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Multidisciplinary Treatment Approach in a Patient with History of Nasopharyngeal Carcinoma

DOI: 10.1155/2014/918461

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Abstract:

Radiotherapy in NPC patients has side effects on the dentition, which affects quality of life dramatically. This case report presents multidisciplinary dental treatment approach in a 17-year-old male patient with a history of nasopharyngeal carcinoma (NPC), which was treated with chemotherapy and radiotherapy. The adolescent patient applied to dental hospital 4 years after the radiotherapy with aesthetic and functional problems on dentition affecting psychological, social, and physical aspects of his life. The dentition of the patient demonstrated the severe destruction as a devastating side effect of radiotherapy. With a successful multidisciplinary approach, our patient’s aesthetics, function, and self-confidence were obtained. Well-established procedures, which include preventative care and maintenance, can reduce the duration and expenses of the treatment and help in challenging the life-long complications of radiotherapy. 1. Introduction Nasopharyngeal carcinoma (NPC) is a malign neoplasm occurring in the epithelial layer of the nasopharynx. The first symptom of the disease in the 60% of the patients is enlarged cervical lymph nodes which represents metastasis. Obstruction of the eustachian tube occurs in nearly 50% of patients, which leads to unilateral serous otitis media and hearing loss. Less frequent symptoms may be like the symptoms of temporomandibular dysfunction, which is more common for the dentist, thus complicating the problem [1]. Nasopharyngoscopy, computerized tomography and/or magnetic resonance imaging on suspicious lesions, and histological examination by biopsy are required for diagnosis [2]. All the major and minor salivary glands of the NPC patients who were treated with radiotherapy are affected by the large irradiation doses, thus leading the patients into severe and persistent xerostomia [3]. Occasionally, the most anterior portion of the floor of the mouth may stand unaffected [2]. Recovery of salivary output of patients is not significant [3]. Radiotherapy may lead to dental caries, even in the patients who had not experienced caries in lifetime [4]. The decrease of saliva secretion and alternation of its quality are the key factors of the radiation caries. Also dental tissues are affected by radiation directly, making teeth more susceptible to decalcification [4]. Other complications are oral candidiasis consequent to shift in the oral microflora, transient taste alterations, malnutrition and weight loss, and restricted movement of mandible as a sequel of fibrosis on mastication muscles [3, 5]. Osteoradionecrosis is the

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