The SOMA (Subjective, Objective, Management, Analytic) – LENT (Late Effects of Normal Tissue) scoring system can be used to evaluate mandibular complications following radiation and chemotherapy.
Subjective measures:
(1) pain
(2) mastication
(3) denture use
(4) trismus
Objective measures:
(1) exposed bone
(2) trismus
Management measures:
(1) management of pain
(2) management of exposed bone
(3) management of trismus and mastication
Analytic studies:
(1) mandibular radiographs
(2) panograph X-rays: assessment of necrosis progression
(3) CT: assessment of necrosis progression
If no toxicity is present, then the 0 points are assigned.
If a toxicity is present, then the grade indicates the number of points to assign.
|
SOM |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
pain |
occasional and minimal |
intermittent and tolerable |
persistent and intense |
refractory and excruciating |
|
mastication |
NA |
difficulty with solids |
difficulty with soft foods |
NA |
|
denture use |
NA |
loose dentures |
unable to use dentures |
NA |
|
trismus |
noted but not measurable |
prevents normal eating |
any eating difficult |
inadequate oral intake |
|
exposed bone |
NA |
<= 2 cm |
> 2 cm or limited sequestration |
fracture |
|
trismus |
NA |
opening 1-2 cm |
opening 0.5 to 1.0 cm |
opening < 0.5 cm |
|
management of pain |
occasional non-narcotics |
regular non-narcotics |
regular narcotic |
surgery |
|
management of exposed bone |
NA |
antibiotics |
debridement, hyperbaric oxygen |
resection |
|
management of trismus and mastication |
NA |
soft diet |
liquid diet, medications |
NG tube, gastrostomy tube |
total score =
= SUM(points for all 9 items)
LENT score =
= (total score) / 9
|
Analytic |
Grade 1 |
Grade 2 |
Grade 3 |
Grade 4 |
|
mandibular radiographs |
questionable changes |
osteoporosis or osteosclerosis |
sequestra |
fracture |
where:
• Osteoporosis appears radiolucent; osteosclerosis as radiodense.
Interpretation:
• maximum total score: 34
• minimum LENT score: 0
• maximum LENT score: 3.78
Specialty: Hematology Oncology, Otolaryngology
