237 Summary 8 Summary The patient population presenting with head and neck cancer (HNC) is changing. On the one hand, the prevalence of tobacco use is decreasing, with a synchronous decrease in the incidence of laryngeal cancer in particular. At the same time, the incidence of oropharyngeal cancer is increasing, mainly due to the human papilloma virus (HPV). The young age at diagnosis combined with better prognosis for HPVpositive HNC and the associated longer life expectancy, has increased awareness of late treatment-related toxicity. Advances in surgical and radiation techniques are also contributing to the shift in focus from survival to survival with the best quality of life (QoL) possible. Fear of the cancer recurrence is now closely followed by the side effects of cancer treatment, such as dry mouth, limitations in chewing and swallowing, speech and social integration, decreased QoL and follow-up surgery. Therefore, optimizing the masticatory system and thus improving the QoL of each patient is becoming increasingly important. Optimizing the masticatory system should take into account patient related factors such as age, patient preferences, dental awareness and, of course, cancer treatment-related factors itself. The overall aim of this thesis was to evaluate masticatory function after prosthetic rehabilitation of edentulous patients with HNC and to assess the accuracy and potential consequences of tooth extractions prior to radiotherapy (RT). The first section of this thesis addressed the prosthetic rehabilitation of edentulous patients with an acquired defect and/or side effects after RT (Chapters 2-4). The second section examined 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 investigated the functional treatment outcomes and patient satisfaction of mandibular prostheses with and without implant retention using patient-reported outcomes (PROs) in 51 irradiated patients with HNC. Nineteen patients were treated with removable conventional dentures and 32 patients with implant-retained mandibular prostheses between January 2006 and January 2011. A total of 45 (88.3%) of these 51 mandibular prostheses, were in function at the time of assessment. Overall satisfaction with the prostheses was 7.3. Patients treated with additional approaches, such as surgical tumor removal, scored lower than patients who received RT alone. In addition, edentulous patients appeared to benefit from implants, particularly in terms of denture retention. Men benefited more from IODs than women.
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