Surgery: The procedures involved in the surgical management of ORN are as listed: Removal of small sequestra, sequestrectomy, alveolectomy with primary closure, closure of orocutaneous fistula and large resections. Surgical management is usually required in cases of advanced disease, or if conservative measures fail to work. Methods used to reconstruct anatomical structures involve plates, autogenous bone grafts, regional flaps and free tissue transfer. Vascularised bone flaps are known to be the most effective mode of reconstruction. Therapeutic approach
Research to treat ORN at a molecular level has increased with progress in the field of medicine. The pharmacological methods to treat ORN listed below were developed to treat the etiologic factors. Pentoxifylline is methylxanthine derivative that drives vascular dilation and increased erythrocyte flexibility, resulting in enhanced blood flow. It also contains anti-tumour necrosis factor α activity, and reduces the cytokine cascade that facilitates the process of ORN. However, pentoxifylline is not meant for the long-term treatment of ORN. Tocopherols can occur in various forms. Its alpha form, also known as vitamin E, has antioxidant properties which results in the inhibition of platelet aggregation. Alpha-tocopherol is also able to scavenge reactive oxygen species involved in the ORN disease process, by inducing cell membrane peroxidation. Clodronate is a non-nitrogenous bisphosphonate used in the treatment of numerous diseases, such as hyperparathyroidism, osteoporosis, and multiple myeloma. Clodronate functions by inhibiting bone resorption, due to the reduction in the activity and quantity of osteoclasts. Clodronate also acts directly on osteoblasts, which increases bone formation and reduces the growth of fibroblasts. == References ==
Avanafil is a PDE5 inhibitor approved for erectile dysfunction by the FDA on April 27, 2012 and by EMA on June 21, 2013. Avanafil is sold under the brand names Stendra and Spedra. It was invented at Mitsubishi Tanabe Pharma, formerly known as Tanabe Seiyaku Co., and licensed to Vivus Inc., which partnered with Menarini Group to commercialise Spedra in over forty European countries, Australia, and New Zealand. Metuchen Pharmaceuticals obtained exclusive rights within the United States.Avanafil acts by inhibiting a specific phosphodiesterase type 5 enzyme found in various body tissues, primarily in the corpus cavernosum penis. Other similar drugs are sildenafil, tadalafil and vardenafil. The advantage of avanafil is that it has very fast onset of action compared with other PDE5 inhibitors. It is absorbed quickly, reaching a maximum serum concentration in about thirty to forty-five minutes. About two-thirds of the participants were able to engage in sexual activity within fifteen minutes. Medical use
Avanafil is used to treat erectile dysfunction (ED). Adverse effects
Although avanafil is generally well tolerated, dose dependent adverse effects can occur. The most common adverse effects include headache, flushing, nasopharynigitis, nasal congestion, and back pain. While it is also uncommon, there is a potential for visual disturbances to occur in patients. Mechanism of action
Avanafil inhibits phosphodiesterase-5, preventing the degradation of cGMP. The increased levels of cGMP causes vasodilation, resulting in an increased blood flow in the penis. Avanafils mechanism of action takes places once nitric oxide is released, in association with sexual stimulation.