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Reabilitação oral em pacientes oncológicos submetidos a tratamentos cirúrgicos da cabeça e do pescoço
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O cancro da cabeça e do pescoço é um grave problema mundial, constituindo atualmente o sexto cancro mais prevalente na população.
Os fatores etiológicos principais para o carcinoma espinocelular são o tabaco e o álcool, contudo, na última década o aumento do cancro orofaríngeo devido à infeção pelo vírus do papiloma humano tem aumentado drasticamente.
Este tumor afeta as diferentes localizações da cavidade oral como da orofaringe, contudo, as restantes localizações da cabeça e do pescoço, poderão também ser afetadas, tais como: as glândulas salivares, nasofaringe, laringe e hipofaringe. O médico dentista, devido ao seu contacto diário com a cavidade oral dos doentes, possui um papel primordial no diagnóstico precoce de lesões potencialmente malignas e malignas numa fase inicial assintomática das mesmas. O sucesso do tratamento oncológico, está diretamente relacionada com o acompanhamento do doente por parte de uma equipa multidisciplinar.
O tratamento oncológico primário, passará pela realização de cirurgia, provocando esta, sequelas extremamente graves na qualidade de vida dos pacientes, principalmente em estadios mais avançados.
A reabilitação oral dos doentes oncológicos, após os tratamentos cirúrgicos e complementares, continua a consistir num desafio na área da medicina dentária. As propostas de reabilitação dividem-se entre técnicas removíveis ou técnicas fixas. A utilização de implantes dentários, tem vindo a ser demonstrada como superior relativamente às próteses removíveis, no aumento de qualidade de vida dos pacientes, contudo ambas as hipóteses de reabilitação apresentam limitações. Desta forma, não tem existido consenso relativamente à hipótese de reabilitação oral ideal, cada paciente terá um planeamento individualizado, garantido assim a melhoria parcial ou a recuperação total das capacidades perdidas (mastigação, deglutição e fonação).
O objetivo desta monografia, passa pela análise das várias hipóteses de reabilitação do doente oncológico, após as sequelas deixadas pelo tratamento oncológico.
Head and neck cancer is a serious global problem and is currently the sixth most prevalent cancer worldwide. The main risk factors for squamous-cell carcinoma of the head and neck are tobacco and alcohol. However, in the last decade oropharyngeal cancer secondary to human papillomavirus infection has increased dramatically. This tumor originates primarily from the mucosa of the oropharyngeal cavity, including the tongue, and to a lesser extent the salivary glands and the remaining aerodigestive tract up to and including the larynx. Due to their daily contact with patient’s oral cavity, the dental practitioner plays a key role in the early diagnosis of potentially malignant and malignant lesions at an early asymptomatic stage. The prognosis is directly related to patient follow-up by a multidisciplinary team. The primary oncological treatment involves surgical intervention. The consequent sequelae caused by extensive tumour and tissue resection, especially in more advanced stages, have a significant detrimental impact on patient’s quality of life. Oral rehabilitation of cancer patients, after surgical and chemoradiotherapy regimen continues to be a challenge in the area of dentistry. The rehabilitation proposals are divided between removable and fixed techniques. Although, dental implants have the most favorable long-term outcomes, there are certain clinical scenarios, such as extent of resection, that preclude its ubiquitous implementation. The removable techniques are crucial in management of such patients. In this way, there is no consensus regarding the ideal oral rehabilitation pathway, as each patient will require an individualized plan to ensure optimal recovery of lost essential physical faculties (chewing, swallowing and phonation). The objective of this monograph is to analyze the rehabilitation pathways available after the primary therapy of head and neck cancers, which inevitably leads to severe loss and reconstruction of the maxillofacial anatomy.
Head and neck cancer is a serious global problem and is currently the sixth most prevalent cancer worldwide. The main risk factors for squamous-cell carcinoma of the head and neck are tobacco and alcohol. However, in the last decade oropharyngeal cancer secondary to human papillomavirus infection has increased dramatically. This tumor originates primarily from the mucosa of the oropharyngeal cavity, including the tongue, and to a lesser extent the salivary glands and the remaining aerodigestive tract up to and including the larynx. Due to their daily contact with patient’s oral cavity, the dental practitioner plays a key role in the early diagnosis of potentially malignant and malignant lesions at an early asymptomatic stage. The prognosis is directly related to patient follow-up by a multidisciplinary team. The primary oncological treatment involves surgical intervention. The consequent sequelae caused by extensive tumour and tissue resection, especially in more advanced stages, have a significant detrimental impact on patient’s quality of life. Oral rehabilitation of cancer patients, after surgical and chemoradiotherapy regimen continues to be a challenge in the area of dentistry. The rehabilitation proposals are divided between removable and fixed techniques. Although, dental implants have the most favorable long-term outcomes, there are certain clinical scenarios, such as extent of resection, that preclude its ubiquitous implementation. The removable techniques are crucial in management of such patients. In this way, there is no consensus regarding the ideal oral rehabilitation pathway, as each patient will require an individualized plan to ensure optimal recovery of lost essential physical faculties (chewing, swallowing and phonation). The objective of this monograph is to analyze the rehabilitation pathways available after the primary therapy of head and neck cancers, which inevitably leads to severe loss and reconstruction of the maxillofacial anatomy.
Descrição
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Palavras-chave
Cancro da cabeça e pescoço Cirurgia Reabilitação oral Carcinoma espinocelular