Individualized 3D-Printed Tissue Retraction Devices for Head and Neck Radiotherapy
BackgroundRadiotherapy for head and neck cancer may cause various oral sequelae, such as radiation-induced mucositis. To protect healthy tissue from irradiation, intraoral devices can be used. Current tissue retraction devices (TRDs) have to be either individually manufactured at considerable cost a...
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Frontiers Media S.A.
2021-03-01
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| Series: | Frontiers in Oncology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fonc.2021.628743/full |
| _version_ | 1830199138188263424 |
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| author | Christopher Herpel Franz Sebastian Schwindling Thomas Held Thomas Held Thomas Held Leo Christ Kristin Lang Kristin Lang Kristin Lang Martha Schwindling Julius Moratin Karim Zaoui Tracy Moutsis Peter Plinkert Klaus Herfarth Klaus Herfarth Klaus Herfarth Klaus Herfarth Christian Freudlsperger Peter Rammelsberg Jürgen Debus Jürgen Debus Jürgen Debus Jürgen Debus Jürgen Debus Jürgen Debus Sebastian Adeberg Sebastian Adeberg Sebastian Adeberg Sebastian Adeberg Sebastian Adeberg Sebastian Adeberg |
| author_facet | Christopher Herpel Franz Sebastian Schwindling Thomas Held Thomas Held Thomas Held Leo Christ Kristin Lang Kristin Lang Kristin Lang Martha Schwindling Julius Moratin Karim Zaoui Tracy Moutsis Peter Plinkert Klaus Herfarth Klaus Herfarth Klaus Herfarth Klaus Herfarth Christian Freudlsperger Peter Rammelsberg Jürgen Debus Jürgen Debus Jürgen Debus Jürgen Debus Jürgen Debus Jürgen Debus Sebastian Adeberg Sebastian Adeberg Sebastian Adeberg Sebastian Adeberg Sebastian Adeberg Sebastian Adeberg |
| author_sort | Christopher Herpel |
| collection | DOAJ |
| description | BackgroundRadiotherapy for head and neck cancer may cause various oral sequelae, such as radiation-induced mucositis. To protect healthy tissue from irradiation, intraoral devices can be used. Current tissue retraction devices (TRDs) have to be either individually manufactured at considerable cost and time expenditure or they are limited in their variability. In this context, a 3D-printed, tooth-borne TRD might further facilitate clinical use.MethodsA novel approach for the manufacturing of TRDs is described and its clinical application is analysed retrospectively. The devices were virtually designed for fabrication by 3D-printing technology, enabling—in only a single printing design—caudal or bi-lateral tongue displacement, as well as stabilization of a tongue-out position. For a total of 10 patients undergoing radiotherapy of head and neck tumors, the devices were individually adapted after pre-fabrication. Technical and clinical feasibility was assessed along with patient adherence. Tissue spacing was calculated by volumetric analysis of tongue retraction. In one exemplary case, radiotherapy treatment plans before and after tissue displacement were generated and compared. The reproducibility of maxillomandibular relation at device re-positioning was quantified by repeated intraoral optical scanning in a voluntary participant.Results3D-printing was useful for the simplification of TRD manufacture, resulting in a total patient treatment time of less than 30 min. The devices were tolerated well by all tested patients over the entire radiation treatment period. No technical complications occurred with the devices. The TRDs caused an effective spacing of the healthy adjacent tissue, e.g., the tongue. Position changes of maxillomandibular relation were limited to a mean value of 98.1 µm ± 29.4 µm root mean square deviation between initial reference and follow-up positions.ConclusionsThe presented method allows a resource-efficient fabrication of individualized, tooth-bourne TRDs. A high reproducibility of maxillomandibular relation was found and the first clinical experiences underline the high potential of such devices for radiotherapy in the head and neck area. |
| first_indexed | 2024-12-18T02:06:49Z |
| format | Article |
| id | doaj.art-5b8c57de42154ff5acdec56ae5f415c9 |
| institution | Directory Open Access Journal |
| issn | 2234-943X |
| language | English |
| last_indexed | 2024-12-18T02:06:49Z |
| publishDate | 2021-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Oncology |
| spelling | doaj.art-5b8c57de42154ff5acdec56ae5f415c92022-12-21T21:24:34ZengFrontiers Media S.A.Frontiers in Oncology2234-943X2021-03-011110.3389/fonc.2021.628743628743Individualized 3D-Printed Tissue Retraction Devices for Head and Neck RadiotherapyChristopher Herpel0Franz Sebastian Schwindling1Thomas Held2Thomas Held3Thomas Held4Leo Christ5Kristin Lang6Kristin Lang7Kristin Lang8Martha Schwindling9Julius Moratin10Karim Zaoui11Tracy Moutsis12Peter Plinkert13Klaus Herfarth14Klaus Herfarth15Klaus Herfarth16Klaus Herfarth17Christian Freudlsperger18Peter Rammelsberg19Jürgen Debus20Jürgen Debus21Jürgen Debus22Jürgen Debus23Jürgen Debus24Jürgen Debus25Sebastian Adeberg26Sebastian Adeberg27Sebastian Adeberg28Sebastian Adeberg29Sebastian Adeberg30Sebastian Adeberg31Department of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg, GermanyHeidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, Heidelberg, GermanyNational Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, GermanyDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg, GermanyHeidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, Heidelberg, GermanyNational Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, GermanyDesign Studio M. Schwindling, Berlin, GermanyDepartment of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Otorhinolaryngology, University of Heidelberg, Heidelberg, GermanyDepartment of Otorhinolaryngology, University of Heidelberg, Heidelberg, GermanyDepartment of Otorhinolaryngology, University of Heidelberg, Heidelberg, GermanyDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg, GermanyHeidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, Heidelberg, GermanyNational Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, GermanyHeidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg, GermanyDepartment of Oral and Maxillofacial Surgery, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Prosthetic Dentistry, Heidelberg University Hospital, Heidelberg, GermanyDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg, GermanyHeidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, Heidelberg, GermanyNational Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, GermanyHeidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg, GermanyClinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany0German Cancer Consortium (DKTK), partner site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, GermanyDepartment of Radiation Oncology, Heidelberg University Hospital, Heidelberg, GermanyHeidelberg Institute of Radiation Oncology (HIRO), University Hospital Heidelberg, Heidelberg, GermanyNational Center for Tumor Diseases (NCT), University Hospital Heidelberg, Heidelberg, GermanyHeidelberg Ion-Beam Therapy Center (HIT), University Hospital Heidelberg, Heidelberg, GermanyClinical Cooperation Unit Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany0German Cancer Consortium (DKTK), partner site Heidelberg, German Cancer Research Center (DKFZ), Heidelberg, GermanyBackgroundRadiotherapy for head and neck cancer may cause various oral sequelae, such as radiation-induced mucositis. To protect healthy tissue from irradiation, intraoral devices can be used. Current tissue retraction devices (TRDs) have to be either individually manufactured at considerable cost and time expenditure or they are limited in their variability. In this context, a 3D-printed, tooth-borne TRD might further facilitate clinical use.MethodsA novel approach for the manufacturing of TRDs is described and its clinical application is analysed retrospectively. The devices were virtually designed for fabrication by 3D-printing technology, enabling—in only a single printing design—caudal or bi-lateral tongue displacement, as well as stabilization of a tongue-out position. For a total of 10 patients undergoing radiotherapy of head and neck tumors, the devices were individually adapted after pre-fabrication. Technical and clinical feasibility was assessed along with patient adherence. Tissue spacing was calculated by volumetric analysis of tongue retraction. In one exemplary case, radiotherapy treatment plans before and after tissue displacement were generated and compared. The reproducibility of maxillomandibular relation at device re-positioning was quantified by repeated intraoral optical scanning in a voluntary participant.Results3D-printing was useful for the simplification of TRD manufacture, resulting in a total patient treatment time of less than 30 min. The devices were tolerated well by all tested patients over the entire radiation treatment period. No technical complications occurred with the devices. The TRDs caused an effective spacing of the healthy adjacent tissue, e.g., the tongue. Position changes of maxillomandibular relation were limited to a mean value of 98.1 µm ± 29.4 µm root mean square deviation between initial reference and follow-up positions.ConclusionsThe presented method allows a resource-efficient fabrication of individualized, tooth-bourne TRDs. A high reproducibility of maxillomandibular relation was found and the first clinical experiences underline the high potential of such devices for radiotherapy in the head and neck area.https://www.frontiersin.org/articles/10.3389/fonc.2021.628743/fullHNSCCadvances in management3D printingtissue retractionradiation therapyoral stents |
| spellingShingle | Christopher Herpel Franz Sebastian Schwindling Thomas Held Thomas Held Thomas Held Leo Christ Kristin Lang Kristin Lang Kristin Lang Martha Schwindling Julius Moratin Karim Zaoui Tracy Moutsis Peter Plinkert Klaus Herfarth Klaus Herfarth Klaus Herfarth Klaus Herfarth Christian Freudlsperger Peter Rammelsberg Jürgen Debus Jürgen Debus Jürgen Debus Jürgen Debus Jürgen Debus Jürgen Debus Sebastian Adeberg Sebastian Adeberg Sebastian Adeberg Sebastian Adeberg Sebastian Adeberg Sebastian Adeberg Individualized 3D-Printed Tissue Retraction Devices for Head and Neck Radiotherapy Frontiers in Oncology HNSCC advances in management 3D printing tissue retraction radiation therapy oral stents |
| title | Individualized 3D-Printed Tissue Retraction Devices for Head and Neck Radiotherapy |
| title_full | Individualized 3D-Printed Tissue Retraction Devices for Head and Neck Radiotherapy |
| title_fullStr | Individualized 3D-Printed Tissue Retraction Devices for Head and Neck Radiotherapy |
| title_full_unstemmed | Individualized 3D-Printed Tissue Retraction Devices for Head and Neck Radiotherapy |
| title_short | Individualized 3D-Printed Tissue Retraction Devices for Head and Neck Radiotherapy |
| title_sort | individualized 3d printed tissue retraction devices for head and neck radiotherapy |
| topic | HNSCC advances in management 3D printing tissue retraction radiation therapy oral stents |
| url | https://www.frontiersin.org/articles/10.3389/fonc.2021.628743/full |
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