN.