ABSTRACT
OBJECTIVES@#To compare the effects of different irradiators on the establishment of osteoradionecrosis of jaw model (ORNJ) to explore an ideal modeling method.@*METHODS@#A total of 33 adult SD rats were included and randomly divided into three groups according to the radiation equipment, namely, the blank control (CN, 3 rats), group A (linear accelerator irradiation, 15 rats), and group B (small-animal irradiator irradiation, 15 rats). Groups A and B were irradiated with daily fractions of 7, 8, and 9 Gy for 5 days and further divided into three subgroups as follows: group A@*RESULTS@#At 3 weeks after dental extractions, complete gingival healing was found in the regions of dental extractions in groups A@*CONCLUSIONS@#Small-animal irradiator irradiation is an ideal device for establishing ORNJ model.
Subject(s)
Animals , Rats , Mandible , Molar , Osteoradionecrosis/etiology , Rats, Sprague-Dawley , X-Ray MicrotomographyABSTRACT
La atención dental debe acompañar a los pacientes que reciben terapia contra el cáncer de cabeza y cuello debido a que existen efectos secundarios relacionados con la radioterapia y un mal estado bucal, así como secuelas por la cirugía ablativa. Los principales efectos desarrollados por la radioterapia incluyen xerostomía y mucositis, seguidos por trismus, caries por radiación y osteorradionecrosis. Para disminuir el riesgo de desarrollar estos padecimientos es necesaria la visita alcirujano dentista previa al tratamiento para realizar los procedimientos bajo los requerimentos de un paciente con cáncer y hacer la toma de decisiones ante dientes cariados, restauraciones extensas, enfermedad periodontal o dientes posteriores inaccesibles para una higiene diaria. Sin embargo, puede ser desafi ante llevar a cabo estas tareas en el corto periodo entre el diagnóstico del paciente y el inicio de su tratamiento. De igual manera los pacientes que han terminado el tratamiento deberán ser atendidos con consideraciones especiales por la posibilidad de desarrollar osteorradionecrosis...
Subject(s)
Humans , Male , Female , Dental Care for Chronically Ill/methods , Drug-Related Side Effects and Adverse Reactions , Mouth Diseases/etiology , Neoplasms/complications , Radiotherapy/adverse effects , Dental Caries/etiology , Mucositis/etiology , Oral Manifestations , Osteoradionecrosis/etiology , Xerostomia/etiology , Trismus/etiologyABSTRACT
El tratamiento odontológico del paciente con cáncer es uno de los mayores desafíos a los que se puede enfrentar el odontólogo, ya que requiere de una atención meticulosa, coordinada y con la participación de un equipo multidisciplinario, cuyo objetivo debe ser asistir al paciente de manera integral y con la menor cantidad posible de efectos secundarios. Para lograr este objetivo se debe seguir un protocolo odontológico dividido en tres etapas: pre, intra y post terapia oncológica, que abarcan diversos tratamientos. El paciente acude al hospital para realizar el tratamiento oncológico específico y este debe ofrecerle la asistencia intra y post cirugía en condiciones hospitalarias o sanatoriales. Este artículo está dirigido al odontólogo general integrado al equipo de salud y continúa la descripción, iniciada en la parte I, de las patologías, agudas y crónicas, generadas por la terapia oncológica, como prevenirlas y como tratarlas.
Dental treatment of a cancer patient maybe one of the largest challenges that a dentist can confront with because it requires a meticulous comprehensive, tidy and coordinated assistance by a multidisciplinary team, with the aim of the integral treatment of the patient with the lowest side effects. In order to achieve this, it is essential to follow a dental protocol divided in three stages: pre, intra and post oncologic therapy which have different treatments. The patient goes to the hospital to look for an oncospecific treatments and the institution must give the intra and post care in hospital or sanatorium conditions. This paper is mainly referred to the general dentist integrated in health-team, and it continues with the description, initiated in Part I, of the odontologic acute and chronic pathologies generated by oncologic therapy, and how to prevent and treat them.
Subject(s)
Dental Care for Chronically Ill , Opportunistic Infections , Osteoradionecrosis/etiologyABSTRACT
Los bifosfonatos fueron sintetizados en el siglo XIX por químicos alemanes que buscaban prevenir el depósito industrial de carbonato de calcio en sus chimeneas. Más tarde se observó la gran afinidad de la droga con el tejido óseo y que además inhibía la conversión de fosfato de calcio amorfo a hidroxiapatita (HA), lo cual reducía la velocidad de disolución de los cristales óseos. Se realizó una revisión de la literatura referida a osteonecrosis maxilar asociada a bifosfonatos utilizando las palabras clave. La búsqueda en la base de datos PubMed y LILACS incluyó las publicaciones de los años 2006-2011. Estos compuestos sintéticos son utilizados hace más de tres décadas para el tratamiento de desórdenes esqueletales: osteoporosis, enfermedad de Paget, hipercalcemia asociada a mieloma múltiple y metástasis óseas propias de cáncer de próstata y mama, osteogénesis imperfecta y displasia fibrosa. Recientemente se han descrito algunos casos de osteonecrosis maxilar a causa de tratamiento crónico con bifosfonatos a altas dosis en la prescripción de dichas drogas utilizadas como terapéutica oncológica.
Subject(s)
Humans , Diphosphonates/adverse effects , Jaw Diseases/etiology , Osteoradionecrosis/chemically induced , Bone Neoplasms/drug therapy , Osteoradionecrosis/epidemiology , Osteoradionecrosis/etiology , Risk FactorsABSTRACT
Background: Mouth and pharyngeal cancers account for approximately 6% of cancers worldwide. Radiotherapy is one of the means of treatment of head and neck cancer. Consultation with a dental team experienced in caring for patients undergoing treatment for head and neck cancer will improve the quality of life of such patients. Aims and Objectives: To evaluate the attitude of oncologists toward dental consultation to patients planning for/prior to/undergoing/post radiation therapy for head and neck cancers and to evaluate the number of radiation oncologists who encounter oral complaints and consider worth referring to a dentist. Materials and Methods: A questionnaire-based study was carried out following mailing of covering letter and self-administered questionnaire comprising 11 items, to 25 radiation oncology centers selected in India based on convenient sampling. Results: Out of the 25 centers, we received response from 20 centers with 60 completely filled questionnaires. Five centers did not respond for further correspondences. Conclusion: The study indicated a need for awareness and education among radiation oncologists regarding dental consultation in patients planned/undergoing /post radiation therapy for head and neck cancer.
Subject(s)
Attitude of Health Personnel , Candidiasis, Oral/etiology , Cross-Sectional Studies , Dental Care for Chronically Ill , Dental Caries/etiology , Head and Neck Neoplasms/radiotherapy , Humans , Mouth Diseases/etiology , Osteoradionecrosis/etiology , Patient Care Planning , Quality of Life , Surveys and Questionnaires , Radiation Injuries/etiology , Radiation Oncology , Referral and Consultation , Taste Disorders/etiologyABSTRACT
El objetivo de esta revisión es presentar criterios de evaluación odontológica pre-radioterapia y cuáles son las principales necesidades de tratamiento de estos pacientes después del tratamiento de radiación. Fueron revisados artículos en inglés, español y portugués entre 1995 y 2009 indexados en Pubmed y Scielo. Las palabras claves fueron: cáncer oral y radioterapia, complicaciones de la radioterapia en cabeza y cuello, evaluación oral pre-radioterapia. Los efectos colaterales de la radioterapia en la región de cabeza y cuello pueden ser temporales o tardíos. Aquellos que son tardíos, como la caries de radiación y la osteorradionecrosis pueden estar directamente relacionados con el hecho de no haber realizado una evaluación odontológica previa y pueden afectar severamente la calidad de vida del paciente.La participación del cirujano-dentista en el equipo multidisciplinario y la evaluación odontológica de los pacientes que serán sometidos a radioterapia en la región de cabeza y cuello son de vital importancia en mejorar la calidad de vida post-operatoria de estos pacientes.
The objective of this review is to present pre-radiotherapy evaluation criteria and the main needs for treatment of these patients after the radiation therapy. Were revised articles in English, Spanish and Portuguese language between 1995 and 2009 indexed in Pubmed and Scielo. The keywords were oral cancer and radiotherapy, complications in head and neck radiotherapy, oral pre-radiotherapy evaluation.The adverse complications of radiotherapy in head and neck area could be temporary or late. The late effects, such as radiation caries and osteorradionecrosis could be directly associated with the fact that previous dental evaluation was not performed and can severely affect the post-operatory quality of life. The participation of the dentist in the multidisciplinary team and dental evaluation of the patients that will receive radiotherapy in the head and neck area are of vital importance to improve the post-operatory quality of life of these patients.
Subject(s)
Humans , Dental Caries/etiology , Mouth Diseases/etiology , Mouth Diseases/prevention & control , Radiotherapy/adverse effects , Algorithms , Dental Care for Chronically Ill , Cranial Irradiation/adverse effects , Mouth Mucosa/radiation effects , Mucositis/etiology , Mucositis/prevention & control , Head and Neck Neoplasms/radiotherapy , Osteoradionecrosis/etiology , Osteoradionecrosis/prevention & control , Radiotherapy/methods , Radiation Injuries/etiology , Radiation Injuries/prevention & control , Xerostomia/etiology , Xerostomia/prevention & controlABSTRACT
La radioterapia es usada para el tratamiento de los tumores de cabeza y cuello; la radiació emitida no sólo actúa sobre el tumor, sino que también afecta a los tejidos sanos prodouciendo alteraciones como xerostomía, dermatisis, trismus, candidiasis, necrosis de los tejidos blandos y osteorradionecrosis. La cámara hiperbárica se utiliza para prevenir los efectos no deseados de las radiaciones sobre los tejidos sanos aledaños al tumor. Se presenta un caso clínico de un paciente de sexo masculino de 60 años de edad tratado con radioterapia por un CA epidermoide de cavum y paladar blando. El pacientes requería extracciones múltiples y rehabilitación implantológica. Se realiza un plan de tratamiento con terapia de oxígeno hiperbárica para la prevención de la osteorradionecrosis y a fin de favorecer la preparación del terreno óseo para la colocación de implantes dentales.
Subject(s)
Humans , Dental Implantation, Endosseous/methods , Mouth Rehabilitation , Osteoradionecrosis/etiology , Radiotherapy/adverse effects , Hyperbaric Oxygenation , Osteoradionecrosis/prevention & control , Patient Care PlanningABSTRACT
The aim of this study was to evaluate the oral sequelae of radiotherapy in patients treated between 1999 and 2003 for head and neck tumors. One-hundred patients (24 women, 76 men) ranging in age from 30 to 83 years (mean 59.2 years) were examined. Time since radiotherapy ranged from 1 to 72 months (mean 28 months). The total mean radiation dose received by the patients was 5,955 cGy. The evaluation protocol included anamnesis, intraoral and extraoral examination, measurement of stimulated salivary flow and salivary pH. Symptoms reported by the patients included dry mouth (68 percent), dysphagia (38 percent), and dysgeusia (30 percent). In 64 percent of the patients, the mean stimulated salivary flow rate was less than 0.7 ml/min. The mean salivary pH was 6.97 (± 0.714). Stimulated salivary flow increased with increasing postradiotherapy time (p < 0.05). The prevalence of mucositis was associated with higher radiation doses (p < 0.05), and the prevalence of atrophic candidiasis was related to a longer post-treatment period (p < 0.05). Two cases of recurrence of the primary tumor were detected during the study. The main effect of radiotheraphy in the head and neck region was a reduction of the salivary flow rate, even though our study demonstrated that there was a modest late improvement of the salivary flow.
O objetivo deste estudo foi avaliar as seqüelas bucais provocadas pela radioterapia em pacientes com neoplasias de cabeça e pescoço, tratados entre 1999 e 2003. Foram examinados 100 pacientes (24 mulheres e 76 homens), com idades entre 30 e 83 anos (média de 59,2 anos). O tempo desde a radioterapia variou de 1 a 72 meses (média de 28 meses). A média da dose total de radiação recebida pelos pacientes foi de 5.955 cGy. O protocolo de avaliação consistiu de anamnese, exame físico, aferição do fluxo salivar estimulado e pHmetria da saliva. Os sintomas referidos foram boca seca (68 por cento), disfagia (38 por cento) e disgeusia (30 por cento). Em 64 por cento dos indivíduos o valor médio do fluxo salivar estimulado esteve abaixo de 0.7 ml/min. O pH médio da amostra foi de 6.97 (± 0.714). O fluxo estimulado e a ocorrência de candidíase atrófica aumentaram conforme o aumento do tempo pós-radioterapia (p < 0.05). A ocorrência de mucosite esteve associada a maiores doses de radiação (p < 0.05). Dois casos de segundo tumor primário foram diagnosticados. O principal efeito da radioterapia na região de cabeça e pescoço foi a redução do fluxo salivar, apesar de nosso estudo ter demonstrado que há uma melhora tardia do fluxo salivar.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Cranial Irradiation/adverse effects , Mouth Mucosa/radiation effects , Salivation/radiation effects , Xerostomia/etiology , Carcinoma, Squamous Cell/radiotherapy , Dose-Response Relationship, Radiation , Head and Neck Neoplasms/radiotherapy , Linear Models , Osteoradionecrosis/etiology , Secretory Rate , Saliva , Salivary Glands/radiation effectsABSTRACT
A radioterapia é uma forma terapêutica amplamente utilizada para o tratamento das neoplasias malignas da cabeça e pescoço. Porém, altas doses de radiação em extensos campos que irão incluir a cavidade bucal, maxila, mandíbula e glândulas salivares freqüentemente resultam em diversas reações indesejadas. Dentre as complicações da radioterapia estão a mucosite, candidose, disgeusia, cárie por radiação, osteorradionecrose, necrose do tecido mole e xerostomia. OBJETIVO: O objetivo deste artigo é fazer uma breve revisão das reações adversas que podem ser detectadas durante o tratamento radioterápico em região de cabeça e pescoço. MÉTODO: A literatura pertinente que trata do assunto foi revisada. FORMA DE ESTUDO: Revisão de literatura. RESULTADOS: A radioterapia ainda está associada a diversas reações adversas, que afetam de forma significativa a qualidade de vida dos pacientes. CONCLUSÕES: O tratamento multidisciplinar, incluindo a equipe médica, o cirurgião-dentista, o fonoaudiólogo, o nutricionista e o psicólogo é a melhor alternativa para minimizar ou mesmo prevenir tais complicações.
Radiotherapy is a treatment modality largely used for head and neck malignancies. However, high doses of radiation in large areas, including the oral cavity, maxilla, mandible and salivary glands may result in several undesired reactions. Mucositis, candidosis, disgeusia, radiation caries, osteoradionecrosis, soft tissue necrosis and xerostomia are some of radiotherapyÆs complications. AIM: The aim of this study is to briefly review the side effects that may be seen in the oral cavity during or after radiotherapy treatment in the head and neck region. BASIC METHOD USED: Review of relevant literature. STUDY DESING: Literature review. RESULTS: Radiotherapy is still associated with several side effects, significantly affecting patientsÆ quality of life. CONCLUSIONS: A multidisciplinary treatment, including physicians, dentists, speech therapits, nutritionists, and psychologists, is the best alternative to minimize, or even prevent such reactions.
Subject(s)
Humans , Cranial Irradiation/adverse effects , Mouth Diseases/etiology , Mouth Mucosa/radiation effects , Dental Caries/etiology , Head and Neck Neoplasms/radiotherapy , Jaw Diseases/etiology , Osteoradionecrosis/etiology , Quality of LifeABSTRACT
Head and neck cancer patients need to receive dental care previously to radiotherapy. Even patients who regularly visit dental offices need special attention including profilatic and curative treatments. The purposes of this study were to evaluate the dental status of Brazilian head and neck squamous cell carcinoma patients with low socioeconomic level as well as to discuss the dental treatment performed and the oral side effects of radiotherapy. Forty patients with head and neck squamous cell carcinoma received dental care and dental extractions prior to radiotherapy and were were followed up for a mean period of 28.7 months after the cancer treatment. Before radiotherapy, 28 patients were dentulous and 12 edentulous, and all of them had poor oral health and hygiene. The most common treatment performed were dental extraction and 23 patients had 8.6 teeth extracted on average. One out of 9 (11.1 percent) patients developed radiation caries and 5 out of 23 cases (21.3 percent - Group I) developed osteoradionecrosis, being only 1 case associated with previous dental extraction. Brazilian low-socioeconomic level patients with head and neck cancer were submitted to multiple dental extractions due to poor dental condictions and inadequate oral care. The dental treatment did not prevent osteoradionecrosis, which presumably presented a multifactorial etiology in most cases.
Pacientes portadores de carcinomas espinocelulares em cabeça e pescoço necessitam receber tratamento odontológico antes da radioterapia. Mesmo pacientes que visitam regularmente consultórios odontológicos requerem especial atenção incluindo profilaxias e tratamentos curativos. Os objetivos desse estudo foram avaliar a condição odontológica de 40 pacientes de baixo nível sócio-econômico antes da radioterapia em cabeça e pescoço e discutir o tratamento odontológico realizado. Os pacientes foram acompanhados durante o tratamento oncológico. Antes da radioterapia, 28 pacientes eram dentados e doze edêntulos, sendo que todos esses apresentavam péssimas condições sistêmicas e higiene oral deficiente. O tratamento mais comumente empregado foi a extração dentária e 23 pacientes tiveram a média de 8,6 dentes extraídos (Grupo I). Um em 9 (11,1 por cento) pacientes desenvolveram cárie por radiação e 5 em 23 (21,73 por cento) osteorradionecrose, sendo um caso associado a extrações dentárias prévias à radioterapia e outros de origem multifatorial. Pacientes de baixo nível socioeconômico com carcinoma espinocelular em cabeça e pescoço receberam múltiplas extrações dentárias devido à condição dentária precária e má higienização. O tratamento odontológico não preveniu a osteorradionecrose, que apresenta origem multifatorial na maioria dos casos.
Subject(s)
Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Dental Care , Head and Neck Neoplasms/radiotherapy , Jaw Diseases/prevention & control , Osteoradionecrosis/prevention & control , Poverty , Carcinoma, Squamous Cell/radiotherapy , Dental Caries/etiology , Follow-Up Studies , Jaw, Edentulous, Partially/pathology , Jaw, Edentulous/pathology , Mandibular Diseases/etiology , Mouth/radiation effects , Oral Health , Oral Hygiene , Osteoradionecrosis/etiology , Radiotherapy Dosage , Radiation Injuries/etiology , Tooth ExtractionABSTRACT
A osteorradionecrose é uma séria complicação da radioterapia de cabeça e pescoço. Este artigo destaca a sua fisiopatologia, os seus principais fatores predisponentes e as suas características clínicas e radiográficas, além de discutir formas de prevenir sua ocorrência. Aborda, ainda, os tratamentos tradicionais da osteorradionecrose e as perspectivas futuras, enfatizando a importância da participação do cirurgião-dentista na equipe multidisciplinar oncológica.
Osteoradionecrosis is a serious complication resulting of head and neck radiotheraphy. This article focus on itsphysiopathology, main predisposing factors, clinical and radiographic characteristics, besides the discussion on how to prevent it. In addition, it highlights the osteoradionecrosis traditional treatments and future perspectives, on the matter emphasizing the importance of the participation of the dentist in the multidisciplinary oncologic team.
Subject(s)
Humans , Male , Female , Adult , Middle Aged , Mouth Neoplasms/pathology , Mouth Neoplasms/radiotherapy , Osteoradionecrosis/diagnosis , Osteoradionecrosis/etiology , Osteoradionecrosis/prevention & control , Osteoradionecrosis/radiotherapy , Radiotherapy/adverse effectsABSTRACT
A radioterapia tem atualmente um papel fundamental no tratamento do câncer de cabeça e pescoço. Dois terços dos pacientes com câncer recebem em alguma fase de sua doença tratamento com radiações, seja como tratamento exclusivo ou associado à cirurgia e/ou quimioterapia. As principais conseqüências orais decorrentes da radioterapia de cabeça e pescoço são mucosite, xerostomia, perda do paladar, trismo, cárie de radiação, candidíase e osteorradionecrose. É de fundamental importância que o cirurgião dentista esteja familiarizado com tais complicações para que possa juntamente, com a equipe oncológica, prevenir, controlar e tratar tais conseqüências. O objetivo deste estudo é apresentar as principais complicações orais advindas da radioterapia e descrever a conduta clínica geral em pacientes antes, durante e após o tratamento radioterápico
Subject(s)
Humans , Head and Neck Neoplasms , Mouth , Mouth Mucosa , Head and Neck Neoplasms/radiotherapy , Radiotherapy/adverse effects , Candidiasis, Oral/etiology , Dental Caries , Osteoradionecrosis/etiology , Xerostomia/etiologyABSTRACT
Os efeitos colaterais da radioterapia instituída para o tratamento de pacientes com câncer da região de cabeça e pescoço interferem significativamente na qualidade de vida desses indivíduos. Entre esses efeitos, podem-se citar mucosite, hipossialia, ageusia, cáries por radiação, trismo e osteorradionecrose (ORN). Esta última constitui uma complicação grave e de difícil tratamento. A presente revisão da literatura objetiva enfatizar aspectos da osteorradionecrose, abordando fatores etiológicos, características clínicas e radiográficas, prevalência, tratamento e prognóstico da enfermidade. O cumprimento de medidas protocolares antes, durante e após a radioterapia de cabeça e pescoço previne e minimiza a ocorrência de complicações como a ORN. As consultas de controle após o término da radioterapia são imprescindíveis e devem ser garantidas pela conscientização do paciente sobre a importância das medidas preventivas
Subject(s)
Humans , Head and Neck Neoplasms/radiotherapy , Osteoradionecrosis/etiology , Osteoradionecrosis/therapy , Radiotherapy/adverse effectsSubject(s)
Mouth Neoplasms/classification , Mouth Neoplasms/pathology , Mouth Neoplasms/therapy , Analgesia , Brachytherapy , Carcinogens/classification , Dentistry , Drug Therapy , Drug Therapy/classification , Genes, Tumor Suppressor/physiology , Mouth Neoplasms , Mouth Neoplasms/complications , Mouth Neoplasms/diagnosis , Mouth Neoplasms/drug therapy , Mouth Neoplasms/epidemiology , Mouth Neoplasms/genetics , Mouth Neoplasms/immunology , Mouth Neoplasms/physiopathology , Mouth Neoplasms/prevention & control , Mouth Neoplasms/radiotherapy , Mouth Neoplasms/rehabilitation , Mouth Neoplasms/surgery , Head and Neck Neoplasms/therapy , Oncogenes/physiology , Osseointegration , Osseointegration/radiation effects , Osteoradionecrosis/etiology , Hyperbaric Oxygenation/methods , Prognosis , Chemoprevention/methods , Radiotherapy , Plastic Surgery Procedures , Retinoids/chemistry , Retinoids/pharmacologyABSTRACT
O conhecimento atual sobre a osteorradionecrose foi revisado, com o objetivo de se verificar etiologia, incidência e prevençäo desta patologia. Neste trabalho compilou-se dados da seqüela radioterápica que permititam concluir que os fatores mais comuns desta entidade nosológica säo a radiaçäo, o trauma e a infecçäo. Constatou-se que a sua ocorrência pode existir mesmo sem infecçäo e trauma e que é necessário que se faça uma avaliaçäo rigorosa da saúde bucal antes da radioterapia para que se promova uma boa higiene oral em prol de sua prevençäo
Subject(s)
Osteoradionecrosis/etiology , Osteoradionecrosis/prevention & control , Radiotherapy , Radiotherapy/adverse effectsABSTRACT
A retrospective analysis of 1140 cases of cancer of oral cavity and oropharynx treated with definitive radiotherapy was carried out with regard to the incidence and precipitating factors of mandibular osteoradionecrosis. 14 cases developed osteoradionecrosis out of which 10 had spontaneous mandibular necrosis and 4 had dental extractions in the area where osteoradionecrosis developed. Amongst the 10 cases of spontaneous osteoradionecrosis, 8 patients received doses of 6500 cGy in 6 1/2 weeks or 7000 cGy in 7 weeks by megavoltage cobalt 60 teletherapy and the remaining two patients received the doses of 6000 cGy in 6 weeks. The aforesaid 4 patients of osteoradionecrosis in the area of dental extractions had received doses of only 6000 cGy in 6 weeks.
Subject(s)
Carcinoma, Squamous Cell/radiotherapy , Cobalt Radioisotopes , Cranial Irradiation/adverse effects , Dental Caries/etiology , Female , Humans , Incidence , Male , Mandibular Diseases/etiology , Mouth Neoplasms/radiotherapy , Oropharyngeal Neoplasms/radiotherapy , Osteoradionecrosis/etiology , Radioisotope Teletherapy/adverse effects , Retrospective StudiesABSTRACT
A osteorradionecrose é uma das complicaçöes mais importantes no tratamento radioterápico das neoplasias da cabeça e pescoço. Muitos fatores parecem contribuir para o seu aparecimento, sendo que o emprego de dosagens radioterápicas acima de 6.000 CGY e infecçäo säo os mais importantes. O tratamento da osteorradionecrose da maxila baseia-se no combate à infecçäo e higiene oral, sendo ocasionalmente necessária limpeza cirúrgica