Oral cavity radiotherapy upper and lower separation type support and preparation method thereof
Technical field
The invention belongs to tumor of head and neck radiation therapy technology field, more particularly, to one kind is in Oral and maxillofacial tumors radiotherapy
Upper and lower separation type dental stent and preparation method thereof used in journey.
Background technology
Comprehensive Treatment based on radiotherapy or radiotherapy is in current medical domain, tumor of head and neck to be treated
Basic principle, more than 70% head-neck malignant tumor is both needed to radiocurable intervention in its therapeutic process.But always
Since, function of parotid caused by radiotherapy is damaged, oral mucosa damage and the sense of taste are damaged etc., the xerostomia leading to therefrom and oral cavity
Modal complication in illness, always head-neck malignant tumor radiotherapy, these complication have a strong impact on the existence matter of patient
Amount, sometimes even results in and has to suspend radiotherapy, thus reducing the Partial controll to tumor.
The incidence rate of radioactivity oral mucosa damage and sense of taste damage and the order of severity are shone with oral mucosa and tongue respectively
The dosage penetrated is closely related with volume.At present, for reducing the tongue and oral mucosa radioactive dose in Patients During Radiotherapy, domestic warp
Often using cork, disposable syringe etc., tongue and part oral mucosa are pushed away target area, but the method is primarily present pressure tongue effect
Fruit is not affirmed, position poor repeatability, the shortcoming being unable to individuation.
Content of the invention
It is an object of the present invention to provide a kind of separation type support up and down of oral cavity radiotherapy, contribute to reducing
Jeopardize the radioactive dose of organ, improve field dose, contribute to applying electronic Real time portal imaging (EPID) and improve radiotherapy position
Accuracy.
Another object of the present invention is to the manufacture method that radiotherapy upper and lower separation type support in above-mentioned oral cavity is provided.
Purpose according to a first aspect of the present invention, the invention provides a kind of radiotherapy of oral cavity, with upper and lower separation type support, is wrapped
Containing rack body, this rack body is a hollow shell, and oral cavity intracavity shape when its external shape and people dehisce is coincide;This
The front portion of frame body is standing part, and the upper surface housing of standing part and lower surface housing are respectively equipped with denture impression groove
With mandibular dentition impression groove;The rear portion of this rack body is a bulging tongue portion, and the upper surface of a bulging tongue portion is support palatal surface,
The lower surface propping up bulging tongue portion is support lingual surface;Support palatal surface is that an oral cavity palatal surface shape when shape is dehisced with people is coincide
Curved surface, support lingual surface is the curved surface that an oral cavity lingual surface shape when shape is dehisced with people is coincide, and its medium-height trestle lingual surface must be tight with tongue
Contiguity is touched, and reserves certain space to tongue simultaneously again, has both avoided pressing tongue tension to cause discomfort, will not elapse tongue backward again and cause tongue
After fall, cause patient to suffocate.
Additionally, dividing and a bulging tongue portion between in fixation portions with gas-permeable channels insertion, the two ends of this gas-permeable channels
The first air-vent being respectively opened in rack body front end shell is saturating with second being opened on the housing of rack body end
Pore.
Specifically:The dental stent of the present invention is made for personalization, and its external shape carries out radiation according to need and controls
Oral cavity intracavity shape customization when the sufferer treated is dehisced.The front portion of this dental stent is standing part, and rear portion is a bulging tongue
Point.Denture impression groove and mandibular dentition impression groove are respectively equipped with the standing part of this dental stent, upper and lower surface particles,
And upper and lower denture impression groove is all deeper, it is to avoid this dental stent wear situation about being moved to sufferer oral area it is ensured that
In radiation therapy process this dental stent and upper mandibular bone good position repeatability.The effect of this bulging tongue portion, a side
Face is to separate upper mandibular bone and supporting role, makes to jeopardize organ and is fixed on beyond high dose area, reduces radioactive dose;On the other hand
Be tongue is fixed on oral cavity bottom it is ensured that in radiation therapy process the position of tongue repeatability.Finally, the consolidating of this dental stent
With gas-permeable channels insertion between fixed part and a bulging tongue portion, before the two ends of this gas-permeable channels are respectively opened in rack body
The first air-vent in end housing and the second air-vent being opened on the housing of rack body end;Oral cavity with gas-permeable channels
Support is conducive to keeping sufferer to wear the airway patency that this dental stent carries out during radiotherapy, and this advantage is for oral and maxillofacial surgery
Tumor radiotherapy patient be particularly important, and the situation because of edema of throat airway narrows in its Patients During Radiotherapy happens occasionally;The present invention
Dental stent in be provided with the gas-permeable channels of before and after's insertion, and clinically use the mouth containing thing such as stopper in radiotherapy to sufferer at present
Compare, can effectively prevent respiratory distress, respiratory movement degree increases and leads to target area displacement error to increase, thus maximum possible
Avoid patient and the generation of contingency such as suffocate.
Preferably, the present invention oral cavity radiotherapy with upper and lower separation type support, the cross section of gas-permeable channels is circle, and
A diameter of 1~1.5cm of the cross section of this gas-permeable channels.For in theory, cross section is the gas-permeable channels of any shape
Play the unobstructed effect of above-mentioned holding patient airway;Preferably, the shape of cross section of gas-permeable channels is set to circle, and this is ventilative
The diameter of the cross section of passage is set to 1~1.5cm, in the case that bottom surface maximum diameter is restricted, circular relatively rectangle, pros
The other shapes floor space such as shape is maximum, thus ensureing the ventilation maximum of cylinder gas-permeable channels.
Preferably, the present invention oral cavity radiotherapy with upper and lower separation type support, mandibular dentition impression groove and rack body end
Vertical dimension between end is 4.5~5cm, both can ensure the pressure tongue effect determining, when dental stent can be avoided long, stimulates again
The pars oralis pharyngises of wearer cause the situation of pharynx back wall reflection to occur.
Further, the present invention oral cavity radiotherapy with, in upper and lower separation type support, being provided with around the first air-vent
More than three index aperture, index aperture is also opened in rack body front end shell, and extends different depth, mark into rack body
Note in the hole places non-co-planar metal marker thing, and this metal marker thing is preferably the stainless steel ball of diameter 3mm.MV level x-ray is with Kang Pu
Based on scattering, bone is low with soft-tissue image resolution, and anatomical structure show owes clear, and storing is developed clearly more than three non-
Coplanar metal label, can improve the launched field image precision registering with reference picture (DRR image) and speed, contribute to applying
EPID carries out the termed image-guided radiotherapy (IGRT) of incidence.Further, since upper jaw bone and skull lean on sutura to link, cranium Maxillary region device
The mobile very little of official is it can be assumed that whole head is 1 rigid structural.So in head the coordinate of any point will with 3 with
On the change of non-co-planar labelling article coordinate and change.Because of the function of can carrying out image registration based on metal marker,
The range of application making the dental stent of the present invention expands further, in addition to being suitable for Oral and maxillofacial tumors radiotherapy, also very suitable
Together in being applied in H/N tumors Patients During Radiotherapy.
In theory, the non-co-planar metal marker thing of 3 or more than 3 all can achieve above-mentioned purpose, but label number mistake
The difficulty of registration how can be increased, the therefore number of index aperture and label is preferably 3.Additionally, the suitable metal of all size
Thing all can realize above-mentioned purpose as metal marker thing, but is wherein easily purchased with stainless steel ball economy, therefore is preferred.Through experimentation
Find that the development of diameter 1mm, 2mm steel ball is unclear, the stainless steel ball artifact with diameter greater than 5mm is heavier, therefore preferably diameter 3mm
Stainless steel ball, can best meet clinical practice demand.
Further, the present invention oral cavity radiotherapy with upper and lower separation type support, the thickness of shell of rack body is 2~
The thickness of shell of 10mm, preferably rack body is 5~10mm.In general, the thickness of shell of dental stent is at least 2mm.
When radiotherapy is carried out away from mucomembranous surface nearer sufferer to tumor, the thickness of shell of dental stent increases to 5 by the present invention~
10mm, and fit tightly with mucosal surface, so that tumor is in outside built-up areas, it is allowed to play tissue equivalent's implant
(Bolus) act on.In clinical radiotherapy irradiation process, patient that some skins or mucosal surface are invaded, need to be with tissue etc.
Effect packing material shifts to an earlier date buildup depth to improve field dose.The dental stent housing of the present invention, only needs when making to select
Even density, CT value and soft tissue is close, material can be fitted tightly, meet the requirement as Bolus with mucosal surface is made, that is,
Tissue equivalent's implant (Bolus) effect can be played.
Purpose according to a second aspect of the present invention, the present invention also provides the above-mentioned oral cavity radiotherapy system of upper and lower separation type support
Make method, comprise the steps of:
Step one, data acquisition:
(1) impression taking cream is put in patient's mouth after softening, and occlusion is moulding, takes out and rinses setting under water, obtains thering is this
The model of the shell shape with upper and lower separation type support for the oral cavity radiotherapy of invention;
(2) above-mentioned prepared model is carried out CT tomoscan;Obtain each faultage image;
Step 2, sets up geometric model:
(1) CT faultage image obtained above is imported Mimics software, set up threedimensional model;
(2) delineate gas-permeable channels and the index aperture of different depth in MEDCAD module again, then pass through Boolean subtraction calculation
3D view is shown, is finally saved as STL form;
Step 3, sets up physical model:
(1) this STL formatted file is inputted 3D printer, print threedimensional model, be finally built into metal in index aperture
Label is simultaneously sealed up for safekeeping, that is, obtain the upper and lower separation type support of the oral cavity radiotherapy of the present invention.
Manufacture method provided by the present invention, integrated use die cream molding, CT scan, MIMICS software, MEDCAD
Design and the technology such as 3D printing, can quickly and accurately produce oral cavity radiotherapy according to the customization of sufferer individuation with dividing up and down
Every type support.
Brief description
Fig. 1 is the left view with upper and lower separation type support for the oral cavity radiotherapy of the present invention;
Fig. 2 is the top view with upper and lower separation type support for the oral cavity radiotherapy of the present invention;
Fig. 3 is the upward view with upper and lower separation type support for the oral cavity radiotherapy of the present invention;
Fig. 4 is the front view with upper and lower separation type support for the oral cavity radiotherapy of the present invention;
Fig. 5 is the rearview with upper and lower separation type support for the oral cavity radiotherapy of the present invention.
Specific embodiment
For making the object, technical solutions and advantages of the present invention clearer, below in conjunction with each reality to the present invention for the accompanying drawing
The mode of applying is explained in detail.However, it will be understood by those skilled in the art that in each embodiment of the present invention,
In order that reader more fully understands that the application proposes many ins and outs.But, even if there is no these ins and outs and base
In following embodiment many variations and modification it is also possible to realize each claim of the application technical side required for protection
Case.
The first embodiment of the present invention is related to a kind of radiotherapy of oral cavity with upper and lower separation type support, comprises rack body 1, should
Rack body 1 is a hollow shell, and oral cavity intracavity shape when its external shape and people dehisce is coincide, and that is, basis wears this oral cavity
Oral cavity intracavity shape personalized customization when the sufferer of support is dehisced forms, and the thickness of shell of rack body 1 is 3mm.
The front portion of this rack body 1 is standing part, and the upper surface housing of standing part and lower surface housing set respectively
There are upper denture impression groove 2 and mandibular dentition impression groove 3, on this, distance of denture impression groove 2 and mandibular dentition impression groove 3 is according to sufferer
Mouth opening personalized customization, in general, distance is 2cm between upper and lower denture impression groove, the width of standing part
Denture concrete condition also according to sufferer is adjusted, and is 3.5cm.Additionally, mandibular dentition impression groove 3 and rack body 1 end it
Between vertical dimension be 4.5cm;In the dental stent of present embodiment, upper denture impression groove 2 and mandibular dentition impression groove 3 impressions are equal
Relatively deep, when sufferer wears this dental stent, on this, denture impression groove 2 and mandibular dentition impression groove 3 can play preferable fixation,
Avoid dental stent to be moved after the wearing, ensure the good position of this dental stent and upper mandibular bone in radiation therapy process
Put repeatability.
The rear portion of this rack body 1 is a bulging tongue portion, and the upper surface of a bulging tongue portion is support palatal surface 4, support
The curved surface that oral cavity palatal surface shape when palatal surface 4 is dehisced with people for a shape matches, the lower surface of a bulging tongue portion is support
Lingual surface 5, the curved surface that oral cavity lingual surface shape when support lingual surface 5 is dehisced with people for a shape matches;This bulging tongue portion
Effect, is on the one hand to separate upper mandibular bone and supporting role, makes to jeopardize organ and is fixed on beyond high dose area, reduces and is shone agent
Amount;On the other hand be tongue is fixed on oral cavity bottom it is ensured that in radiation therapy process the position of tongue repeatability.Above-mentioned support
The shape of palatal surface and support lingual surface is all to carry out intraoral palatal surface and lingual surface shape when radiocurable sufferer is dehisced according to need
Personalized customization, in general, mandibular dentition impression go up backward at 0.5~1cm backward diagonal 1cm about constitute support lingual surface before
Edge, support lingual surface extends back and about grinds one's teeth in sleep to the 3rd.Support lingual surface in present embodiment must be in close contact with tongue, give simultaneously again
Tongue reserves certain space, has both avoided pressing tongue tension to cause discomfort, will not elapse tongue backward again and cause glossoptosis, cause patient to stop up
Breath.
Divide and a bulging tongue portion between in fixation portions with gas-permeable channels 6 insertion, the cross section of this gas-permeable channels can
Think the circle of diameter 1cm, the two ends of this gas-permeable channels 6 are respectively opened in of the circle in rack body 1 front end shell
One air-vent 61 and the second air-vent 62 of the circle being opened on rack body 1 end housing, the oral cavity with gas-permeable channels 6
Support is conducive to holding sufferer to wear this dental stent and carries out airway patency during radiotherapy.
What deserves to be explained is, the number of the gas-permeable channels 6 in present embodiment can also be this gas-permeable channels more than
In addition to can be for circular cross section, the cross section of the other shapes such as alternatively oval, square, equally can reach holding sufferer
The effect of airway unobstructed.
The dental stent of present embodiment is applied to tumor of head and neck radiotherapy, is particularly suitable in Oral and maxillofacial tumors
Use in Patients During Radiotherapy, oral cavity intracavity shape customization when it is dehisced according to sufferer forms, and is carried out with upper and lower dentition impression groove
Fix, be supported with support palatal surface and support lingual surface and press tongue.With the current clinically stopper used in Patients During Radiotherapy
Compare Deng mouth containing thing, its comfortableness and position repeatability all have a very significant increase, and can stablize, effectively in tumor of head and neck
Reduce in radiotherapy and jeopardize the radioactive dose of organ, thus reduce salivary gland function in radiotherapy damage, oral mucosa damage and
The sense of taste is damaged, and improves the life quality of sufferer;And it is additionally arranged, in dental stent, the gas-permeable channels running through rack body front and back end,
Airway patency can be ensured, further reduce sense of discomfort in accepting radiation therapy process for the sufferer, complying with of sufferer can be improved
Property and satisfaction.
Oral cavity radiotherapy involved by second embodiment of the present invention upper and lower separation type support, its structure and the first enforcement
The dental stent of mode is essentially identical, and its further improvement is:The thickness of shell of rack body 1 increases to 10mm.
The dental stent of present embodiment, is particularly suitable for tumor away from the nearer sufferer of mucomembranous surface.Present embodiment
In dental stent housing select be 3D printing polylactic acid (PLA) material, even density, CT value is close with soft tissue, energy
Fit tightly with mucosal surface, meet the requirement as tissue equivalent's implant (Bolus).Thickness of shell increases to the oral cavity of 10mm
Support, makes tumor be in outside built-up areas, plays tissue equivalent's implant (Bolus) effect.Compared with first embodiment, this
Dental stent in embodiment improve field dose, the conformal degree that improve plan and uniformity, reduce total jumping figure and
Jeopardize the radioactive dose of organ.
With upper and lower separation type support, its structure is with first, for oral cavity radiotherapy involved by third embodiment of the present invention
The dental stent of two embodiments is essentially identical, and its further improvement is:Set around described first air-vent 61
There are three index aperture 7, index aperture 7 is also opened in rack body 1 front end shell and extends different depth into rack body 1,
Non-co-planar metal marker thing is placed in this index aperture 7.
The metal marker thing that present embodiment is placed in index aperture 7 can be the rustless steel steel ball of a diameter of 3mm, MV level X
, based on Compton scattering, bone is low with soft-tissue image resolution for line, and anatomical structure shows owes clear, puts development clearly three
Non-co-planar metal marker thing, can improve the launched field image precision registering with reference picture (DRR image) and speed, contribute to applying
EPID carries out the termed image-guided radiotherapy (IGRT) of incidence.Further, since upper jaw bone and skull lean on sutura to link, cranium Maxillary region device
The mobile very little of official is it can be assumed that whole head is 1 rigid structural.So in head, the coordinate of any point will be marked with 3
Remember that the change of article coordinate changes.
Above-mentioned technique effect is confirmed by radiotherapy clinical trial:The image registration being carried out based on non-co-planar metal marker thing
Compared with traditional registration based on anatomical structure image, registration error, within 1mm, improves registering speed, and meeting clinic makes
With requiring.Because of the function of can carrying out image registration based on metal marker so that the application of the dental stent of the present invention
Scope expands further, in addition to being suitable for Oral and maxillofacial tumors radiotherapy, is also admirably suitable for being applied to H/N tumors Patients During Radiotherapy
In.
4th embodiment of the present invention, is related to the upper and lower separation type support of oral cavity radiotherapy in above-mentioned 3rd embodiment
Manufacturing process, include data acquisition successively, set up geometric model, set up these three steps of physical model, specifically:
Step one:Data acquisition
(1) it is placed in 70 DEG C of hot water with red two pieces of die cream and puts in patient's mouth after softening, advise it to be slowly engaged moulding,
Take out after two minutes and rinse setting under cold water, obtain the model with the dental stent shell shape of the present invention.
(2) carry out tomography on the large aperture positioning CT simulated machine tool being placed on GE company to produce on above-mentioned prepared model to sweep
Retouch.The condition of scanning:120kv, thickness 0.625mm, away from 0.625mm, each faultage image is directly stored layer with Dicom3.0 standard.
Step 2:Set up geometric model
(1) the CT image of Dicom form is imported Mimics10.01 software, for making oral cavity model details be carried as far as possible
Take, repeatedly attempt defining threshold value setting up and cover cover mask, with -400~1000Hu carry out region increase appropriate, through going except process of making an uproar
Except redundant data, then set up threedimensional model through calculate3D from mask.
(2) delineate the index aperture of different depth again in MEDCAD module three positions with cylinder paintbrush tool, with
When delineate gas-permeable channels, then shown in 3D view by Boolean subtraction calculation, finally saved as Binary STL form, because
Standard File Format for cooperation between design software and printer is stl file form.
Step 3:Set up physical model
By this STL formatted file input 3D printer (Makerbot Replicator2 generation), to print parameters according to need
It is configured, including base, support, internal filling, wall thickness number of plies etc., then prints threedimensional model, finally in index aperture
It is built into metal marker (stainless steel ball) to seal up for safekeeping, that is, obtain the upper and lower separation type support of the oral cavity radiotherapy of the present invention.
It will be understood by those skilled in the art that the respective embodiments described above are to realize the specific embodiment of the present invention,
And in actual applications, can to it, various changes can be made in the form and details, without departing from the spirit and scope of the present invention.