Direct method for construction of prosthetic bite opening and positioning stents for head and neck tumor radiotherapy
DOI:
https://doi.org/10.15448/1980-6523.2017.4.28706Keywords:
radiotherapy, dental prostheses, cancer of head and neck.Abstract
INTRODUCTION: Radiotherapy for head and neck tumors causes a series of adverse effects. Some effects are temporary, such as oral mucositis and taste disorders, and others are permanent, such as xerostomia and increased risk for dental caries and osteoradionecrosis. One way to diminish radiotherapy’s adverse effects is to decrease the radiation dose on healthy tissues outside the tumor area through more precise radiotherapy techniques, such as intensity-modulated radiation therapy (IMRT), which depends on positioners and stabilizers to the anatomic structures.
CASE REPORT: This paper presents direct construction technique examples of mouth openers and positioning stents for tongue and mandible, which allow distance from the radiation field for healthy organs as well the precise stabilization required for the IMRT technique.
CONCLUSION: The clinical cases shown in the present paper also illustrate that the intra-oral devices for stabilization of the dental arches and tongue are effective in reducing unnecessary radiation on healthy organs.
References
Kielbassa AM, Hinkelbein W, Hellwig E, Meyer-Lückel H. Radiationrelated damage to dentition. Lancet Oncol 2006;7(4):326-35. https://doi.org/10.1016/S1470-2045(06)70658-1
Teguh DN, Levendag PC, Ghidey W, van Montfort K, Kwa SL. Risk model and nomogram for dysphagia and xerostomia prediction in head and neck cancer patients treated by radiotherapy and/or chemotherapy. Dysphagia. 2013;28(3):388-94. https://doi.org/10.1007/s00455-0129445-6
Nabil S, Samman N. Incidence and prevention of osteoradionecrosis after dental extraction in irradiated patients: a systematic review. Int J Oral Maxillofac Surg 2010;40(3):229-43.
Beetz I, Schilstra C, Burlage FR, Koken PW, Doornaert P, Bijl HP, et al. Development of NTCP models for head and neck cancer patients treated with three-dimensional conformal radiotherapy for xerostomia and sticky saliva: the role of dosimetric and clinical factors. Radiother Oncol. 2012; 105(1):86-93. https://doi.org/10.1016/j.radonc.2011.05.010
Dobros K, Hajto-Bryk J, Wróblewska M, Zarzecka J. Radiation-induced caries as the late effect of radiation therapy in the head and neck region. Contemp Oncol (Pozn) 2016;20(4):287-90. https://doi.org/10.5114/wo.2015.54081
Owosho AA, Tsai CJ, Lee RS, Freymiller H, Kadempour A, Varthis S, et al. The prevalence and risk factors associated with osteoradionecrosis of the jaw in oral and oropharyngeal cancer patients treated with intensitymodulated radiation therapy (IMRT): The Memorial Sloan Kettering Cancer Center experience. Oral Oncol 2017;64:44-51. https://doi.org/10.1016/j.oraloncology.2016.11.015
Lee IJ, Koom WS, Lee CG, Kim YB, Yoo SW, Keum KC, Kim GE, Choi EC, Cha IH. Risk factors and dose-effect relationship for mandibular osteoradionecrosis in oral and oropharyngeal cancer patients. Int J Radiat Oncol Biol Phys. 2009;75(4):1084-91. https://doi.org/10.1016/j.ijrobp.2008.12.052
Morais-Faria K, Menegussi G, Marta G, Fernandes PM, Dias RB, Ribeiro AC, et al. Dosimetric distribution to the teeth of patients with head and neck cancer who underwent radiotherapy. Oral Surg Oral Med Oral Pathol Oral Radiol. 2015;120(3):416-9. https://doi.org/10.1016/j.oooo.2015.05.009
Nabil S, Samman N. Risk factors for osteoradionecrosis after head and neck radiation: a systematic review. Oral Surg Oral Med Oral Pathol Oral Radiol. 2012;113(1):54-69. https://doi.org/10.1016/j.tripleo.2011.07.042
Ahmed M, Hansen VN, Harrington KJ, Nutting CM. Reducing the risk of xerostomia and mandibular osteoradionecrosis: the potential benefits of intensity modulated radiotherapy in advanced oral cavity carcinoma. Med Dosim. 2009;34(3):217-24. https://doi.org/10.1016/j.meddos.2008.08.008
Ward MC, Ross RB, Koyfman SA, Lorenz R, Lamarre ED, Scharpf J, et al.
Modern Image-Guided Intensity-Modulated Radiotherapy for Oropharynx Cancer and Severe Late Toxic Effects: Implications for Clinical Trial Design. JAMA Otolaryngol Head Neck Surg 2016;142(12):1164-70. https://doi.org/10.1001/jamaoto.2016.1876
Nguyen NP, Kratz S, Lemanski C, Vock J, Vinh-Hung V, Olena G et al. Image-guided radiotherapy for locally advanced head and neck cancer. Front Oncol. 2013 July 8;3:172. https://doi.org/10.3389/fonc.2013.00172
Jiang N, Zhao Y, Jansson H, Chen X, Mårtensson J. Experiences of xerostomia after radiotherapy in patients with head and neck cancer: a qualitative study. J Clin Nurs. 2017;17.
Gerdin EW, Einarson S, Jonsson M, Aronsson K, Johansson I. Impact of dry mouth conditions on oral health-related quality of life in older people. Gerodontology 2005;22(4):219-26. https://doi.org/10.1111/j.1741-2358.2005.00087.x
Kojima Y, Yanamoto S, Umeda M, Kawashita Y, Saito I, Hasegawa T, et al. Relationship between dental status and development of osteoradionecrosis of the jaw: a multicenter retrospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2017. https://doi.org/10.1016/j.oooo.2017.04.012
Vissink A, van Luijk P, Langendijk JA, Coppes RP. Current ideas to reduce or salvage radiation damage to salivary glands. Oral Dis. 2015;21(1): e1 10. https://doi.org/10.1111/odi.12222
Gulbransen H & Beumer III J - Use of Splints and Stents during Radiation Therapy – Foundatition for Oral-facial Rehabilitation, Acesso em: 21 set. 2017, Disponível em: http://www.ffofr.org/education/lectures/maxillofacialprosthetics/use-ofsplints-stents-during-radiation-therapy/
Ranabhatt Jr II R – Radiation therapy and its Prosthodontic implications – Foundatition for Oral-facial Rehabilitation, Acesso em: 21 set. 2017. Disponível em: https://www.slideshare.net/ranikgdu08/radiation therapyand-its-prosthodontic-implications
Jaguar GC, Lima EN, Kowalski LP, Pellizzon AC, Carvalho AL, Boccaletti KW, Alves FA. Double blind randomized prospective trial of bethanechol in the prevention of radiation-induced salivary gland dysfunction in head and neck cancer patients. Radiother Oncol. 2015;115(2):253-6. https://doi.org/10.1016/j.radonc.2015.03.017
Cotomacio C, Campos L, Simões A, Jaguar G, Crosato EM, Abreu-Alves F. Influence of bethanechol on salivary parameters in irradiated patients. Med Oral Patol Oral Cir Bucal 2017;22(1):e76-83.
Yang WF, Liao GQ, Hakim SG, Ouyang DQ, Ringash J, Su YX. Is Pilocarpine Effective in Preventing Radiation-Induced Xerostomia? A Systematic Review and Meta-analysis. Int J Radiat Oncol Biol Phys 2016;94(3): 503-11. https://doi.org/10.1016/j.ijrobp.2015.11.012
Simões A, de Campos L, de Souza DN, de Matos JA, Freitas PM, Nicolau J. Laser phototherapy as topical prophylaxis against radiation-induced xerostomia. Photomed Laser Surg. 2010;28(3):357-63. https://doi.org/10.1089/pho.2009.2486
Rieger JM, Jha N, Lam Tang JA, Harris J, Seikaly H. Functional outcomes related to the prevention of radiation-induced xerostomia: oral pilocarpine versus submandibular salivary gland transfer. Head Neck 2012;34(2):
-74. https://doi.org/10.1002/hed.21682
Verrone JR, Alves Fde A, Prado JD, Boccaletti KW, Sereno MP, Silva ML, Jaguar GC. Impact of intraoral stent on the side effects of radiotherapy for oral cancer. Head Neck. 2013;35(7):E213-7. https://doi.org/10.1002/hed.23028
Johnson B, Sales L, Winston A, Liao J, Laramore G, Parvathaneni U. Fabrication of customized tongue-displacing stents: considerations for use in patients receiving head and neck radiotherapy. J Am Dent Assoc. 2013;144(6):594-600. https://doi.org/10.14219/jada.archive. 2013.0170
Goel A, Tripathi A, Chand P, Singh SV, Pant MC, Nagar A. Use of positioning stents in lingual carcinoma patients subjected to radiotherapy. Int J Prosthodont 2010;23(5):450-2.
Verrone JR, Alves FA, Prado JD, Marcicano Ad, de Assis Pellizzon AC, Damascena AS, Jaguar GC. Benefits of an intraoral stent in decreasing the irradiation dose to oral healthy tissue: dosimetric and clinical features. Oral Surg Oral Med Oral Pathol Oral Radiol. 2014;118(5): 573 8. https://doi.org/10.1016/j.oooo.2014.08.008
Mall P, Chand P, Singh BP, Rao J, Siddarth R, Srivastava K. Effectiveness of Positioning Stents in Radiation-Induced Xerostomia in Patients with Tongue Carcinoma: A Randomized Controlled Trial. Int J Prosthodont 2016;29(5):455-60. https://doi.org/10.11607/ijp.4499
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