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Doctoral Thesis
DOI
https://doi.org/10.11606/T.25.2021.tde-13042022-142556
Document
Author
Full name
Gabriela Moura Chicrala
Institute/School/College
Knowledge Area
Date of Defense
Published
Bauru, 2021
Supervisor
Committee
Santos, Paulo Sergio da Silva (President)
Antunes, Héliton Spíndola
Tieghi Neto, Victor
Tjioe, Kellen Cristine
 
Title in English
Fabrication of intraoral stent for oral protection during radiotherapy
Keywords in English
Intensity-modulated radiotherapy
Quality of life,Trismus
Abstract in English
In the need for cancer treatment involving radiotherapy, several side effects are expected for the therapy to reach, in addition to neoplastic tissue, healthy tissue. The research objectives were: a) to make an intraoral device (stent) to mechanically separate the palate, tongue, and mouth floor and keep the mouth opening stable in an attempt to minimize some of the side effects such as oral mucositis, dysgeusia, and trismus; b) assess the impact of oral health on quality of life (QoL); c) assess the comfort and stability of the device according to the patient's perception; d) compare the results of trismus, dysgeusia and impact of oral health on QoL before and after radiotherapy. The device was fabricated of acrylic resin and used for planning and during all radiotherapy sessions. Oral mucositis was assessed using the World Health Organization (WHO) and Oral Mucositis Assessment Scale (OMAS) scales; dysgeusia was assessed using a dichotomous question (yes/no); trismus was assessed by physical examination with the aid of a universal caliper; the impact of oral health on QoL was calculated using the Oral Health Impact Profile (OHIP-14) questionnaire; a questionnaire was designed to assess the use of the device according to the patient's perception. From a total of 26 patients recruited, the final sample consisted of 20 participants, 12 men (60%) and 8 women (40%) aged between 26 and 88 years. Squamous cell carcinoma was the most prevalent histological type (75%), with the tongue being the most affected site (50%). Half of the sample was diagnosed with tumors up to 2 cm in length, without lymph node involvement in 45% of cases or distant metastasis (90%). The most common treatment protocol was surgery followed by radiotherapy. Most of the sample were non-smokers (60%) and without regular alcohol consumption (70%). At the end of radiotherapy, the participants presented WHO Grade 2 (65%) oral mucositis, with a mean of 2.64 ± 0.87 (OMAS). Patients who underwent all three treatment modalities (surgery, followed by chemotherapy and radiotherapy) had a higher OMAS score than those who underwent radiotherapy combined with chemotherapy alone (p=0.01) or with surgery (p=0.04). There was a significant decrease of 6.6 mm (±7.58) in mouth opening compared to before radiotherapy (p<0.01) and dysgeusia in 80% of the sample, without a statistical difference (p>0.05). There was a worsening in the impact of oral health on QL in global values (p=0.002) and Domain 4 (p=0.014). For most participants, the device was comfortable (60%), its use did not cause pain (80%), and remained stable in the mouth during radiotherapy sessions (90%). All (100%) patients rated its use as important for treatment. Despite the variety of side effects presented, most were well tolerated by the patient during treatment. The use of stents, as well as the comprehensive and multidisciplinary treatment of the patient, may have contributed to these results.
 
Title in Portuguese
Confecção de dispositivo intraoral para proteção bucal durante a radioterapia
Keywords in Portuguese
Qualidade de vida
Radioterapia de intensidade modulada
Trismo
Abstract in Portuguese
Na necessidade de tratamento oncológico que envolva radioterapia, diversos efeitos colaterais são esperados pela terapia atingir, além de tecido neoplásico, tecido sadio. Os objetivos da pesquisa foram: a) confeccionar um dispositivo intraoral (stent) para separar mecanicamente palato, língua e assoalho bucal e manter a abertura bucal estável na tentativa de minimizar alguns dos efeitos colaterais como mucosite oral, disgeusia e trismo; b) avaliar o impacto da saúde bucal na qualidade de vida (QV); c) avaliar o conforto e estabilidade do dispositivo pela percepção do paciente; d) comparar os resultados de trismo, disgeusia e impacto da saúde bucal na qualidade de vida no momento pré e pós-radioterapia. O stent foi fabricado em resina acrílica, sendo utilizado para planejamento e durante todas as sessões de radioterapia. A mucosite oral foi avaliada através das escalas da Organização Mundial de Saúde (OMS) e Oral Mucositis Assessment Scale (OMAS); a disgeusia foi avaliada através de pergunta dicotômica (sim/não); o trismo foi avaliado por exame físico com auxílio de paquímetro universal; o impacto da saúde bucal na QV foi calculado através do questionário Oral Health Impact Profile (OHIP-14); foi elaborado questionário para avaliação do uso do dispositivo pela percepção do paciente. De um total de 26 pacientes recrutados, a amostra final foi composta por 20 participantes, 12 homens (60%) e 08 mulheres (40%) com idade variando entre 26 e 88 anos. O carcinoma espinocelular foi o tipo histológico mais prevalente (75%), sendo a língua o sítio mais acometido (50%). Metade da amostra foi diagnosticada com tumores de até 2 cm de extensão, sem comprometimento linfonodal em 45% dos casos ou metástase à distância (90%). O protocolo de tratamento mais realizado foi de cirurgia seguida de radioterapia. A maioria da amostra eram não fumantes (60%) e sem ingestão regular de bebida alcoólica (70%). Ao final da radioterapia, os participantes apresentavam mucosite oral Grau 2 (65%) pela OMS, com média de 2,64 ± 0,87 (OMAS). Pacientes submetidos às três modalidades de tratamento (cirurgia, seguida de quimioterapia e radioterapia) apresentaram maior score de OMAS que os que foram submetidos à radioterapia combinada apenas com quimioterapia (p=0,01) ou com cirurgia (p=0,04). Houve diminuição significativa de 6.6 mm (±7.58) de abertura de boca em comparação à inicial (p<0,01) e disgeusia em 80% da amostra, sem diferença estatística (p>0,05). Houve piora no impacto da saúde bucal na QL nos valores globais (p=0,002) e no domínio 4 (p=0,014). Para a maioria dos participantes, o dispositivo não era incômodo (60%), seu uso não provocava dor (80%), sendo estável na boca durante as sessões de radioterapia (90%). Todos (100%) os pacientes avaliaram seu uso como importante para o tratamento. Apesar da variedade de efeitos colaterais apresentados, a maioria foi bem tolerado pelo paciente durante o tratamento. O uso do stent, assim como o tratamento integral e multidisciplinar do paciente, pode ter contribuído para estes resultados.
 
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Publishing Date
2022-04-27
 
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