CLINICAL-EVALUATION OF DIFFERENT TREATMENT METHODS FOR ORAL SUBMUCOUSFIBROSIS - A 10-YEAR EXPERIENCE WITH 150 CASES

Over a 10-year period (1982-1991), a total of 150 patients divided int o two groups with varying degrees of oral submucous fibrosis (OSF) wer e treated by either medical or surgical therapies. Medical treatment i nvolved (a) conservative oral administration of vitamin B-complex, buf lomedial hydrochloride and topical triamcinolone acetonide 0.1%, or (b ) conventional submucosal injections of a combination of dexamethasone and hyaluronidase, or (c) a combination of both (a) and (b). The surg ical group was treated by the excision of fibrotic tissues and coverin g the defect with split-thickness skin, fresh human amnion, or buccal fat pad (BFP) grafts. Treatment was chosen according to the stage of c linical progression to gain maximal interincisal distance (ID). The ca ses were followed up by monthly examinations for at least two years, o r when possible even longer. A combination of (a) and (b) medical trea tment was satisfactory in cases of mild impairment (ID >20 mm) but in the long term it led to symptomatic relief only. Surgical therapy, on the other hand, when accepted by the patients, led to a significant im provement of trismus in cases of severe limitation (ID <20 mm). Follow ing this strategy, an additional ID increase was observed in all patie nts. BFP grafting was particularly successful in diminishing scarring after two years as compared with the other two grafts. Together with a cessation of the betel quid chewing habit before and after therapy, t hese treatment regimens combined with daily mouth opening exercises we re found to be necessary to manage OSF cases in early and advanced sta ges of progression.