SURGICAL REPAIR VERSUS INTRALESIONAL INJECTIONS OF HYALURONIDASE AND HYDROCORTISONE FOR THE MANAGEMENT OF ORAL SUUBMUCOUS FIBROSIS- A COMPARITIVE PROSPECTIVE STUDY

Abstract

Background: Oral submucous fibrosis (OSMF) is a most prevalent potentially malignant disorder associated with betel quid chewing frequently observed in the Indian population. The incidence has been found to about 13% of the general population, varying from 0 to 4% depending on the geographic location.
Objective: Aim of this clinical trial was to compare the efficacy of two treatment modalities on different stage OSMF to improve mouth opening and to evaluate other sign and symptoms. To compare the efficacy of Z- plasty surgery versus intralesional hyluronidase with Dexamethasone for improving mouth opening in the Oral sub mucous fibrosis.
Material and Method: This prospective comparative study consisted of 80 patients suffering from oral sub mucous fibrosis of Grade I, II and III based on the clinical grading by Gupta et al. Group A were treated with nutritional and iron supplement with intralesional injection therapy using Hyaluronidase, Dexamethasone, and Placentrex and topical application of Triamcinolone Acetonide 0.1%. Group B patients were treated by Z- plasty surgery and nasolabial flap repair. Mouth opening, burning sensation, painful ulceration, blanching of oral mucosa and pallor was evaluated preoperatively, after 1 month and after 3 month follow up.
Result: local and systemic therapy employing nutritional and iron supplement with intralesional injection therapy using Hyaluronidase, Dexamethasone, and Placentrex and topical application of Triamcinolone Acetonide 0.1% caused a marked improvement in the patient. Surgical treatment also gave promising results in Grade III patients where first regimen was not sufficient. Mouth opening was found to be highly significant. Burning sensation, painful ulceration, blanching of oral mucosa and pallor was observed in very less candidates and with significant reduction in severity and discomfort.
Conclusion: Conservative as well as surgical repair can definitely help to reduce the OSMF intensity in all grades. We are happy to conclude that habit break counselling in school age children and college going individuals can reduce the prevalence to OSMF.
Keywords: Burning sensation, Hyalouronidase, Intralesional injections, Oral sub mucous Fibrosis (OSMF), Premalignant condition.