Rehabilitation of severe dentofacial deformity after early radiotherapy of retinoblastoma: a case report

• Published in: Journal of medical case reports 2023-03, Vol.17 (1), p.103-103, Article 103
• Main Authors: Kim, So-Hyun, Choi, Tae-Hyun, Lee, You-Sun, Kim, Young-Kyun, Jo, Deuk-Won, Kim, Baek-Kyu, Choi, He-Li, Lee, Nam-Ki
• Format: Article
• Language: English
• Subjects: Adult; Anodontia; Bone cancer; Cancer; Cancer therapies; Care and treatment; Case Report; Case reports; Chemotherapy; Child; Dental crowns; Dental implants; Dental occlusion; Dentofacial Deformities; Facial esthetics; Health aspects; Humans; Implant dentures; Interdisciplinary treatment; Male; Malocclusion - etiology; Malocclusion - therapy; Maxilla - surgery; Nasopharyngeal Neoplasms; Open Bite; Oral rehabilitation; Orthodontics; Patients; Plastic surgery; Prostheses; Radiation; Radiation therapy; Radiotherapy; Rehabilitation; Retinal Neoplasms - radiotherapy; Retinoblastoma; Retinoblastoma - radiotherapy; Skin & tissue grafts; Surgery, Plastic; Teeth; Tooth Loss; Transplants & implants; Tumors; Two-jaw surgery; Young Adult
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-023-03761-z

Retinoblastoma is an intraocular cancer of infancy and childhood, which has been treated with radiation therapy and chemotherapy. Radiation on growing patients can cause deterioration in maxillofacial growth and development that leads to severe skeletal discrepancies between the maxilla and mandible, and dental problems such as crossbite, openbite, and hypodontia. We present the case of a 19-year-old Korean man with chewing disability and dentofacial deformities. He had undergone enucleation of the right eye and radiation therapy of the left eye due to retinoblastoma 100 days after birth. Subsequently, he received cancer therapy for the secondary nasopharyngeal cancer at the age of 11 years. He was diagnosed with severe skeletal deformity including sagittal, transverse, and vertical growth deficiency of the maxilla and midface, and with class III malocclusion, severe anterior and posterior crossbite, posterior openbite, multiple missing upper incisors, right premolars, and second molars, and impaction of the lower right second molars. To restore impaired functions and esthetics of the jaw and dentition, the orthodontic treatment combined with two jaw surgery was performed. At the end of surgical orthodontics, dental implants were placed for prosthetic treatment of missing teeth. Additional plastic surgery for zygoma elevation was done with calvarial bone graft followed by fat graft. Facial esthetics and occlusal functions of patient were favorably enhanced with the improvement of skeletal discrepancy and the rehabilitation of maxillary dentition by prosthetic work. At the 2-year follow-up, the skeletal and dental relationships and implant prosthetics were well maintained. In an adult patient with dentofacial deformities caused by early cancer therapy in the head and neck area, interdisciplinary interventions including additional plastic surgery of zygoma depression and prosthetic work of missing teeth as well as surgical-orthodontic treatment could establish favorable facial esthetics and oral rehabilitation.