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Department of Anaesthesia, Royal Free Hospital, London, UK
It is the most common painful complication associated with systemic chemotherapy (5-fluorouracil, methotrexate) or radiotherapy to the head and neck. It is seen typically 5–7 days post chemotherapy and is mostly seen in haematology patients having ablation therapy. Immunoglobulins are decreased in saliva which may increase the risk of mucositis. It is more common in those that receive accelerated fractionated irradiation.
42.1 Pathophysiology
Direct toxicity because of IL-1β, TNFα and IL-6 causing hyperalgesia.
Myelosuppression: causes mucosal denudation and oral ulcers.
Radiotherapy: damages bone leading to soft tissue necrosis and osteonecrosis. Oral fluorouracil adds to mucosal damage.
Risk factors include xerostomia and baseline neutrophil levels <4,000/cumm.
42.1.1 WHO Grading
Grade 0 – no mucositis
Grade 1 – painless ulcer, erythema
Grade 2 – painful erythemaRelated posts:
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