Mucositis
It is the most common painful complication associated with systemic chemotherapy (5-fluorouracil, methotrexate) or radiotherapy to the head and neck. It is seen typically 5–7 days post chemotherapy and is mostly seen in haematology patients having ablatio
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It is the most common painful complication associated with systemic chemotherapy (5-fluorouracil, methotrexate) or radiotherapy to the head and neck. It is seen typically 5–7 days post chemotherapy and is mostly seen in haematology patients having ablation therapy. Immunoglobulins are decreased in saliva which may increase the risk of mucositis. It is more common in those that receive accelerated fractionated irradiation.
42.1
Pathophysiology
• Direct toxicity because of IL-1β, TNFα and IL-6 causing hyperalgesia. • Myelosuppression: causes mucosal denudation and oral ulcers. • Radiotherapy: damages bone leading to soft tissue necrosis and osteonecrosis. Oral fluorouracil adds to mucosal damage. Risk factors include xerostomia and baseline neutrophil levels 220 cGY/day of radiotherapy. • Oral cryotherapy is used for those receiving 5-fluorouracil or high-dose Melphalan.
42.3.2 Treatment • Good oral care including brushing and antimicrobial mouth wash. • Saline or hydrogen peroxide rinses. • Physical treatment: ice chips before chemotherapy vasoconstrict blood vessels in the oral mucosa and decrease permeability of the chemotherapeutic agent. • Topical analgesics: topical morphine and doxepin. • Topical anaesthetics: lidocaine viscous solution, benzocaine and diphenhydramine. • Coating agents: sucralfate and milk of magnesia. • Topical antimicrobials: chlorhexidine, polymyxin and amphotericin B. • Antibiotics: acyclovir prophylaxis in HSV-positive patients, ganciclovir in CMVpositive patients and clindamycin and ceftazidime for streptococcal infections. • Cognitive interventions: relaxation, biofeedback and TENS have shown varied results.
Further Reading Scully C, Epstein J, Sonis S. Oral mucositis: a challenging complication of radiotherapy, chemotherapy, and radiochemotherapy. Part2: Diagnosis and management of mucositis. Head Neck. 2004;26(1):77–84.
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