Tomoyasu Nakamura

Treatment of oral leukoplakia with a low-dose of beta-carotene and vitamin C supplements: A randomized controlled trial

Management of oral leukoplakia—a potentially malignant disorder—is currently not evidence‐based. Of the few randomized trials that have been reported, most have negative data. Therefore, a multi‐centre, randomized, double‐blind controlled trial (RCT) was undertaken to evaluate the use of low‐dose beta‐carotene combined with vitamin C supplements for the treatment and to prevent malignant transformation of oral leukoplakia. 46 Japanese participants with oral leukoplakia were allocated randomly either to an experimental arm (10 mg day−1 of beta‐carotene and 500 mg day−1 of vitamin C) or placebo arm (50 mg day−1 of vitamin C). Current or ex‐smokers within 3 months of cessation were excluded. The supplements were continued over a period of 1 year. The primary endpoint was clinical remission at 1‐year and the likelihood of malignant transformation during a 5‐year follow‐up period as a secondary endpoint. The overall clinical response rate in the experimental arm was 17.4% (4/23) and 4.3% (1/23) in the placebo arm (p = 0.346). During the median 60‐month follow‐up period, two subjects in the experimental arm and three in the control arm developed oral cancer. Under the intention‐to‐treat principle, relative risk by supplementing with beta‐carotene and vitamin C was 0.77 (95%CI: 0.28–1.89) (p = 0.580) by the Cox proportional hazards model. No unfavorable side‐effects were noted. Beta‐carotene (10 mg day−1) and vitamin C were neither effective for clinical remission, nor for protection against the development of cancer. Data from this RCT does not support the hypothesis that chemoprevention with this treatment is effective for oral leukoplakia.

Persistence of a foreign body in the pterygopalatine fossa for 30 years

We report a patient in whom a foreign body in the pterygopalatine fossa was removed after 30 years. The patient was a 32-year-old woman. When she was 2 years old, the edge of a scissors entered the left cheek and remained accidentally in the pterygopalatine fossa. There were no complications up to the present.We removed the cutting edge of the scissors via an intraoral approach with the patient under general anesthesia. There was no remarkable bleeding or liquorrhea. During the operation, we used X-ray-fluoroscopy to confirm the exact position of the foreign body, and this technique was useful.

A case of reankylosis of the temporomandibular joint caused by psoriatic arthritis that was indicated for condylar replacement with an artificial joint prosthesis

Psoriatic arthritis is seronegative arthritis associated with skin psoriasis. However, involvement of the temporomandibular joint (TMJ) is very rare. Here, we describe and discuss a case of reankylosis of TMJ secondary to psoriatic arthritis that was indicated for an artificial joint prosthesis.A 48-year-old man had TMJ ankylosis secondary to psoriatic arthritis and underwent bilateral TMJ condylectomy in June 1993. After surgery, he could open his mouth 23 mm. He consistently performed jaw exercises, but reankylosis of TMJ developed gradually and the patient could not open his mouth more than 1 mm again. A computed tomographic scan showed complete bony reankylosis of the bilateral TMJs. In October 1996, bilateral condylectomy of TMJ with replacement by an artificial titanium joint prosthesis was performed.Postoperatively, the patient was able to open his mouth 25mm, and he continued performing jaw exercises.