Tata laksana perburukan mukositis oral akibat radiasi pada pasien kanker kepala leher: Laporan kasus

Adrianus Surya Wira Rajasa, Tenny Setiani Dewi

Abstract


Pendahuluan: Mukositis oral merupakan kondisi inflamasi dan ulserasi mukosa oral yang salah satunya akibat terapi radiasi. Dokter gigi berperan dalam melakukan tata laksana mukositis oral akibat radioterapi, meski demikian belum ada cara dan strategi yang paling ampuh dalam menanggulanginya. Laporan kasus ini bertujuan untuk membahas tata laksana komprehensif mukositis oral yang bertambah buruk akibat penambahan dosis radiasi. Laporan kasus: Pasien wanita, 33 tahun dirujuk dari bagian onkologi-radiasi ke departemen Ilmu Penyakit Mulut dengan keluhan sulit membuka mulut dan sakit pada seluruh rongga mulutnya. Diagnosis utama adalah kanker sel basal area zigoma, dan sudah dilakukan terapi penyinaran sebanyak 16 kali. Obat-obat dari bagian onkologi-radiasi berupa sulcralfat sirup, mikostatin, klindamisin, parasetamol, metilprednisolon, vitamin B kompleks, dan asam folat. Pemeriksaan ekstra oral terdapat luka bekas jahitan area zigoma bilateral dari operasi sebelumnya yang menyulitkan dalam membuka mulut. Pemeriksaan intra oral terlihat mukostis tingkat 3 skala WHO dan xerostomia sedang skala Challacombe. Instruksi dari bagian Ilmu Penyakit Mulut dengan berkumur dan kompres bibir menggunakan kassa steril yang dilembabkan dengan larutan NaCl 0,9%. Sebagai agen anti-inflamasi diberikan ice chips dan asam hialuronat 0,025%. Pemberian petroleum jelly dan saliva artifisial diberikan terkait rasa kering pada mulut dan bibir pasien. Penambahan dosis radiasi menghambat proses penyembuhan mukositis oral dan mengganggu kemandirian pasien dalam pembersihan rongga mulut, sehingga alat bantu berkumur berupa modifikasi alat cuci-hidung diterapkan. Simpulan: Proses penyembuhan mukositis oral dapat terganggu akibat penambahan dosis radiasi, oleh karena itu tata laksana komprehensif dan simtomatis yang tepat harus dilakukan untuk mencegah perburukan.



Management of exacerbation on radiation-induced oral mucositis in head and neck cancer patients: A case report


Introduction: Radiation-induced oral mucositis (RIOM) is an inflammatory condition and ulceration of the oral mucosa due to radiation therapy. Dentists have an important role in the management of oral mucositis, however, the most effective ways and strategies are yet to be discovered. This case report aims to discuss the comprehensive management of oral mucositis that worsened due to additional radiation dose. Case report: A 33-year-old female patient was referred from the oncology-radiation department to the Oral Medicine department with complaints of difficulties opening her mouth and pain throughout her oral cavity. The patient's initial diagnosis was basal cell carcinoma of the zygoma and had undergone 16 irradiations. Medications from the oncology-radiation department include sucralfate syrup, mycostatin, clindamycin, paracetamol, methylprednisolone, vitamin B complex, and folic acid. Extra oral examination showed suture scars on bilateral zygoma from prior surgeries and limited mouth opening. Intra-oral examination revealed a grade 3 oral mucositis (WHO) and moderate xerostomia in the Challacombe scale. Instructions for rinsing and compressing the lips using sterile gauze moistened with 0.9% NaCl solution. Ice chips and 0.025% hyaluronic acid were given as anti-inflammatory agents. Petroleum jelly and artificial saliva were administered due to the dryness of the patient's oral cavity and lips. Additional radiation dose inhibits the healing process of oral mucositis and independence in oral hygiene, therefore a gargling aid from a modified nasal-rinse device was implemented. Conclusion: The healing process of oral mucositis may be impaired due to additional radiation dose, hence comprehensive and suitable symptomatic management is required to prevent exacerbation.


Keywords


Terapi; Mukositis oral; Radiasi; Kanker; Dosis

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References


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DOI: https://doi.org/10.24198/jkg.v36i2.52823

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