MAXILLOFACIAL PROSTHETICS IN THE MANAGEMENT OF ORAL CANCER PATIENTS

Radiotherapy cures, and it injures. For the patient with cancer of the head and neck, the same beam that controls the tumour passes through salivary glands, mucosa, bone and skin that have done nothing wrong. This book is about the narrow, practical territory in which a prosthodontist can change that arithmetic: the intraoral devices that position tissue, shield it, carry a source to it, or measure the dose it receives. The account is built from the ground up. The opening chapters set out how ionizing radiation interacts with living matter, how dose is defined and measured, and how a course of treatment is planned and delivered — external beam and brachytherapy alike, through to IMRT, VMAT, IGRT and proton therapy. A full chapter is then given to what goes wrong: skin toxicity, oral mucositis, xerostomia, dental disease, trismus and osteoradionecrosis, each with its pathogenesis, clinical picture and management. Against that background the prosthodontic contribution is set out in detail. The materials chapter weighs heat-cure acrylic resin, lead, Cerrobend and Lipowitz alloy, aluminium and the thermoplastics EVA and PETG against the requirements of a device that must be inert, sterilisable, dimensionally stable and either transparent to the beam or reliably opaque to it. The chapters that follow classify and illustrate the devices themselves: radiation carriers, pre-loaded and after-loaded, with their computed tomography and rapid-prototyping successors; positioning stents; and protective and shielding stents, from tongue-depressing and displacing devices to custom mouth protectors and bolus compensators. Twenty-four figures, a table of milestones from 1972 to 2023, two appendices of formulae and reference tables, and eighty-one references support the text. The book is written for postgraduate students and practitioners of prosthodontics and maxillofacial prosthetics, for radiation oncologists and medical physicists working with head and neck patients, and for the dental team that meets these patients before, during and after treatment.