"Management of the Patient Irradiated for Head and Neck Cancer"
A.Effects of Radiation or Chemotherapeutic Drug
B. Prevention & Management of the Effects of Radiation & Chemotherapy
C.The Use of Hyperbaric Oxygen Therapy
D.The Use of Lasers & Cryosurgery in Oral & Maxillofacial Surgery
37. Fibrosis of muscle
in the area that
receives radiation.
Breakdown of
bone in the area
that receives
radiation.
38.
39.
40. Inflamed mucous
membranes in the
mouth.
Infections in the mouth
or that travel through
the bloodstream. These
can reach and affect
cells all over the body.
43. Tooth decay and gum
disease. Oral
complications may be
caused by the
treatment itself
(directly) or by side
effects of the
treatment (indirectly).
47. Problems such
as cavities, broken
teeth, loose crowns or
fillings, and gum disease
can get worse or cause
problems
during cancer treatment.
48. Bacteria live in the
mouth and may
cause an infection
when the immune
system is not
working well or
when white blood
cell counts are low.
49. If dental problems
are treated before
cancer treatments
begin, there may
be fewer or
milder oral
complications.
50. Prevention of Oral
Complications
includes a healthy
diet, good oral
care, and dental
checkups
51. Eat a wellbalanced diet. Healthy
eating can help the
body stand the stress of
cancer treatment, help
keep up your energy,
fight infection, and
rebuild tissue.
52. Keep your mouth
and teeth clean. This
helps prevent
cavities, mouth
sores, and
infections.
Have a complete
oral health exam.
54. Continuing to
smoke tobacco may
slow down recovery. It
can also increase the
risk that the head or
neck cancer
will recur or that
a second cancer will
form.
55.
56. Regular Oral Care
“Good dental hygiene may
help prevent or decrease
complications.”
Everyday oral care for
cancer patients includes
keeping the mouth clean
and being gentle with the
tissue lining the mouth.
57. Oral Mucositis
“Oral mucositis is an
inflammation of mucous
membranes in the mouth.”
Care of mucositis during
chemotherapy and
radiation therapy
includes cleaning the
mouth and relieving pain.
58. Swishing ice chips
in the mouth for 30
minutes, beginning 5
minutes before
patients
receive fluorouracil,
may help prevent
mucositis. Patients
59. who receive high-dose
chemotherapy and
stem cell transplant
may be
given medicine to help
prevent mucositis or
keep it from lasting as
long.
60. Pain
A cancer patient's pain may
come from the following:
- The cancer.
- Side effects of cancer
treatments.
- Other
medical conditions not
related to the cancer.
61. Non-drug treatments may
also help, including the
following:
Physical therapy.
TENS (transcutaneous
electrical nerve
stimulation).
Applying cold or heat.
64. Infection
Infections may be
caused by bacteria, a
fungus, or a virus.
Treatment of bacterial
infections in patients
who have gum disease
and receive high-dose
chemotherapy may
65. include the following:
a. Using medicated and
peroxide mouth rinses.
b. Brushing and flossing.
c. Wearing dentures as
little as possible.
d. Patients receiving
cancer treatment may
66. be given drugs to help
prevent fungal
infections from
occurring.
e. Giving antiviral drugs
before treatment starts
can lower the risk of
viral infections.
67. Bleeding
Bleeding may occur
when anticancer drugs
make the blood less able
to clot.
Most patients can safely
brush and floss while
blood counts are low.
68. Treatment for bleeding
during chemotherapy may
include the following:
Medicines to reduce
blood flow and help clots
form.
Topical products that
cover and seal bleeding
areas.
69. Topical products that
cover and seal bleeding
areas.
Rinsing with a mixture of
saltwater and 3%
hydrogen peroxide. (The
mixture should have 2 or
3 times the amount of
saltwater than hydrogen
70. peroxide.) To make the
saltwater mixture, put
1/4 teaspoon of salt in
1 cup of water. This
helps clean wounds in
the mouth. Rinse
carefully so clots are
not disturbed.
71. Dry Mouth
“Dry mouth (xerostomia)
occurs when the salivary
glands don't make
enough saliva.”
Salivary glands usually
return to normal after
chemotherapy ends.
72. Salivary glands may
not recover completely
after radiation therapy
ends.
“Careful oral hygiene can
help prevent mouth sores,
gum disease, and tooth
decay caused by dry
mouth.”
73. Care of dry mouth may
include the following:
Clean the mouth and
teeth at least 4 times a
day.
Floss once a day.
Brush with a fluoride
toothpaste.
74. Apply fluoride gel once a
day at bedtime, after
cleaning the teeth.
Rinse 4 to 6 times a day
with a mixture of salt
and baking soda (mix ½
teaspoon salt and ½
teaspoon baking soda in
1 cup of warm water).
75. Avoid foods and liquids
that have a lot of sugar
in them.
Sip water often to
relieve mouth dryness.
A dentist may give the
following treatments:
• Rinses to replace
76. minerals in the teeth.
Rinses to fight infection in
the mouth.
Saliva substitutes or
medicines that help the
salivary glands make more
saliva.
Fluoride treatments to
prevent tooth decay.
77. Taste Changes
Changes in taste
(dysguesia) are common
during chemotherapy and
radiation therapy.
In most patients receiving
chemotherapy and in
some patients receiving
radiation therapy, taste
78. returns to normal a few
months after treatment
ends. However, for many
radiation therapy patients,
the change is permanent.
In others, the taste buds
may recover 6 to 8 weeks
or more after radiation
therapy ends.
81. The following may help
patients with cancer meet
their nutrition needs:
• Serve food
chopped, ground, or
blended, to shorten the
amount of time it needs to
stay in the mouth before
being swallowed.
82. • Eat between-meal snacks
to
add calories and nutrients
• Eat foods high in calories
and protein.
• Take supplements to
get vitamins, minerals,
and calories.
83. Swallowing Problems
Pain during swallowing
and being unable to
swallow (dysphagia) are
common in cancer
patients before, during,
and after treatment.
• Swallowing problems are
managed by a team of
84. experts.
• Speech therapist: A
speech therapist can
assess how well the
patient is swallowing and
give the patient
swallowing therapy and
information to better
understand the problem.
85. • Dietitian: A dietitian can
help plan a safe way for
the patient to receive
the nutrition needed for
health while swallowing
is a problem.
• Dental specialist:
Replace missing teeth
and damaged area of the
86. mouth with artificial
devices to help
swallowing.
• Psychologist: For patients
who are having a hard
time adjusting to being
unable to swallow and eat
normally, psychological
counseling may help.
87. Tooth Decay
• Dry mouth and changes in
the balance of bacteria in
the mouth increase the
risk of tooth decay
(cavities).
• Careful oral hygiene and
regular care by a dentist
can help prevent cavities.
88. Mouth and Jaw Stiffness
“Treatment for head and
neck cancers may affect
the ability to move the
jaws, mouth, neck, and
tongue”
Treatment should begin as
soon as possible to keep
the condition from getting
89. worse or becoming
permanent. Treatment may
include the following:
• Medical devices for the
mouth.
• Pain treatments.
• Medicine to relax muscles.
• Jaw exercises.
• Medicine to treat depression
90. Tissue and Bone Loss
• Radiation therapy can destroy
very small blood vessels
within the bone. This can kill
bone tissue and lead to bone
fractures or infection.
Radiation can also kill tissue
in the mouth. Ulcers may
form, grow, and cause pain,
loss of feeling, or infection.
91. The following may help
prevent and treat tissue
and bone loss:
• Eat a well-balanced diet.
• Wear removable
dentures or devices as
little as possible.
• Don't smoke.
• Don't drink alcohol.
92. • Use topical antibiotics.
• Use painkillers as
prescribed.
• Surgery to remove dead
bone or to rebuild bones
of the mouth and jaw.
• Hyperbaric
oxygen therapy
99. Monoplace Chambers
• single patient is placed
in a pressurized clear,
acrylic chamber, about
seven feet long, while
pure oxygen is
compressed into the
chamber
100. • Chamber is comfortable,
with an atmosphere
similar to that of an
airplane
• Chamber pressures
typically rise to two-anda-half times the normal
atmospheric pressure
101. • Session can last
anywhere from thirty
minutes to two hours
• Cost less to operate
• Internal environment
is maintained at
100% oxygen
122. WHAT IS CRYOSURGERY?
Cryosurgery (also called
cryotherapy or
cryoablation ) is the use of
extreme cold produced by
liquid nitrogen (or argon
gas) to destroy abnormal
tissue.
122
123. BRIEF HISTORY
The first cryogens were
liquid air and compressed
carbon dioxide snow.
Liquid nitrogen became
available in the 1940s and
currently is the most
widely used cryogen.
123
125. MECHANISM OF ACTION
Liquid nitrogen or
argon gas is
circulated through a
hollow instrument.
The doctor uses
ultrasound or MRI to
guide the cryoprobe.
125
126. A ball of ice crystals
forms around the
probe, freezing nearby
cells.
126
138. Auricular basal cell
carcinoma.
A, Preoperative view of basal cell
carcinoma of the ear. B, Basal cell
carcinoma of the ear 1 week posttreatment
C, Left ear 6 weeks post-treatment.
138
139. Complications
• 24 and 72 hours following
cryotherapythere is
edema and sometimes
blister formation
• hemorrhage and
ulceration.
• Pigmentary changes are
the most common.
139
140.
141. LASER stands for:
L ight
A mplification by
S timulated
E mission of
R adiation
142. HISTORICAL BACKGROUND
• Albert Einstein – 1917 –
Quantum theory
• Theodore Maiman –
1960 – 1st Laser using
Ruby crystal
• Leon Goldman – 1963 –
Father of modern lasers
156. 3. no option for switching
between different
wavelengths.
4.laser surgery systems
are bulky, which
particularly limits their
use in the narrow space
of the oral cavity.
5. no flexible light guide
157.
158. Oral Tumors
squamous cell carcinoma is
the most common oral
cancer.
Laser used :
CO2 and Er-YAG-lasers
Nd:YAG lasers
KTP lasers (potassium
titanyl phosphate laser)