Aftereffect of radiotherapy of upper aero-digestive tracts in odontological care

In its first part, this thesis proposes a detailed presentation of the upper aero-digestive tract cancer. The author defines the cancerous process, describes anatomic aspects, and discusses epidemiological aspects (occurrence, mortality, survival, and epidemiological data in different countries). In the second part, the author discusses the role of radiotherapy and of dental surgery in taking a cancerous patient into care (general principles of radiotherapy, therapeutic options and choices, association of radiotherapy, chemotherapy and surgery). Principles of radiotherapy are then more precisely addressed: physical principles (X rays, gamma rays, electrons, neutrons, and protons), radioactivity doses, radiotherapy effect, main equipment, radiotherapy techniques (conformational or intensity-modulated radiotherapy, computed tomography, Cyberknife, external radiotherapy, brachytherapy). The third part addresses early oral-facial complications induced by radiotherapy: factors favouring these complications, nervous effects, effects on the blood system and on the skin, hyposialia and xerostomia, radio-induced mucositis of upper aero-digestive tracts. The next part addresses late effects: late cutaneous after-effects, late radio-mucositis, limitation of mouth opening, tooth decays, osteoradionecrosis. The last part addresses the role of the dental surgeon in taking into care a patient whose head and neck have been irradiated: role before irradiation, during irradiation, and after irradiation