Cervico-facial irradiation and orthodontic treatment

Cancers during infancy and childhood affect 1 to 3% of children under the age of 15. Among these cancers the most frequent are malignant hemopathies, and in particular, acute lymphoblastic leukemia, which represents 80% of infant leukemias, with a peak of incidence around the age of 3-4. The overall prognosis for infant malignant hemopathies has improved significantly thanks to progress made in chemotherapy and radiotherapy. However, these anti-cancer treatments, particularly radiotherapy, when performed early, generally before 5 years of age, can have harmful effects that interfere with overall growth and particularly cranio-facial growth, and also with the child's oro-dental development. Some effects such as mandibular retrognathia, macrodontia, microdontia, agenesis and delayed eruption could increase the need for orthodontic treatment, while other complications, particularly the reduced height of the alveolar processes, short thin roots and modification of the superficial and profound periodontium, are likely to make such treatment more difficult. The aim of this review of the literature is to identify the essential factors that must be analyzed before orthodontic treatment is proposed for subjects who have undergone radiotherapy at an early age, and the precautions to be taken before and during orthodontic treatment.