Dento-maxillofacial Abnormalities Caused by Radiotherapy and Chemotherapy

Cheol-Woo Park, Eui-Hwan Hwang, Sang-Rae Lee

Department of Oral and Maxillofacial Radiology, College of Dentistry, Kyung Hee University

ABSTRACT

A case of dento-maxillofacial abnormality involving a 10-year-old male patient with a history of esthesioneuro­
blastoma is presented. This patient had been treated with 54 Gy 60 Co-gamma-radiation to the nasal cavity for 6
weeks and 6 cycles of combination chemotherapy of Cyclophosphamide, Cisplatin, Adriamycin, VM-26 (Tenipo­
side), and DTIC (Dacarbazine) when he was 16 months of age. Five years after cessation of cancer therapy, he was
disease free and transferred for extensive dental care to Kyung Hee University Dental Hospital. A clinical and
radiologic follow-up over last 4 years showed root stunting, premature closure of the root apices, microdontia,
developmental arrest, small crowns, and partial anodontia. Maxillofacial morphology evaluated by cephalometric
analysis showed deficiency of maxillary development. (Korean J Oral Maxillofac Radiol 2000; 30: 287-292)

KEY WORDS : radiotherapy, chemotherapy, esthesioneuroblastoma

Pediatric cancer in the early year of life is the second largest
cause of mortality surpassed only by accidents. Between 50 to
60% of the children diagnosed with cancer would be cured
from the use of different therapies including surgery, radio­
therapy (RT), and chemotherapy (CT). 1 The combination of
RT and CT is used frequently on pediatric oncological pati­
ents. In this type of treatment the maxillofacial complica-tions
constitute a common problems and may start anomalies in the
dentomaxillofacial development. If the affected children are
treated in the early life, this raises the possibility of complica­
tions.
Chemotherapy interferes with the cell cycle and with intra­
cellular metabolism, and may cause retarded dental develop­
ment, rnicrodontia, taurodontism, and root stunting. Alteration
of ameloblastic reproduction secretory function, membrane
permeability and calcium exchange across the cell membrane
can produce irregular enamel matrix formation and irregul­
arities in the surface of enamel, manifested clinically by ena­
mel radiopacities. Also altered odontoblastic activity can pro­
duce shortend, thinned, and blunted roots.2• 3 Radiation dam­
age occurs simultaneously to the bone, tooth, periodontal liga­
ment, and pulp.2 Radiation effects, unlike chemotherapy se­
quelae, are limited to the irradiated area. Mature ameloblasts
are permanently damaged by 10 Gy of radiation; 30 Gy halts
"J?'ll: 2000\! 8-'/J 4'll *l@I 'lJ: 2000\! 9-'/J 5'll
Correspondence to : Eui-Hwan Hwang
Department of Oral and Maxillofacial Radiology, College of Dentistry,
Kyung Hee University, #1 Hoeki-dong, Dongdaemun-ku, Seoul 130-701, Korea
Tel) 02-958-9403, Fax) 02-965-1256
E-mail) hehan@khu.ac.kr
tooth development at the point of maturation at which the
teeth are irradiated.4 Chemoradiation effects on facial bones
result from osteocyte death, microvascular injury, periosteal
damage, and fibrous replacement of marrow spaces. This
changes lead to altered bone growth and development.
The nature and severity of potential side effects vary with
the child's age at diagnosis, doses and schedules of treatment,
and the anatomic regions treated.2• 3· 5• 6 Knowledge of the
stage of dental development at the time of oncology treatment
and the type of therapy allows the clinician to predict dento­
maxillofacial effects of the chemoradiation.
Representative case illustrates the clinical and radiographic
manifestations of chemoradiation on the dental and craniofa­
cial development.
Case report
An 1-year-old male presented with a soft tissue mass of the
left nasal cavity. The mass involved upper nasal cavity area.
Computed tomography showed the lesion extend from the
nasal cavity to ethmoid sinus. There was partial destruction of
the ethmoid sinus. Biopsy revealed an esthesioneuroblastoma.
Because the tumor extension was not significant, surgical
resection was excluded at this stage. This patient had been
treated with RT and CT. Electron energy had been applied by
means of a 6°Co-gamma-radiation. Radiation therapy were
carried out with a total tumor dose of 5,400 cGy in 30 frac­
tions of 180 cGy. The field of irradiation included the both side
of nasal cavity and ethmoid sinus, and the size of irradiation

-287-