Figure 2.

(A) A 55-year-old- male patient, diagnosed with HPV positive T2N2M1 squamous cell carcinoma of left palatine tonsil and treated with concurrent chemoradiation (6996cGy in 33 fractions), reported to our Dental Service for opinion and management of grossly decayed left mandibular posterior teeth. (B) CT slide with 5 different teeth regions contoured in the mandible. (C) Dose volume histogram depicting maximum and mean radiation dose to 10 different teeth region in the maxilla and mandible. (D) Mean and maximum dose to the different teeth regions are mapped on to the patient's panoramic radiograph. Teeth-bearing regions with prescribed dose = above 5000Gy are considered at increased risk for ORN. For example, the ipsilateral mandibular left molar region had prescribed mean and maximum doses of 6030cGy and 7438cGy, respectively. Thus, this region is believed to be at high risk for development of ORN. Our recommended treatment included endodontic therapy of tooth # 17 followed by crown amputation and maintenance of tooth #18 to allow self-exfoliation.