Evaluation of Different Treatment Modalities in Oral Submucous Fibrosis
Abstract
Background: A prospective randomized study was carried out to establish a standard surgical protocol for patients with advanced cases of oral submucous fibrosis (OSMF) and to assess the post-operative mouth opening following various surgical treatment modalities.
Materials and Methods: A total of 15 patients having interincisal distance (IID) less than or equal to 20 mm were treated surgically for OSMF. Patients with pre-operative IID between 16 and 20 mm were treated with bilateral fibrotomy, surgical removal of all the 3rd molars and grafting of the raw defect. Patients with pre-operative IID between 6 and 15 mm were treated with the above procedure along with bilateral intraoral coronoidectomy with temporalis muscle myotomy. However if pre-operative IID was ≤5 mm, than coronoidectomy and temporalis muscle myotomy were done from the extraoral approach along with other procedures.
Results and Observation: The results were then evaluated comparing the pre-operative and the post-operative IID measurements and followed up for 18 months with vigorous mouth opening exercises. The mean pre-operative IID was 13 mm, the mean intraoperative IID was 40 mm, and the mean 6 month IID was 33 mm, and the mean 18 month IID was 35 mm. In two patients where extraoral approach was used, there were pain and swelling in the preauricular area which took long time to resolve.
Conclusion: All the patients showed satisfactory epithelialization, sustained mouth opening and minimum wound contracture but patients cooperation in the form of discontinuation of habit and aggressive post-operative physiotherapy are utmost important to get a satisfactory outcome of all the efforts.
References
Coronoidectomy, masticatory myotomy and buccal fat pad
graft in management of advanced oral submucous fibrosis.
Int J Oral Maxillofac Surg 2012;41:1416-21.
2. Rajendran R. Benign and malignant tumors of the oral
cavity. In: Shafer, Hine and Levy, Shafer’s Textbook of
Oral Pathology. 5th ed. Amsterdam, Netherlands: Elsevier
Publication; 2006.
3. Khanna JN, Andrade NN. Oral submucous fibrosis: A new
concept in surgical management, report of 100 cases. Int J
Oral Maxillofac Surg 1995;24:433-9.
4. Agrawal D, Shrivastava BM, Newaskar V, Waskle R,
Maheshwari B, Rawat A. Management of oral submucous
fibrosis with fibrous release and defect coverage with
buccal pad of fat and collagen sheath. Natl J Med Dent Res
2012;1:14-8.
5. Khalam SA, Zachariah RK. Fibrotomy with bilateral
coroniodectomy without reconstruction in the surgical
management of oral submucous fibrosis. Health Sci
2013;4:1-6.
6. Haider SM, Merchant AT, Fikree FF, Rahbar MH. Clinical
and functional staging of oral submucous fibrosis. Brit J
Oral Maxillofac Surg 2000;38:12-5.
7. Pandya S, Chaudhary AK, Singh M, Mehrotra R. Correlation
of histopathological diagnosis with habits and clinical
findings in oral submucous fibrosis. Head Neck Oncol
2009;1:1-10.
8. Hazarey VK, Erlewad DM, Mundhe KA, Ughade SN. Oral
submucous fibrosis-study of 1000 cases from central India.
J Oral Patho Med 2007;36:2-7.
9. Zhang X, Reichart PA. A review of betel quid chewing,
oral cancer and pre cancer in mainland china. Oral Oncol
2007;43:424-30.
10. Reddy V, Wanjari PV, Banda NR, Reddy P. Oral submucous
fibrosis-correlation of clinical grading to various habit
factors. Int J Dent Clin 2011;3:21-4.
11. Mehrotra D, Kumar S, Agarwal GG, Asthana A, Kumar S.
Odds ratio of risk factors for oral submucous fibrosis in a case
control model. Br J Oral Maxillofac Surg 2013;51:e169-73.
12. Yeh CY. Application of the buccal fat pad to the surgical
treatment of oral submucous fibrosis. Int J Oral Maxillofac
Surg 1996;25:130-3.
13. Algappan M, Parthiban SV, Muthukumar RS. The role
of buccal fat pad in the surgical management of oral
submucous fibrosis. Chetinnad Health City Med J 2012;1:1.
14. Gupta H, Tandon P, Kumar D, Sinha VP, Gupta S, Mehra H,
et al. Role of coronoidectomy in increasing mouth opening.
Nat J Maxillofac Surg 2014;5:23-30.