Design of 3D-printed universal oral stent for tongue immobilization in head and neck radiotherapy

Abstract

The primary treatment for head and neck cancer is radiotherapy, which can cause complications and effects, such as the ability to speak, taste, produce saliva, and swallow. An oral stent is an immobilization tool for minimizing the dose in the tongue (or hard palate) by locking the tongue position during radiation delivery. It can improve the treatment accuracy due to less uncertainty caused by tongue position uncertainty between treatment fractions. However, commercial oral stents are not widely adopted in developing countries due to their unaffordable price. This study aimed to design the universal oral stent (UOS) to achieve high efficiency, ease to use, and low-cost fabrication based on 3D printing technology. There were five experiments to evaluate the UOS design and fabrication versus the modified cut syringe, including finite element analysis (FEA), the usability test, the micro Vickers hardness test, single beam dose analysis, and dose calculation on treatment plan simulations. The proposed UOS design and fabrication presented a high capability to apply for clinical use.

Wearing individualized 3D printed oral stent to protect normal tissues in patients with nasopharyngeal carcinoma during radiotherapy

“…In recent years, many literatures have studied the mechanism, prevention and nursing intervention of oral toxicity in patients with head and neck tumors during radiotherapy 12–17 . Wearing oral stent during radiotherapy is an important measure to reduce oral tissues radiation dose to reduce oral toxicity 18–25 . When wearing an oral stent, the patient's mouth opens to separate the upper and lower jaw, and the tongue and part of the oral mucosa can be fixed as far away from the high dose area as possible, so as to reduce the oral dose and the occurrence of adverse reactions such as oral mucositis and taste dysfunction.…”

“…[12][13][14][15][16][17] Wearing oral stent during radiotherapy is an important measure to reduce oral tissues radiation dose to reduce oral toxicity. [18][19][20][21][22][23][24][25] When wearing an oral stent, the patient's mouth opens to separate the upper and lower jaw, and the tongue and part of the oral mucosa can be fixed as far away from the high dose area as possible, so as to reduce the oral dose and the occurrence of adverse reactions such as oral mucositis and taste dysfunction. However, the literature reports are mainly on malignant tumors in the oral cavity (OC), nasal cavity and paranasal sinuses, there are few reports on the wearing of oral devices in patients with NPC during radiotherapy.…”

Novel tongue-positioning device to reduce tongue motions during radiation therapy for head and neck cancer: Geometric and dosimetric evaluation

“…In 2022, it was reported that the use of positioning stent to reduce the irradiation dose to the palate resulted in a reduction of radiation-induced oral mucositis on the palate [10]. Several three-dimensional (3D) printed customized tongue devices were suggested to take the patient-specific structures into account, and dosimetric efficacies were also reported [6][7][8][9][12][13][14][15][16]. In 2022, the interfractional head-up and-down motions in the thermoplastic mask with and without 3D printed tongue-positioning devices were investigated using magnetic resonance imaging [14].…”