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Cirurgia oral em pacientes submetidos a radioterapia de cabeça e pescoço
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As alterações orais malígnas estão entre os tipos de cancro que mais afetam a população, das quais, aproximadamente, 3,6% de todos os cancros atingem as regiões orais e faríngeas e assim ocupam a posição de sexto mais comum no mundo (Balermpas et al., 2022). A cirurgia oral em pacientes irradiados de cabeça e pescoço ainda é um desafio para a medicina dentária, visto que a radiação ionizante afeta a capacidade de cicatrização dos tecidos. Entre as principais preocupações do médico dentista no momento de realizar esse procedimento está: anatomia alterada por possíveis cirurgias resultantes do tratamento oncológico, complicações na osseointegração e osteorradionecrose. Protocolos clínicos de tratamento dentário pré-radioterapia existem numa tentativa de minimizar o aparecimento de complicações. Estudos mostram a possibilidade de realizar com sucesso intervenções pós-radioterapia, porém atualmente ainda se defende a realização de um tratamento dentário antes do processo de ionização. As terapias ionizantes sofreram mudanças, tornaram-se menos agressivas pela introdução da técnica de Radioterapia de Intensidade Modulada (IMRT) e alterações como osteorradionecrose se tornam cada vez menos frequentes. O sucesso ou fracasso do procedimento cirúrgico está relacionado à quantidade de radiação a qual a região foi submetida, a protocolos realizados durante os procedimentos cirúrgicos, às comorbidades presentes e também aos cuidados e hábitos do paciente. A presente revisão narrativa realça aspetos gerais do paciente irradiado de cabeça e pescoço e procedimentos adequados ao manejo em cirurgia oral desse paciente. O levantamento bibliográfico foi realizado nas bases de busca científica Pubmed, Lilacs, Medline e SciELO, nos idiomas português e inglês, dos últimos 10 anos.
Malignant oral changes are among the types of cancer that most affect the population, in which approximately 3.6% of all cancers affect the oral and pharyngeal regions and thus occupy the position of sixth most common in the world. Oral surgery in head and neck irradiated patients is still a challenge for dentistry, as ionizing radiation affects the tissue's healing capacity; among the dentist's main concerns when performing this procedure are altered anatomy due to possible surgeries resulting from oncological treatment, complications in osteointegration and osteoradionecrosis. Clinical pre-radiotherapy dental treatment protocols exist in an attempt to minimize the appearance of complications. Studies show the possibility of successfully carrying out post-radiotherapy interventions, but it is still advocated that dental treatment be carried out before the ionization process. Ionizing therapies have undergone changes, becoming less aggressive due to the introduction of the intensity-modulated radiotherapy technique, and changes such as osteoradionecrosis are becoming less and less frequent. The success or failure of the surgical procedure is related to the amount of radiation the region was subjected to the protocols carried out during the surgical procedures, the comorbidities present, and the patient's care and habits. This narrative review highlights general aspects of head and neck irradiated patients and appropriate procedures for managing these patients in oral surgery. The bibliographic survey was carried out in the scientific search databases Pubmed, Lilacs, Medline, and SciELO in Portuguese and English over the last ten years.
Malignant oral changes are among the types of cancer that most affect the population, in which approximately 3.6% of all cancers affect the oral and pharyngeal regions and thus occupy the position of sixth most common in the world. Oral surgery in head and neck irradiated patients is still a challenge for dentistry, as ionizing radiation affects the tissue's healing capacity; among the dentist's main concerns when performing this procedure are altered anatomy due to possible surgeries resulting from oncological treatment, complications in osteointegration and osteoradionecrosis. Clinical pre-radiotherapy dental treatment protocols exist in an attempt to minimize the appearance of complications. Studies show the possibility of successfully carrying out post-radiotherapy interventions, but it is still advocated that dental treatment be carried out before the ionization process. Ionizing therapies have undergone changes, becoming less aggressive due to the introduction of the intensity-modulated radiotherapy technique, and changes such as osteoradionecrosis are becoming less and less frequent. The success or failure of the surgical procedure is related to the amount of radiation the region was subjected to the protocols carried out during the surgical procedures, the comorbidities present, and the patient's care and habits. This narrative review highlights general aspects of head and neck irradiated patients and appropriate procedures for managing these patients in oral surgery. The bibliographic survey was carried out in the scientific search databases Pubmed, Lilacs, Medline, and SciELO in Portuguese and English over the last ten years.
Descrição
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Palavras-chave
Cirurgia oral Radioterapia Osteorradionecrose Reabilitação oral