A Comfortable Bitelok? for Oral Cavity and Oropharyngeal Cancer

Present situation and problems

When the salivary glands and oropharynx in the head, neck, and shoulder areas are fixed, the radiotherapy mask must be aligned with the patient's face every reset. And the patient's body shape may change due to his/her edema or weight loss, resulting in a gap between the mask and the patient so that the fixing precision decreases. Some patients do not have special bite blocks when fixing their tongues. They only use foam or cork as an auxiliary tool to strut the mouth. The oral positioning solution needs to be more mature.?

Besides, radiative rays will cause damage to normal tissues and organs such as oral mucosa, salivary glands, mandible, etc., while killing cancer cells. The most common complications are oral mucositis, xerostomia, taste changes, etc. It has been reported in the literature [1] that xerostomia is one of the important factors leading to poor quality of life of patients with head and neck tumors after radiotherapy. These adverse reactions will not only aggravate patients' clinical symptoms and affect their sleep and nutrition intake but, more importantly, reduce the tolerance of local normal tissues to radiotherapy and limit the application of clinical radiotherapy, thus affecting the treatment effect of patients with head and neck tumors.

Solution

Solving ideas:

A bite block increases the rigid connection between the mask and the face.

Improvement method:

1. Use a bite block to fix teeth in the proper position, increase the distance between the upper jaw and lower jaw, and keep normal tissues away from the target area;
2. Use a tongue depressor to fix the tongue in a natural posture, and fit the gums, to reduce the irradiated volume of the tongue.

Clinical effect

1. Fix the normal tissues as far away from the target area as possible to reduce the occurrence of adverse reactions such as oral mucositis, dry mouth, dysgeusia, etc.
2. Because of the patient's weight change and the thinning of facial subcutaneous fat, the bite block can reduce the movement and rotation caused by the gap between the mask and the head and face at the later stage of treatment and reduce the setting error.
3. The bite look and teeth can form an excellent rigid structure. If the position is incorrect in the setup process of a patient, oral discomfort will be caused, and the patient will spontaneously ask for body position adjustment.

References

[1]Fischer D, Epstein J. Management of patients who have undergone head and neck cancer therapyl[J]. Dent Clin North Am.2008.52(1):39-61.

[2]Fu K K, Pajak T F, Trotti A, et al.A Radiation Therapy Oncology Group(RTOG) phaseIII randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard?fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003[J]. Int J Radiat Oncol Biol Phys,2000,48(1):7-16.