DOI QR코드

DOI QR Code

Long-Term Complications of Radiotherapy in a Patient with Maxillary Squamous Cell Carcinoma: A Matter of Trismus and Osteoradionecrosis

  • Kim, Keon-Hyung (Department of Oral Medicine, College of Dentistry, Dankook University) ;
  • Park, Jo-Eun (Department of Oral Medicine, College of Dentistry, Dankook University) ;
  • Kim, Mee-Eun (Department of Oral Medicine, College of Dentistry, Dankook University) ;
  • Kim, Hye-Kyoung (Department of Oral Medicine, College of Dentistry, Dankook University)
  • Received : 2018.09.08
  • Accepted : 2018.11.29
  • Published : 2018.12.30

Abstract

Oral cancer is a malignant neoplasm of the lips or oral cavity. Surgery, radiotherapy and chemotherapy depending on the location and stage of the tumor can be considered as important treatment modalities of oral cancer. Unfortunately, all three treatments can have both acute and chronic complications. Among them, trismus and osteoradionecrosis (ORN), unique complications of radiotherapy in the orofacial region, are particularly difficult to treat once manifested. Therefore, these two complications of radiotherapy have devastating effects on the patient's oral health and furthermore, overall quality of life. In this study, we present a case of a patient showing trismus and ORN following radiotherapy for the treatment of maxillary squamous cell carcinoma and briefly discuss this matter of trismus and ORN in the perspective of a dentist.

GGNGBC_2018_v43n4_136_f0001.png 이미지

Fig. 1. Panoramic view before maxillectomy on the left side. Partial destruction and diffuse bone resorption are observed on the left posterior maxillary alveolar bone.

GGNGBC_2018_v43n4_136_f0002.png 이미지

Fig. 2. Computerized tomography image of the patient. Partial destruction and diffuse bone resorption are observed on the left posterior maxillary alveolar bone.

GGNGBC_2018_v43n4_136_f0003.png 이미지

Fig. 3. Panoramic view after maxillary resection on the left side.

GGNGBC_2018_v43n4_136_f0004.png 이미지

Fig. 4. Progression of the amount of active range of motion (AROM).

GGNGBC_2018_v43n4_136_f0005.png 이미지

Fig. 5. Whole body bone scan image. Hot spot can be seen on the left mandible. ANT, anterior; POST, posterior.

References

  1. Rivera C. Essentials of oral cancer. Int J Clin Exp Pathol 2015; 8:11884-11894.
  2. Feller LL, Khammissa RR, Kramer BB, Lemmer JJ. Oral squamous cell carcinoma in relation to field precancerisation: pathobiology. Cancer Cell Int 2013;13:31. https://doi.org/10.1186/1475-2867-13-31
  3. van der Waal I. Potentially malignant disorders of the oral and oropharyngeal mucosa; terminology, classification and present concepts of management. Oral Oncol 2009;45:317-323. https://doi.org/10.1016/j.oraloncology.2008.05.016
  4. Chen AY, Myers JN. Cancer of the oral cavity. Curr Probl Surg 2000;37:633-731. https://doi.org/10.1016/S0011-3840(00)80018-0
  5. Sharma R, Tobin P, Clarke SJ. Management of chemotherapyinduced nausea, vomiting, oral mucositis, and diarrhoea. Lancet Oncol 2005;6:93-102. https://doi.org/10.1016/S1470-2045(05)01735-3
  6. Sciubba JJ, Goldenberg D. Oral complications of radiotherapy. Lancet Oncol 2006;7:175-183. https://doi.org/10.1016/S1470-2045(06)70580-0
  7. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995;31:1341-1346. https://doi.org/10.1016/0360-3016(95)00060-C
  8. Dijkstra PU, Kalk WW, Roodenburg JL. Trismus in head and neck oncology: a systematic review. Oral Oncol 2004;40:879-889. https://doi.org/10.1016/j.oraloncology.2004.04.003
  9. Bensadoun RJ, Riesenbeck D, Lockhart PB, et al. A systematic review of trismus induced by cancer therapies in head and neck cancer patients. Support Care Cancer 2010;18:1033-1038. https://doi.org/10.1007/s00520-010-0847-4
  10. O'Dell K, Sinha U. Osteoradionecrosis. Oral Maxillofac Surg Clin North Am 2011;23:455-464. https://doi.org/10.1016/j.coms.2011.04.011
  11. Johnson J, Johansson M, Ryden A, Houltz E, Finizia C. Impact of trismus on health-related quality of life and mental health. Head Neck 2015;37:1672-1679. https://doi.org/10.1002/hed.23816
  12. Dijkstra PU, Huisman PM, Roodenburg JL. Criteria for trismus in head and neck oncology. Int J Oral Maxillofac Surg 2006;35:337-342. https://doi.org/10.1016/j.ijom.2005.08.001
  13. Kamstra JI, van Leeuwen M, Roodenburg JL, Dijkstra PU. Exercise therapy for trismus secondary to head and neck cancer: a systematic review. Head Neck 2017;39:160-169. https://doi.org/10.1002/hed.24366
  14. Jeremic G, Venkatesan V, Hallock A, et al. Trismus following treatment of head and neck cancer. J Otolaryngol Head Neck Surg 2011;40:323-329.
  15. Epstein JB, Wong FL, Stevenson-Moore P. Osteoradionecrosis: clinical experience and a proposal for classification. J Oral Maxillofac Surg 1987;45:104-110. https://doi.org/10.1016/0278-2391(87)90399-5
  16. Rapidis AD, Dijkstra PU, Roodenburg JL, et al. Trismus in patients with head and neck cancer: etiopathogenesis, diagnosis and management. Clin Otolaryngol 2015;40:516-526. https://doi.org/10.1111/coa.12488
  17. van der Geer SJ, Kamstra JI, Roodenburg JL, et al. Predictors for trismus in patients receiving radiotherapy. Acta Oncol 2016;55:1318-1323. https://doi.org/10.1080/0284186X.2016.1223341
  18. Tang Y, Shen Q, Wang Y, Lu K, Wang Y, Peng Y. A randomized prospective study of rehabilitation therapy in the treatment of radiation-induced dysphagia and trismus. Strahlenther Onkol 2011;187:39-44. https://doi.org/10.1007/s00066-010-2151-0
  19. Dijkstra PU, Sterken MW, Pater R, Spijkervet FK, Roodenburg JL. Exercise therapy for trismus in head and neck cancer. Oral Oncol 2007;43:389-394. https://doi.org/10.1016/j.oraloncology.2006.04.003