Oral Mucositis due to Radiotherapy

Author: V. Dimov, M.D.
Reviewer: S. Randhawa, M.D.

A 80-year-old CF with widespread multiple myeloma is admitted to the hospital with CC: jaw pain and not being able to eat.

PMH

Myeloma, HTN.

Physical examination

Painful left side of the jaw, limited mobility.

What do you think is going on?

Lytic lesion of jaw bone due to myeloma.
Pathologic bone fracture of mandibula or maxilla.

What would you do?

X-ray of mandibula and maxilla.
CT scan of the brain and facial bones.

What happened?

CT scan of the brain and facial bones showed a 2 x 2.8 x 2 cm expansile lucent area in the left body of the mandible consistent with multiple myeloma. Probable medial angulation displacement of a left-sided molar associated with the focal lytic lesion in the mandible.

What happened next?

Hem/Onc and radiation therapy consults were called and radiotherapy of mandible was recommended.

After 4 radiation treatments, patient started to complain of dry mouth and local pain. Physical examination showed mucositis. She is scheduled for a 10 treatments-course.

What is the treatment for mucositis due to radiation or chemotherapy?

Local treatment with Miracle Mouthwash" (see below).

Final diagnosis

Oral mucositis due to radiotherapy.

What did we learn from this case?

Radiation treatment interferes with the regeneration of oral epithelium resulting in mucositis. This process is painful and interferes with food intake. Chemotherapy can have a similar effect on the mucosa.

Mucositis develops in 60-70 % of patients receiving radiotherapy for head or neck malignancy.

Mucositis is treated symptomatically with oral hygiene and topical anesthetics which can be combined in a "cocktail," commonly called "Miracle Mouthwash" (lidocaine, diphenhydramine, and Maalox).

References

Complications of radiotherapy for head and neck cancer - UpToDate (subscription required)

Published: 06/12/2005