Radiotherapy molds: An approach to fabricating facial moulage.

Impression procedures for recording large maxillofacial defects are tedious and difficult because of the unavailability of stock impression trays. This article describes the procedure of fabricating a straightforward facial moulage with predictable accuracy by using a reusable radiotherapy thermoplastic sheet.

Osteoradionecrosis of the jaws: A retrospective cohort study.

Introduction: Radiotherapy (RT) combined with chemotherapy and surgery is the indicated treatment for head and neck cancers. Even with the advent of modern technological advances in RT and improved oral hygiene awareness, osteoradionecrosis (ORN) still remains as one of the most debilitating side effects of RT. Methodology: This is a retrospective review assessing 72 patients aged over 18 years of age reporting in the Dental Department, for treatment of ORN from April 2010 to July 2019. Each patient was clinically examined and treated according to standard protocol. The stage of ORN was noted at the diagnosis and at follow-up. The demographic data, the tumor characteristics, and the treatment of patients were evaluated using descriptive statistics. Results: At the time of diagnosis, 84.7% of the study population was found to have Epstein Type II chronic persistent nonprogressive lesions and 11.1% of the cohort had Type III active progressive lesions. Statistically significant correlation (P = 0.00) was found for ORN grade at diagnosis and at follow-up. ORN being a chronic pathology, stabilization of the disease was observed in 72.3% of cases. The resolution of the necrotic lesion and down staging of the disease was seen only in 2.8% of patients. Conclusion: ORN is mainly a chronic long standing pathology which is difficult to treat completely. Stabilization of symptoms and preventing further spread of the necrotic lesion should be the ultimate aim of the treatment to improve the quality of life of the patients.

Two-piece oral facial prothesis retained with magnets for a complex maxillary facial defect: A clinical report.

Total flap failure is a devastating complication in head and neck reconstruction. This clinical report describes the rehabilitation of an extensive maxillectomy defect communicating with the midface by using a 2-piece magnet-retained orofacial prosthesis fabricated in heat-processed acrylic resin. The innovative design and choice of material allowed early rehabilitation of a patient receiving palliative care at a resource-constrained tertiary care oncology center. Prosthetic treatment served to reduce the period of hospitalization and helped the patient to resocialize.

Oral and dental health status in patients undergoing neoadjuvant chemotherapy for locally advanced head and neck cancer.

OBJECTIVE: A prospective, longitudinal assessment of oral and dental health status was done from baseline until treatment completion in patients scheduled to receive neoadjuvant chemotherapy (NACT) for locally advanced head and neck cancer (LAHNC). STUDY DESIGN: One hundred fifty consecutive, treatment-naïve adult patients with biopsy-proven LAHNC scheduled to receive NACT were recruited. One hundred thirty-five patients completed all assessments at 3 designated time points: baseline (T0), midtreatment (T1), and posttreatment (T2). Variables assessed were: Oral Hygiene Index-Simplified (OHI-S) score; decayed, missing, or filled teeth (DMFT) score; mucositis grade; pain score; and grade of trismus. RESULTS: Median OHI-S scores showed a statistically significant increase (higher the score, poorer the oral hygiene) when the patients were evaluated from baseline to completion of NACT (T1 vs. T2; T0 vs. T2; P < .001), which indicated a decrease in oral health. There was no change in median DMFT score (P = .32), but a significant change was seen in all-grade mucositis over time (P < .001). Median pain scores and trismus grades decreased significantly (P < .001) over time. CONCLUSIONS: There was a decrease in oral health status without any change in dental health seen in patients undergoing NACT. Mucositis was initially noted as an aftermath of chemotherapy, which resolved with time.

Osteonecrosis of the jaw associated with imatinib therapy in myeloproliferative neoplasm: a rare case report.

Medication-related osteonecrosis of the jaw (MRONJ) is a relatively infrequent but very well-known adverse effect of bisphosphonates. This rare complication of bisphosphonates is rarest with the use of certain drugs. Tyrosine kinase inhibitors (TKIs), particularly used in renal cell carcinoma or gastrointestinal tumors as a chemotherapeutic agent, can precipitate this particular medical condition of bone when it is associated with either radiation or bisphosphonates, though, monodrug therapy with TKIs rarely causes MRONJ. This article describes a rare case of necrosis of the jawbone in a patient with a myeloproliferative neoplasm who was receiving the TKI imatinib and had no history of bisphosphonate or radiation therapy to head and neck region.

Changes in the quality of life and acoustic speech parameters of patients in various stages of prosthetic rehabilitation with an obturator after maxillectomy.

STATEMENT OF PROBLEM: Prosthetic interventions at various stages help patients recover from esthetic and functional disabilities. However, little is known regarding their impact on patient quality of life (QOL) during various phases of treatment. PURPOSE: The purpose of this clinical study was to evaluate changes in the QOL and acoustic speech parameters of patients rehabilitated by using a prosthesis at various stages after undergoing maxillectomy. MATERIAL AND METHODS: A total of 30 consecutive patients who underwent maxillectomy resection and successfully completed all phases of rehabilitation with obturator prostheses were included. The study was conducted in 4 phases. In the preoperative phase, patients were evaluated for QOL and speech, and dental impressions were made. In the immediate postoperative phase, patients were rehabilitated with a delayed surgical obturator on the fifth postoperative day and were evaluated for QOL and speech on the 12th postoperative day. In the interim obturator phase, patients were rehabilitated with an interim maxillary obturator between the 12th and 15th postoperative days and were evaluated for QOL and speech after using the prosthesis for a minimum of 1 week. In the definitive phase, nonradiated patients were rehabilitated with a definitive prosthesis in the sixth week, and radiated patients were rehabilitated with a definitive prosthesis in the sixth month. The QOL and speech parameters of the patients were evaluated after 1 week. QOL evaluation in each phase was performed by using the EORTC QLQ-C30 and EORTC QLQ-H&N35 questionnaires. Speech parameters, namely intensity, fundamental frequency, habitual frequency, jitter, shimmer, maximum phonation time, and the S/Z ratio, were measured by using acoustic speech software. The change in QOL over various phases of rehabilitation with an obturator was analyzed by using repeated measures analysis of variance, whereas changes in acoustic speech parameters were analyzed by using the Friedman test (α=.05). RESULTS: A statistically significant difference (P<.05) was observed in the physical function, role function, fatigue, nausea, vomiting, dyspnea, sleep, and appetite loss domains of the EORTC QLQ-C30 and in the speech, social eating, social contact, mouth opening, dry mouth, sticky saliva, use of painkillers, and feeding tube domains of the EORTC QLQ-H&N35. The analysis of speech parameters also revealed significant improvement in intensity, jitter, shimmer, maximum phonation time, and the S/Z ratio, suggesting improvement in speech with the use of different types of obturators. CONCLUSIONS: The overall QOL and speech of the patients showed increasing improvement with the use of surgical obturators, immediate obturators, and definitive obturators in that order. The disease symptoms and oral functions deteriorated in the immediate postoperative phase but improved steadily and approached the preoperative level with definitive obturator prostheses.

Variations in concerns reported on the patient concerns inventory in patients with head and neck cancer from different health settings across the world.

BACKGROUND: The aim was to collate and contrast patient concerns from a range of different head and neck cancer follow-up clinics around the world. Also, we sought to explore the relationship, if any, between responses to the patient concerns inventory (PCI) and overall quality of life (QOL). METHODS: Nineteen units participated with intention of including 100 patients per site as close to a consecutive series as possible in order to minimize selection bias. RESULTS: There were 2136 patients with a median total number of PCI items selected of 5 (2-10). "Fear of the cancer returning" (39%) and "dry mouth" (37%) were most common. Twenty-five percent (524) reported less than good QOL. CONCLUSION: There was considerable variation between units in the number of items selected and in overall QOL, even after allowing for case-mix variables. There was a strong progressive association between the number of PCI items and QOL.

Factors Affecting Dental Rehabilitation Following Jaw Reconstruction With Free-Fibular Graft In Patients With Head and Neck Cancer.

Existing anatomic factors play a significant role in affecting the possibility of dental rehabilitation in head and neck cancer patients undergoing free-fibular graft reconstruction. An observational, cross-sectional study was initiated to evaluate factors affecting dental rehabilitation following free-fibular graft jaw reconstruction in head and neck cancer patients.Patients who had undergone jaw reconstruction with free-fibular graft, requiring dental rehabilitation were recruited. Irradiated, reconstructed patients who had completed at least 1 year since the last dose of radiotherapy and nonradiated patients who had completed 6 months since reconstruction were recruited. Patients who had undergone soft-tissue reconstruction or free-fibular graft in non-condyle sparing resections were excluded. Patient's demographic data, disease and treatment-related data were obtained. An intra-oral examination was carried out to evaluate anatomic variables affecting dental rehabilitation. Descriptive statistical analyses were carried out to study demographic data. Logistic regression analysis was carried out using Pearson χ test and Fisher exact test. Estimates of regression coefficient and their standard errors with 95% confidence interval were calculated.Total of 138 patients were enrolled and considered for prosthetic rehabilitation. A review of the frequency-based data revealed that 30% (n = 41) patients were considered suitable for prosthetic rehabilitation. On multivariate logistic regression analysis, morbidity of radiotherapy (P = 0.01), interference to placement of implants by reconstruction plates and screws (P = 0.023), unfavorable diagnostic maxilla-mandibular relationship (P = 0.011), and obliterated vestibule (P = 0.001) were statistically established (P < 0.05) as the most significant reasons for not carrying out dental rehabilitation in patients who had undergone free-fibular graft reconstruction.

High-dose-rate brachytherapy in severe trismus: Making it happen!

Brachytherapy has been widely employed as a salvage or adjuvant modality in localized early and/or recurrent lesions. In recent years, advances in brachytherapy techniques have helped to achieve better loco-regional disease control and higher survival rates at the cost of limited morbidity. This is mainly owing to the development of technologically advanced three-dimensional computer planning systems and treatment delivery techniques. Low-dose-rate brachytherapy has been substituted by high-dose-rate and pulsed-dose-rate techniques, which allow better dose optimization. Inter-disciplinary approach results in fabrication of customized intra-oral surface mould, which allows accurate dose delivery, excellent dose distribution, and is less time-consuming. However, fabrication of surface mould becomes extremely challenging when intra-oral anatomic factors are unfavorable. We present a report on the management of a previously-irradiated completely edentulous patient with severe trismus for whom high-dose-rate surface mould brachytherapy had been prescribed. A unique, reliable, and practical solution has been presented based firmly on the scientific knowledge of contemporary implant dentistry.

Dental implants in irradiated jaws: a literature review.

Surgical treatment of head and neck cancer frequently results in defects that challenge conventional prosthetic rehabilitation. Successful rehabilitation using tissue supported dentures in such cases has been reported to be less than 20%. With the loss of jaw bones and thus the support, there is loss of retention to a great deal. Also, teeth loss on the side of the defect adds to failure in retention. Scar tissue formation, deviation of jaw due to muscle pull, decreased mouth opening, loss of sulcus and non vertical force are some of the common adversaries of jaw resection especially mandibular resection which pose great limitation on the stability and success of prospective prosthetic rehabilitation. The advent and application of biologically acceptable implants in clinical dentistry has contributed to restoring the defects of the deficient maxillofacial systems. Surgical intervention in patients who had received head and neck irradiation is preferably avoided as it has been associated with decreased healing and increased potential for development of osteoradionecrosis. Hence an implant as an option when surgical field has received tumerocidal radiation is empirically excluded. The purpose of this article is to review the studies and reports published in various journals related to osseointegrated implant rehabilitation in irradiated bones.