Ryohei Ito

Professional oral health care reduces oral mucositis pain in patients treated by superselective intra-arterial chemotherapy concurrent with radiotherapy for oral cancer

PurposeOral mucositis (OM) is a painful complication of radiation therapy (RT) for head and neck cancer. OM can compromise nutrition, require opioid analgesics and hospitalization for pain control, and lead to interruption of treatment. Severe oral mucositis appears inevitable in superselective intra-arterial chemotherapy concurrent with radiotherapy (SSIACRT), requiring management of OM for the patient. The objective of this study was to assess the utility of professional oral health care (POHC) for the management of OM in patients undergoing SSIACRT.MethodsThirty-three patients were enrolled in this study. The first 17 patients underwent SSIACRT before we created an oral management team, and thus did not receive POHC. The remaining 16 patients received POHC. Fever duration, duration of oral feeding difficulty, opioid usage, duration of opioid administration, duration of hospitalization, and number of hospital days from the end of irradiation to discharge were compared between these two groups.ResultsMedian total dose of morphine during SSIACRT, median number of hospital days from end of irradiation to discharge, and duration of hospitalization all differed significantly between groups (P < 0.05). Duration of opioid administration, fever duration, and duration of oral feeding difficulty did not differ significantly between groups.ConclusionsThese findings indicate that POHC may reduce opioid use and shorten the hospital stay. Such results might be obtained through infection control by POHC. This report appears to be the first study to evaluate the efficiency of POHC in SSIACRT for oral cancer from the perspective of mucositis pain and opioid use.

Comparative Study of Superselective Intra-Arterial Chemoradiotherapy versus Radical Surgery on Distant Metastasis for Advanced Oral Cancer

Background. Distant metastasis is considerably more frequent in superselective intra-arterial chemoradiotherapy than other radical treatments for advanced oral cancers. However, there is no evidence supporting such claim. The purpose of this study was to report our experience in superselective intra-arterial chemoradiotherapy and conventional surgical management with particular focus on distant metastasis. Methods. One hundred seventy-two patients with oral squamous cell carcinoma in stages III and IV were included in this study. Retrospective analysis for DM rates and background between surgical management and superselective intra-arterial chemoradiotherapy was performed. Results. Distant metastasis developed clinically was detected in 24 out of 141 patients (17.0%) treated surgically and in 6 out of 31 patients (19.4%) treated with superselective intra-arterial chemoradiotherapy. There was no significant difference in the rate of distant metastasis between the 2 groups. Comparison of patients in both groups with and without distant metastasis revealed no differences in age, T classification, N classification, and treatment effect. Neck recurrence was the only significant risk factor for distant metastasis. Conclusion. No significant difference was found in the rate of distant metastasis between patients treated with surgical treatment and superselective intra-arterial chemoradiotherapy, and additional effort is needed to reduce the risk of distant metastasis.

Impalement of an unusual foreign body on the temporomandibular joint causing severe trismus.

A penetrating injury by a foreign body is comparatively common in the oral and maxillofacial region. On the other hand, injury to the temporomandibular joint (TMJ) by a foreign object is very rare. The TMJ is an anatomically narrow space surrounded by hard bony processes. An unusual case of trauma with severe trismus caused by a foreign body that impaled the TMJ is reported. A 55-year-old man presented with a 5 × 1-cm laceration to the right cheek caused by a flying object propelled during the use of a lawn mower. The edge of the foreign body had a metallic wire, which became imbedded in the wound. His jaw opening was severely limited. Computed tomography revealed that the foreign body was 3 mm in diameter and was impaled on the articular capsule. The object was successfully removed, and the wound and interior of the TMJ were irrigated. Rehabilitation of mouth opening was started on postoperative day 3. On day 9, mouth opening had improved to 35 mm, and he was discharged. After 1 year, mouth opening was 45 mm with no sign of any TMJ disorders.