Fabrication of intraoral stent for oral protection during radiotherapy

• Ano de defesa: 2021
• Autor(a) principal: Chicrala, Gabriela Moura
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: eng
• Instituição de defesa: Biblioteca Digitais de Teses e Dissertações da USP
• Palavras-chave em Português: Intensity-modulated radiotherapy; Qualidade de vida; Quality of life,Trismus; Radioterapia de intensidade modulada; Trismo
• Link de acesso: https://www.teses.usp.br/teses/disponiveis/25/25149/tde-13042022-142556/

In the need for cancer treatment involving radiotherapy, several side effects are expected for the therapy to reach, in addition to neoplastic tissue, healthy tissue. The research objectives were: a) to make an intraoral device (stent) to mechanically separate the palate, tongue, and mouth floor and keep the mouth opening stable in an attempt to minimize some of the side effects such as oral mucositis, dysgeusia, and trismus; b) assess the impact of oral health on quality of life (QoL); c) assess the comfort and stability of the device according to the patient\'s perception; d) compare the results of trismus, dysgeusia and impact of oral health on QoL before and after radiotherapy. The device was fabricated of acrylic resin and used for planning and during all radiotherapy sessions. Oral mucositis was assessed using the World Health Organization (WHO) and Oral Mucositis Assessment Scale (OMAS) scales; dysgeusia was assessed using a dichotomous question (yes/no); trismus was assessed by physical examination with the aid of a universal caliper; the impact of oral health on QoL was calculated using the Oral Health Impact Profile (OHIP-14) questionnaire; a questionnaire was designed to assess the use of the device according to the patient\'s perception. From a total of 26 patients recruited, the final sample consisted of 20 participants, 12 men (60%) and 8 women (40%) aged between 26 and 88 years. Squamous cell carcinoma was the most prevalent histological type (75%), with the tongue being the most affected site (50%). Half of the sample was diagnosed with tumors up to 2 cm in length, without lymph node involvement in 45% of cases or distant metastasis (90%). The most common treatment protocol was surgery followed by radiotherapy. Most of the sample were non-smokers (60%) and without regular alcohol consumption (70%). At the end of radiotherapy, the participants presented WHO Grade 2 (65%) oral mucositis, with a mean of 2.64 ± 0.87 (OMAS). Patients who underwent all three treatment modalities (surgery, followed by chemotherapy and radiotherapy) had a higher OMAS score than those who underwent radiotherapy combined with chemotherapy alone (p=0.01) or with surgery (p=0.04). There was a significant decrease of 6.6 mm (±7.58) in mouth opening compared to before radiotherapy (p<0.01) and dysgeusia in 80% of the sample, without a statistical difference (p>0.05). There was a worsening in the impact of oral health on QL in global values (p=0.002) and Domain 4 (p=0.014). For most participants, the device was comfortable (60%), its use did not cause pain (80%), and remained stable in the mouth during radiotherapy sessions (90%). All (100%) patients rated its use as important for treatment. Despite the variety of side effects presented, most were well tolerated by the patient during treatment. The use of stents, as well as the comprehensive and multidisciplinary treatment of the patient, may have contributed to these results.