23 Aims and outline of this thesis 1 Aims and outline of this thesis With the changing head and neck cancer (HNC) population, advances in surgical techniques and innovative radiation systems, the focus is shifting from survival to survival with the best possible quality of life (QoL). As a result, attention to the side effects of cancer treatment is increasing. Fear of cancer recurrence is now closely followed by concerns about dry mouth, chewing, swallowing, speach, and dental health. Therefore, it is becoming increasingly important to optimize each patient’s masticatory system to improve QoL. Patient-related factors such as age, patient preferences, dental awareness and factors related to cancer treatment should be considered. The overall aim of this thesis is to evaluate the masticatory function after prosthetic rehabilitation of edentulous HNC patients and to assess the accuracy and possible consequences of tooth extractions prior to radiotherapy (RT). The first section of this thesis focuses on the prosthetic rehabilitation of edentulous patients with an acquired defect and/or side effects after RT (Chapters 2-4). The second section examines the initial steps in the search for optimal preservation of the existing masticatory system of the patient with HNC (Chapters 5-6). In Chapter 2 we examined the overall percentage of functioning mandibular prostheses with and without implant retention in irradiated patients with HNC. In addition, we determined patient satisfaction with dental rehabilitation in terms of QoL. The available general QoL questionnaires, such as the EORTC QLQ-C30 en QLQH&N35, lack the discriminating ability to measure the effect of prosthodontic treatment on chewing, swallowing, speech, aesthetics, retention, and pain. In 2004 the Liverpool Oral Rehabilitation Questionnaire (LORQ) was developed to provide a more sophisticated measure of the impact of prosthetic treatment on QoL in patients with HNC. In order to be able to use the LORQv3 for Dutchspeaking patients we translated the questionnaire into Dutch and evaluated the internal consistency, reliability, and validity of the resulting LORQv3-NL in Chapter 3. Mastication with an obturator prosthesis is challenging, especially when retention is limited, as in edentulous patients. In Chapter 4, we evaluated the potential benefits of implant placement on masticatory performance and
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