Reabilitação do doente oncológico da cabeça e pescoço

: considerandos clínicos e protocolos da atuação

Abstract

Treatment of tumors of the head and neck involves performing surgery with high morbidity, concomitant with the resource, or not, the radio and / or chemotherapy. Patients undergoing surgical resections of the maxilla and / or mandible see their masticatory function and aesthetics orofacial often compromised, so it is important to undertake the rehabilitation of defects arising under penalty of treatment induce significant implications for the quality of life of patients. This dissertation aimed to meet and discuss, in light of the "state of the art" protocols applied clinical performance in patients with cancer of the head and neck, the locus of the study's Hospital Centre of Vila Nova de Gaia. To this end, we proceeded to the review of 5 clinical cases of patients with cancer of the head and neck and the discussion and review of the literature and applied analysis of scientific articles published in journals referenced in Index Medicus, using such search engines PUBMED, OVID MEDLINE and EMBASE. For many years, prosthetic accommodated directly on the remaining tissues were used in an attempt to minimize mutilation from the treatment. In the cases analyzed, all patients underwent surgery (maxillectomy and mandibulectomy), of which two of them were subjected to radiotherapy. The effects of radiation can compromise the rehabilitation since the radiation induced vascularization, and reduces hypoxia processes, interfering with the healing process. Indeed, patients undergoing radiotherapy had to undergo further surgery for placement of new graft, having affected their quality of life. In this connection it was found also that in all patients, there was a negative impact of surgery on quality of life. However, his speeches have shown that this effect, although negative, was not as devastating as expected, acknowledging even that this was a second opportunity of life. It was found that the surgery, radiotherapy and chemotherapy are available therapeutic approaches for cancer of the head and neck. Its combination and their order depend on various factors such as clinical stage, anatomic location, size of the tumor histology and patient data such as, for example, age, general condition, among others. As such, a proper preoperative evaluation, associated with a surgical planning and an effective postoperative follow-up is the best guarantee for the success of any intervention. In this context, the rehabilitation of the oro-facial defects resulting from cancer treatment are of utmost importance to minimize morbidity and quality of life implications. It is therefore important that the dentist is an integral part of the hospital staff in order to evaluate the most appropriate protocol to act as regards the rehabilitation of these patients.

Date of Award	5 Aug 2013
Original language	Portuguese
Awarding Institution	Universidade Católica Portuguesa
Supervisor	Rui Alberto Amaral Mendes (Supervisor)