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Mandibular changes on panoramic imaging after head and neck radiotherapy.
King Chong Chan1, Susanne E Perschbacher2, Ernest W N Lam3
1Clinical Assistant Professor, Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, New York, USA.
Summary
Widened periodontal ligament space (WPLS) is a common radiographic change after head and neck radiotherapy. This finding is a reliable marker of irradiated bone and helps differentiate from other conditions.
Area of Science:
- Dental radiology
- Oncology
- Head and neck cancer treatment
Background:
- Radiographic changes in the jaw after head and neck radiotherapy are not well-defined.
- Intensity-modulated radiotherapy (IMRT) is a common treatment modality.
Purpose of the Study:
- To characterize radiographic changes in the mandible after IMRT.
- To correlate these changes with patient comorbidities and radiation dose.
Main Methods:
- Retrospective analysis of 126 patients treated with IMRT.
- Independent review of medical, dental, and panoramic imaging by three observers.
Main Results:
- 60% of patients showed post-IMRT radiographic changes.
- Widened periodontal ligament space (WPLS) was the most common finding (88% of changes).
- Median time to WPLS was 29 months; female gender and higher radiation dose correlated with faster onset.
Conclusions:
- WPLS is a frequent radiographic outcome following head and neck radiotherapy.
- WPLS serves as a significant indicator of irradiated bone.
- Differentiating WPLS from other pathologies is crucial to prevent overtreatment and potential osteoradionecrosis.
