Manejo multimodal para la rehabilitación oral de un paciente irradiado en la cabeza y el cuello: reporte de un caso

Autores/as

DOI:

https://doi.org/10.33448/rsd-v9i7.4062

Palabras clave:

Radioterapia; Tratamiento dental; Neoplasias de cabeza y cuello.

Resumen

El objetivo del presente estudio fue informar un caso clínico de un enfoque multimodal para la rehabilitación oral de un paciente masculino de 69 años de edad, irradiado en la cabeza y el cuello (radioterapia conformacional 3D, dosis total de 70Gy), después de metástasis en la laringe del cáncer de intestino. En la consulta inicial, el paciente se quejó de dientes perdidos y boca seca. Además, se observaron lesiones de caries por radiación en la mayoría de los dientes, que también exhibieron una gran destrucción coronaria. El plan de tratamiento consistió en la extracción del diente 27 con la ayuda de una terapia fotodinámica antimicrobiana para curar el alvéolo, seguido de un tratamiento endodóntico con posterior enterramiento de las raíces residuales, restauraciones y rehabilitación con prótesis parciales removibles. El tratamiento dental de los pacientes pos irradiados en la cabeza y el cuello debe ser cuidadosamente planificado y realizado por un equipo dental interdisciplinario, considerando las graves consecuencias que resultan de los efectos nocivos de la radioterapia en la cavidad oral. De esta forma, se puede mitigar el impacto negativo de la radioterapia en la calidad de vida de estos pacientes.

Citas

Al-Bazie, S., Bahatheq, M., Al-Ghazi, M., Al-Rajhi, N., & Ramalingam, S. (2016). Antibiotic protocol for the prevention of osteoradionecrosis following dental extractions in irradiated head and neck cancer patients: A 10 years prospective study. Journal of Cancer Research and Therapeutics, 12(2), 565–570. https://doi.org/10.4103/0973-1482.159090

Beech, N., Robinson, S., Porceddu, S., & Batstone, M. (2014). Dental management of patients irradiated for head and neck cancer. Australian Dental Journal, 59(1), 20–28. https://doi.org/10.1111/adj.12134

Comodo, G. V., Palma, L. F., Dos Santos, M. S., Seoanes, G. A., Gonnelli, F. A. S., Segreto, R. A., Segreto, H. R. C., & Reimão, J. Q. (2020). Infecções orais oportunistas em pacientes submetidos à radioterapia para câncer de cabeça e pescoço: um estudo retrospectivo. Research, Society and Development, 9(3), 164932685. https://doi.org/10.33448/rsd-v9i3.2685

De Campos, L., Migliorati, C. A., & Simões, A. (2015). Antimicrobial photodynamic therapy in cancer patients. In Lasers in Dentistry: Guide for Clinical Practice. https://doi.org/10.1002/9781118987742.ch43

de Menezes, B. C., Noronha, V. R. A. S., Carvalho, A. L., Freire, A. R. S., & Jham, B. C. (2014). Incidence of osteoradionecrosis following oral and maxillofacial surgery in irradiated head and neck cancer patients. Oral Surgery, 7(1), 12–17. https://doi.org/10.1111/ors.12054

Dhanda, J., Pasquier, D., Newman, L., & Shaw, R. (2016). Current Concepts in Osteoradionecrosis after Head and Neck Radiotherapy. Clinical Oncology, 28(7), 459–466. https://doi.org/10.1016/j.clon.2016.03.002

Dholam, K. P., Dugad, J. A., & Sadashiva, K. M. (2017). Impact of oral rehabilitation on patients with head and neck cancer: A study using the Liverpool Oral Rehabilitation Questionnaire and the Oral Health Impact Profile-14. The Journal of Prosthetic Dentistry, 117(4), 559–562. https://doi.org/10.1016/j.prosdent.2016.06.019

Gonnelli, F. A. S., Palma, L. F., Giordani, A. J., Deboni, A. L. S., Dias, R. S., Segreto, R. A., & Segreto, H. R. C. (2016a). Low-Level Laser for Mitigation of Low Salivary Flow Rate in Head and Neck Cancer Patients Undergoing Radiochemotherapy: A Prospective Longitudinal Study. Photomedicine and Laser Surgery, 34(8), 326–330. https://doi.org/10.1089/pho.2016.4104

Gonnelli, F. A. S., Palma, L. F., Giordani, A. J., Deboni, A. L. S., Dias, R. S., Segreto, R. A., & Segreto, H. R. C. (2016b). Low-level laser therapy for the prevention of low salivary flow rate after radiotherapy and chemotherapy in patients with head and neck cancer. Radiologia Brasileira, 49(2), 86–91. https://doi.org/10.1590/0100-3984.2014.0144

Gupta, N., Pal, M., Rawat, S., Grewal, M., Garg, H., Chauhan, D., Ahlawat, P., Tandon, S., Khurana, R., Pahuja, A., Mayank, M., & Devnani, B. (2015). Radiation-induced dental caries, prevention and treatment - A systematic review. National Journal of Maxillofacial Surgery, 6(2), 160. https://doi.org/10.4103/0975-5950.183870

Kielbassa, A. M., Attin, T., Schaller, H. G., & Hellwig, E. (1995). Endodontic therapy in a postirradiated child: review of the literature and report of a case. Quintessence International, 26(6), 405–411.

Kielbassa, A. M., Hinkelbein, W., Hellwig, E., & Meyer-Lückel, H. (2006). Radiation-related damage to dentition. The Lancet Oncology, 7(4), 326–335. https://doi.org/10.1016/S1470-2045(06)70658-1

Kuhnt, T., Stang, A., Wienke, A., Vordermark, D., Schweyen, R., & Hey, J. (2016). Potential risk factors for jaw osteoradionecrosis after radiotherapy for head and neck cancer. Radiation Oncology, 11(1), 101. https://doi.org/10.1186/s13014-016-0679-6

Lanzos, I., Herrera, D., Lanzos, E., & Sanz, M. (2015). A critical assessment of oral care protocols for patients under radiation therapy in the regional University Hospital Network of Madrid (Spain). Journal of Clinical and Experimental Dentistry, 7(5), e613–e621. https://doi.org/10.4317/jced.52557

Lieshout, H. F. J., & Bots, C. P. (2014). The effect of radiotherapy on dental hard tissue—a systematic review. Clinical Oral Investigations, 18(1), 17–24. https://doi.org/10.1007/s00784-013-1034-z

Lilly, J. P., Cox, D., Arcuri, M., & Krell, K. V. (1998). An evaluation of root canal treatment in patients who have received irradiation to the mandible and maxilla. Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology, and Endodontology, 86(2), 224–226. https://doi.org/10.1016/S1079-2104(98)90129-9

Marta, G. N., Silva, V., de Andrade Carvalho, H., de Arruda, F. F., Hanna, S. A., Gadia, R., da Silva, J. L. F., Correa, S. F. M., Vita Abreu, C. E. C., & Riera, R. (2014). Intensity-modulated radiation therapy for head and neck cancer: Systematic review and meta-analysis. Radiotherapy and Oncology, 110(1), 9–15. https://doi.org/10.1016/j.radonc.2013.11.010

Maxymiw, W. G., Wood, R. E., & Liu, F. F. (1991). Postradiation dental extractions without hyperbaric oxygen. Oral Surgery, Oral Medicine, Oral Pathology, 72(3), 270–274. https://doi.org/10.1016/0030-4220(91)90212-U

Palma, L. F., Gonnelli, F. A. S., Marcucci, M., Dias, R. S., Giordani, A. J., Segreto, R. A., & Segreto, H. R. C. (2017). Impact of low-level laser therapy on hyposalivation, salivary pH, and quality of life in head and neck cancer patients post-radiotherapy. Lasers in Medical Science, 32(4), 827–832. https://doi.org/10.1007/s10103-017-2180-3

Palma, L. F., Gonnelli, F. A. S., Marcucci, M., Giordani, A. J., Dias, R. S., Segreto, R. A., & Segreto, H. R. C. (2018). A novel method to evaluate salivary flow rates of head and neck cancer patients after radiotherapy: a pilot study. Brazilian Journal of Otorhinolaryngology, 84(2), 227–231. https://doi.org/10.1016/j.bjorl.2017.03.004

Palma, L. F., Tateno, R. Y., Remondes, C. M., Marcucci, M., & Cortes, A. R. G. (2020). Impact of radiotherapy on mandibular bone: A retrospective study of digital panoramic radiographs. Imaging Science in Dentistry, 50, 31–36. https://doi.org/10.5624/isd.2020.50.1.31

Ray-Chaudhuri, A., Shah, K., & Porter, R. J. (2013). The oral management of patients who have received radiotherapy to the head and neck region. British Dental Journal, 214(8), 387–393. https://doi.org/10.1038/sj.bdj.2013.380

Silva, A. R. S., Alves, F. A., Berger, S. B., Giannini, M., Goes, M. F., & Lopes, M. A. (2010). Radiation-related caries and early restoration failure in head and neck cancer patients. A polarized light microscopy and scanning electron microscopy study. Supportive Care in Cancer, 18(1), 83–87. https://doi.org/10.1007/s00520-009-0633-3

Sood, A. J., Fox, N. F., O’Connell, B. P., Lovelace, T. L., Nguyen, S. A., Sharma, A. K., Hornig, J. D., & Day, T. A. (2014). Salivary gland transfer to prevent radiation-induced xerostomia: A systematic review and meta-analysis. Oral Oncology, 50(2), 77–83. https://doi.org/10.1016/j.oraloncology.2013.10.010

Tanasiewicz, M., Hildebrandt, T., & Obersztyn, I. (2016). Xerostomia of Various Etiologies: A Review of the Literature. Advances in Clinical and Experimental Medicine, 25(1), 199–206. https://doi.org/10.17219/acem/29375

Wiener, R. C., Wu, B., Crout, R., Wiener, M., Plassman, B., Kao, E., & McNeil, D. (2010). Hyposalivation and xerostomia in dentate older adults R. J Am Dent Assoc, 141(3), 279–284. https://doi.org/10.14219/jada.archive.2010.0161

Publicado

07/05/2020

Cómo citar

ANDRADE, N. S.; GRANCHELLI, A. F.; GALLOTTINI, M.; CAMPOS, L.; TATENO, R. Y.; PALMA, L. F.; MARTINS, F. Manejo multimodal para la rehabilitación oral de un paciente irradiado en la cabeza y el cuello: reporte de un caso. Research, Society and Development, [S. l.], v. 9, n. 7, p. e192974062, 2020. DOI: 10.33448/rsd-v9i7.4062. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/4062. Acesso em: 11 jun. 2025.

Número

Sección

Ciencias de la salud