Tongue stabilisation during CT simulation in radiotherapy using a customised dental biomaterial appliance: a case report

Khalida Kamarudin; Muhammad Syahir Mohd Suhaimi; Nur Sabrina Zainol Abidin; Wan Adwaa Afiq Wan Zainalam

doi:10.2340/biid.v13.45900

Authors

Khalida Kamarudin Oral and Maxillofacial Surgery Unit, School of Dental Sciences, Hospital Pakar Universiti Sains Malaysia (HPUSM), Kubang Kerian, Kota Bharu, Kelantan, Malaysia
Muhammad Syahir Mohd Suhaimi Oral and Maxillofacial Surgery Unit, School of Dental Sciences, Hospital Pakar Universiti Sains Malaysia (HPUSM), Kubang Kerian, Kota Bharu, Kelantan, Malaysia https://orcid.org/0009-0001-2503-1888
Nur Sabrina Zainol Abidin Oral and Maxillofacial Surgery Unit, School of Dental Sciences, Hospital Pakar Universiti Sains Malaysia (HPUSM), Kubang Kerian, Kota Bharu, Kelantan, Malaysia
Wan Adwaa Afiq Wan Zainalam Oral and Maxillofacial Surgery Unit, School of Dental Sciences, Hospital Pakar Universiti Sains Malaysia (HPUSM), Kubang Kerian, Kota Bharu, Kelantan, Malaysia

DOI:

https://doi.org/10.2340/biid.v13.45900

Keywords:

Tongue stabilisation, squamous cell carcinoma of the tongue, clear acrylic resin, computed tomography stimulation, radiotherapy

Abstract

Introduction: Precise tongue stabilisation is essential during radiotherapy (RT) planning to ensure accurate target delineation in patients with squamous cell carcinoma of the tongue. Conventional tongue- depressing techniques can be difficult to apply in completely edentulous patients due to the absence of dentition and limited tongue control. This report aims to present a simple prosthodontic solution for effective tongue stabilisation during RT planning in an edentulous patient.

Patients: A 72-year-old completely edentulous woman diagnosed with stage III (T3N0M0) well-differentiated squamous cell carcinoma of the left side of the tongue was scheduled for definitive RT. Conventional tongue stabilisation methods failed during computed tomography (CT) simulation. A custom-designed clear acrylic resin intraoral appliance was fabricated to maintain a constant 1.5 cm distance between the tongue and the palate and to achieve reproducible tongue depression. Repeated CT simulations were performed to assess the consistency of tongue positioning.

Results: The custom intraoral appliance provided stable and repeatable tongue positioning, allowing improved visualisation of the target volume and facilitating accurate RT planning. Consistent tongue depression was confirmed across repeated CT simulations.

Conclusion: The proposed low-cost, custom-made prosthodontic appliance is an effective method for tongue stabilisation in edentulous patients undergoing head and neck RT. Its use can enhance treatment planning accuracy and may be beneficial in similar clinical situations.

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References

Pfister DG, Spencer S, Adelstein D, Adkins D, Anzai Y, Brizel DM, et al. Head and neck cancers, Version 2.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw [Internet]. 2020;18(7):873–98. Available from: https://jnccn.org/view/journals/jnccn/18/7/article-p873.xml (Accessed: 21 January 2026)

Machiels JP, René Leemans C, Golusinski W, Grau C, Licitra L, Gregoire V. Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx: EHNS–ESMO–ESTRO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2020;31(11): 1462–75.

https://doi.org/10.1016/j.annonc.2020.07.011 DOI: https://doi.org/10.1016/j.annonc.2020.07.011

AJCC cancer staging manual [Internet]. Springer International Publishing; 2017. Available from: https://link.springer.com/deleted (Accessed: 13 January 2026)

Wu Q, Yoo S, Das S, Yin F. Evaluation of IMRT and VMAT for head-and-neck cancer with flattening filter-free (FFF) beams. Int J Radiat Oncol. 2012;84(3):S863.

https://doi.org/10.1016/j.ijrobp.2012.07.2308 DOI: https://doi.org/10.1016/j.ijrobp.2012.07.2308

Stieb S, McDonald B, Gronberg M, Engeseth GM, He R, Fuller CD. Imaging for target delineation and treatment planning in radiation oncology: current and emerging techniques. Hematol Oncol Clin North Am. 2019;33(6):963–75.

https://doi.org/10.1016/j.hoc.2019.08.008 DOI: https://doi.org/10.1016/j.hoc.2019.08.008

Zhang YZ, Zhu XG, Song MX, Yao KN, Li S, Geng JH, et al. Improving the accuracy and consistency of clinical target volume delineation for rectal cancer by an education program. World J Gastrointest Oncol. 2022;14(5):1027–36.

https://doi.org/10.4251/wjgo.v14.i5.1027 DOI: https://doi.org/10.4251/wjgo.v14.i5.1027

Tino R, Roach MA, Fuentes GD, Agrawal A, Zaid M, Cooper DJ, et al. Development and clinical implementation of a digital workflow utilizing 3D-printed oral stents for patients with head and neck cancer receiving radiotherapy. Oral Oncol. 2024;157:106944.

https://doi.org/10.1016/j.oraloncology.2024.106944 DOI: https://doi.org/10.1016/j.oraloncology.2024.106944