261
CLINICAL CONCEPTS/
INSPYRED
Volume 34, Number 2, 2021
Correspondence to:
Dr Christopher Herpel
Department of Prosthodontics,
Heidelberg University Hospital
Im Neuenheimer Feld 400, 69120
Heidelberg, Germany
Tel.: +49 6221 56 8799
Email: christopher.herpel@
med.uni-heidelberg.de
Submitted June 24, 2020;
accepted October 13, 2020.
©2021 by Quintessence
Publishing Co Inc.
Tissue retraction devices (TRDs) are used for head and neck radiotherapy to displace soft tissues and fxate
the mandible. They can increase the accuracy of irradiation and reduce its side effects, such as oral mucositis.
However, no method has been described for fabrication of TRDs in edentulous patients. In this case report,
an edentulous 67-year-old patient undergoing radiotherapy of the tongue was provided with a TRD. The
tongue was immobilized, ensuring irradiation consistency and the retraction of healthy oral tissues. Using 3D
printing, an effcient workfow for fabrication of TRDs based on the patient’s existing complete prostheses
can be realized. Int J Prosthodont 2021;34:261–266. doi: 10.11607/ijp.7241
Tissue Retraction for Head and Neck
Radiotherapy in Edentulous Patients
Christopher Herpel
Jana Kostunov
Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany.
Thomas Held
Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; Heidelberg
Institute of Radiation Oncology (HIRO), Heidelberg, Germany; National Center for Tumor Diseases
(NCT), Heidelberg, Germany.
Leo Christ
Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; HIRO,
Heidelberg, Germany.
Sebastian Adeberg
Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany; HIRO,
Heidelberg, Germany; NCT, Heidelberg, Germany; Clinical Cooperation Unit Radiation Oncology,
German Cancer Research Center (DKFZ), Heidelberg, Germany; Heidelberg Ion-Beam Therapy Center
(HIT), Heidelberg, Germany; German Cancer Consortium (DKTK), partner site Heidelberg, DKFZ,
Heidelberg, Germany.
Peter Rammelsberg
Franz Sebastian Schwindling
Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, Germany.
I
n order to protect healthy tissues during head and neck radiotherapy, it is essential to
maintain a consistent position of the irradiated area within and between all therapy
sessions.
1
For this purpose, thermoplastic head masks are used in combination with
tissue retraction devices (TRDs).
2
TRDs are intended to both fx the position of the
mandible and to space irradiated tissue from healthy tissue. The fxation allows for
precise radiation delivery to the target tissue, while the spacing protects the surrounding
healthy tissues, thus mitigating oral sequelae.
3,4
TRDs can minimize radiation-induced
xerostomia by sparing salivary glands
5
and can reduce radiation-induced mucositis,
which affects up to 60% of patients with resulting pain, superinfection, and dysphagia.
6
However, TRD retention is diffcult to achieve in edentulous patients, and no method
has yet been described. Traditionally, TRDs require complex fabrication, including dental
impressions, stone models, sculpting of a wax model, and conversion into acrylic resin.
7
CAD/CAM processes could facilitate their fabrication and clinical implementation.
CASE REPORT
An edentulous 67-year-old female patient was referred from the Department of
Radiation Oncology for the provision of a TRD. The device was made in three steps:
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