An overview of radiological manifestations of acquired dental developmental disturbances in paediatric head and neck cancer survivors

Abstract

Objectives: In paediatric cancer survivors treated with chemotherapy and radiotherapy therapy, late effects on dental development are quite common. Oral radiologists are not familiar with the radiographic images of these specific dental consequences of chemotherapy and radiotherapy. With the goal of educating colleagues, to raise awareness of the needs of survivors, and to identify directions for future research, we present dental radiographs of survivors treated for head and neck rhabdomyosarcoma with chemotherapy and radiotherapy. Also, based on the survivors reviewed, a radiographic inventory of commonly found late dental developmental effects seen in conjunction with treatment is presented. Methods: Panoramic radiographic findings of five illustrative cases are presented, from a group of 42 survivors of head and neck rhabdomyosarcoma treated at the Academic Medical Center Amsterdam, The Netherlands over the past 25 years. Results: Five cases showing dental developmental disorders are presented. These cases show an association of the location of the radiation field and the developmental stage of the teeth with the severity of the effect on dental development. We also report an inventory of severe and moderate effects of chemotherapy and radiotherapy on the development of molars and anterior teeth. Conclusions: This paper presents five cases and a radiographic inventory to illustrate disturbances of dental development associated with chemotherapy and radiotherapy in children. Medical and dental professionals involved in the treatment of cancer survivors are relatively unaware of the dental consequences of radiation therapy and the age dependency of specific regional effects. These effects can be severe, with great impact on quality of life. Further research in this area could help improve planning of radiation therapy for children, potentially preventing or limiting dental or maxillofacial sequelae.

Head and neck radiotherapy-induced changes in dentomaxillofacial structures detected on panoramic radiographs: A systematic review

“…A total of 13,261 research articles were initially found in the databases after searching for all keywords. After applying the eligibility criteria and removing overlapping studies, 13,228 investigations were excluded, and a total of 33 studies 5 , 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 on the oral and maxillofacial effects of radiotherapy, as assessed by panoramic radiographs, were included. Table 1 summarizes the details of the selected studies.…”

“…The oldest study was published in 1980, 40 while the most recent ones were published in 2020. 9 10 The number of participants evaluated in the sample studied ranged from 8 37 to 176, 31 and the samples included were highly heterogeneous. Patients with head and neck cancer were often included in the investigated samples, 5 17 19 22 24 28 29 30 31 32 33 34 35 36 37 40 as were patients with hematopoietic neoplasms (such as leukemia), 12 18 23 28 33 although those with neck cancer were also studied independently.…”

“…Patients with head and neck cancer were often included in the investigated samples, 5 17 19 22 24 28 29 30 31 32 33 34 35 36 37 40 as were patients with hematopoietic neoplasms (such as leukemia), 12 18 23 28 33 although those with neck cancer were also studied independently. 38 39 Some studies were exclusively dedicated to patients with oral squamous cell carcinomas, 21 25 32 rhabdomyosarcoma survivors, 10 14 22 patients with osteoradionecrosis, 17 36 40 and patients in whom the outcomes of surgical procedures such as mandibulotomy 11 19 34 or the use of mandible reconstruction methods were investigated. 13 15 26 27 …”

“… 17 31 The effects on oral structures such as teeth in children survivors of head and neck rhabdomyosarcoma was the subject of 4 investigations. 10 14 22 33 Surgical outcomes or complications in patients who received radiotherapy were evaluated in 10 studies, 9 11 13 15 19 25 26 27 34 37 while changes in marginal bone levels or survival rates of implants were investigated in 2 studies. 21 24 Lastly, the appearance of the mandible, 20 29 apical periodontitis, 5 and dental abnormalities or dental status alterations due to radiotherapy 18 23 28 30 32 33 were also assessed using panoramic radiographs.…”

European guideline for imaging in paediatric and adolescent rhabdomyosarcoma — joint statement by the European Paediatric Soft Tissue Sarcoma Study Group, the Cooperative Weichteilsarkom Studiengruppe and the Oncology Task Force of the European Society of Paediatric Radiology

“…Site-specific sequelae from chemotherapy and radiotherapy need specific attention in a developing child. For example, in head and neck rhabdomyosarcoma, dental growth deficits and asymmetrical development of facial bones have been described [85][86][87][88][89]. We did not define specific guidance for evaluating sequelae.…”