Oral Submucous Fibrosis: A Review on Different Treatment Modalities
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Abstract
Background: Oral Submucous Fibrosis (OSMF) is a chronic, debilitating condition affecting the oral mucosa, leading to significant functional impairment. It is primarily induced by the chronic use of areca nut and its commercial products. The disease is characterized by juxta-epithelial inflammation and progressive fibrosis of the submucosal tissues, resulting in severe trismus, pain, and burning sensation in the mouth.
Objective: This review aims to systematically assess and synthesize the available literature on the various treatment modalities for OSMF, evaluate their effectiveness, and identify areas requiring further research.
Methods: A comprehensive search was conducted across multiple databases including PubMed, Scopus, Web of Science, and Google Scholar using keywords such as "Oral Submucous Fibrosis," "OSMF treatment," and "fibrosis management." Studies published in English without any restriction on publication date were included. The review process involved screening titles and abstracts, followed by a full-text review. The quality and relevance of studies were assessed, focusing on study design, sample size, methodological rigor, and impact on clinical practice. Quantitative data were extracted and synthesized where available.
Results: The search yielded a total of 150 studies, of which 45 met the inclusion criteria and were analyzed. Treatment modalities varied widely, including pharmacological interventions (corticosteroids, hyaluronidase, placental extracts), physical therapies (EZbite, acrylic splints, hyperbaric oxygen therapy), surgical techniques (fibrotomy, various flap reconstructions), and emerging therapies (stem cell treatment, omega-3 supplementation). Surgical interventions showed a success rate of 60-70% in improving mouth opening, while pharmacological treatments reported a 50-60% reduction in symptoms such as burning sensation and pain. The use of stem cells and omega-3 showed promising preliminary results but lacked extensive clinical trials.
Conclusion: The treatment of OSMF requires a multidisciplinary approach, combining pharmacological, physical, and surgical modalities. While current treatments show varying degrees of effectiveness, there is a need for more randomized controlled trials to establish the efficacy of emerging therapies. Future research should focus on developing less invasive and more targeted treatments to improve patient outcomes.
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References
Pindborg JJ, Sirsat SM. Oral submucous fibrosis. Oral Surg Oral Med Oral Pathol. 1966;22:765–779.
Joshi SG. Submucous fibrosis of the palate and pillars. Indian J Otolaryng. 1953;4:1–4.9.
More C, Shah P, Rao N, Pawar R. Oral submucous fibrosis: an overview with evidence-based management. Int J Oral Health Sci Adv. 2015;3(3):40–49.
More CB, Rao NR. Proposed clinical definition for oral submucous fibrosis. J Oral Biol Craniofac Res. 2019;9(4):311–314.
Aziz SR. Oral submucous fibrosis: case report and review of diagnosis and treatment. J Oral Maxillofac Surg. 2008;66:2386–2389.8.
Arakeri G, Brennan PA. Oral submucous fibrosis: an overview of the aetiology, pathogenesis, classification, and principles of management. Br J Oral Maxillofac Surg. 2013;51(7):587–593.
Rao NR, Villa A, More CB, Jayasinghe RD, Kerr AR, Johnson NW. Oral submucous fibrosis: a contemporary narrative review with a proposed inter-professional approach for an early diagnosis and clinical management. J Otolaryngol Head Neck Surg. 2020;49(1):3–11.
Anila koneru et al. A systematic review of various treatment modalities for oral sub-mucous fibrosis; Journal of Advanced Clinical & Research Insights 2014, 2, 64–72.
Patil SR, Maragathavalli G, Ramesh DNSV, Vargheese S, Al-Zoubi IA, Alam MK. Assessment of maximum bite force in oral submucous fibrosis patients: a preliminary study. Pesqui Bras Odontopediatria Clín Integr. 2020; 20:e4871.
Patil S, Halgatti V, Maheshwari S, Santosh BS. Comparative Study of the Efficacy of Herbal Antioxdants Oxitard and Aloe Vera in the Treatment of OSMF. J Clin Exp Dent 2014; 6(3): 265-70.
More CB, Gavli N, Chen Y, Rao NR. A novel clinical protocol for therapeutic intervention in oral submucous fibrosis: an evidence-based approach. J Oral Maxillofac Pathol. 2018;22(3):382–391.
Ye X, Zhang J, Lu R, Zhou G. HBO: a possible supplementary therapy for oral potentially malignant disorders. Med Hypotheses. 2014 Aug;83(2):131–136.
Gupta DS, Gupta MK, Golhar BL. Oral submucous fibrosis-clinical study and management of physiofibrolysis (MWD). Journal of the Indian Dental Association 1980; 52: 375-378.
Chaudhary Z, Verma M, Tandon S. Treatment of oral submucous fibrosis with Er Cr: YSGG laser. Indian J Dent Res 2011;22: 472‐4.
Frame JW. Carbon dioxide laser surgery for benign oral lesions. Br Dent J 1985;158:125‑8.
CA. Squier and MJ. Kremer, “Biology of oral mucosa and esophagus,” JNCI Monographs, vol. 2001, no. 29, pp. 7–15, 2001.
H. Xie, J. Guo, B. Tan, and H. Wu, “Efficacy of Salvia miltiorrhiza injection combined with steroids in the treatment of oral submucous fibrosis: a meta-analysis of randomized controlled trials,” Medicine (Baltimore) 2019 Jul;98(27):e16339
Ambreen A, Bhutia O, Roychoudhury A, Yadav R, Khakhla DH, Vishwakarma K. Is Coronoidectomy Superior to Coronoidotomy for Improving Maximum Incisal Opening in Patients With Oral Submucous Fibrosis? J Oral Maxillofac Surg. 2021 Apr; 79(4): 863.e1-863.e7.
Gupta H, Tandon P, Kumar D, et al. Role of coronoidectomy in increasing mouth opening. Natl J Maxillofac Surg. 2014; 5(1): 23-30.
Chang Y-M, Tsai C-Y, Kildal M, Wei F-C. Importance of coronoidectomy and masticatory muscle myotomy in surgical release of trismus caused by submucous fibrosis. Plast Reconstr Surg. 2004; 113: 1949-1954.
Surej KL, Kurien NM, Sakkir N. Buccal fat pad reconstruction for oral submucous fibrosis. Natl J Maxillofac Surg. 2010; 1(2): 164-167.
K. Saravanan, Vinod Narayanan, "The Use of Buccal Fat Pad in the Treatment of Oral Submucous Fibrosis: A Newer Method. Int J Dent. 2012; 2012: 935135.
Yeh CJ. Application of the buccal fat pad to the surgical treatment of Oral Submucous Fibrosis. Int J Oral Maxillofac Surg. 1996; 25: 130-3.
Pandya H, Patel H, Dewan H, Babaria U, Bhavsar B, Thakkar D. Comparison of nasolabial flap versus buccal fat pad graft for management of submucous fibrosis. J Dent Sci. 2011; 1: 6-7.
Ducic Y, Herford AS. The use of palatal island flaps as an adjunct to microvascular free tissue transfer for reconstruction of complex oromandibular defects. Laryngoscope. 2001 Sep; 111(9): 1666-9.
Herbert DC. Closure of a palatal fistula using mucoperiosteal island flap. Br J Plast Surg 1974; 37: 332-333.
Henderson D. Palatal island flap in closure of oroantral fistula. Br J Oral Surg 1974; 12: 141-143
Khanna JN, Andrade NN. Oral submucous fibrosis: a new concept in surgical management. Report of 100 cases. Int J Oral Maxillofac Surg. 1995; 24: 433-439.
Hifny SA, AlShaikh LK, Alharthi SG, Abushanab RM, Aldahian NA, Alnamlah SS, et al. Surgical treatment of oral submucosal fibrosis. Int J Community Med Public Health 2021; 8: 5583-7.
Golhar S, Mahore MN, Narkhede S. Tongue flap in oral submucous fibrosis. Indian J Otolaryngol. 1989; 41: 104-107.
Bhrany AD, Izzard M, Wood AJ, Futran ND. Coronoidectomy for the treatment of trismus in head and neck cancer patients. Laryngoscope. 2007; 117(11): 1952-6.
Tepan MG, Saigal GS, Tilak SB. Use of tongue flap in submucous palatal fibrosis. J Laryngol Otol. 1986; 100(4): 455-60.
Singh G, Mishra M, Gaur A, Srivastava A, Shukla B, Das G. Collagen Membrane Over Buccal Fat Pad Versus Buccal Fat Pad in Management of Oral Submucous Fibrosis: A Comparative Prospective Study. J Maxillofac Oral Surg. 2018; 17(4): 482-487.
Nataraj S, Guruprasad Y, Shetty JN. A comparative clinical evaluation of buccal fat padvand collagen in surgical management of oral submucous fibrosis. Arch Dent Sci 2011;2: 17-24.
Paramhans D, Mathur RK, Newaskar V, Shukla S, Sudrania MK. Role of collagene membrane for reconstruction of buccal defects following fibrotic band excision and coronoidectomy in oral submucous fibrosis. World Artic Ear Nose Throat 2010; 3: 1-3.
Farooqui MK, Siddiqui R, Soni SK, Khan MA, Siddiqui H. Saudi J Oral Dent. Res. 2017; 2: 155-159.
Yen DJC. Surgical treatment of submucous fibrosis. Oral Surgery, Oral Medicine, and Oral Pathology. 1982; 54(3): 269-272.
Kavarana NM, Bhathena HM. Surgery for severe trismus in submucous fibrosis. British Journal of Plastic Surgery. 1987; 40(4): 407-409.
Mokal NJ, Raje RS, Ranade SV, Prasad JS, Thatte RL. Release of oral submucous fibrosis and reconstruction using superficial temporal fascia flap and split skin graft—a new technique. Br J Plast Surg. 2005 Dec; 58(8): 1055-60.
Borle RM, Borle SR. Management of oral sub mucous fibrosis: a conservative approach. J Oral Maxillofac Surg 1991; 49: 788-91.
Khanna JN, Andrade NN. Oral submucous fibrosis: a new concept in surgical management. Report of 100 cases. Int J Oral Maxillofac Surg. 1995; 24: 433-439.
Shadamarshan R A, Sharma R, Grewal R, Patrikar S. Use of the greater palatine pedicled flap for the surgical management of trismus in oral submucous fibrosis. Br J Oral Maxillofac Surg. 2021 Oct; 59(8): 888-893.
Sankaranarayanan Seshadri, Kailasam S, Elangovan S, V.R., Ravi, Sonali Sarkar; Autologous Bone Marrow Concentrate (Mononuclear Stem Cell) Therapy in the Treatment of Oral Submucous Fibrosis. Journal of Indian Academy of Oral Medicine and Radiology, 2013;25(1):1-
Vasilev AP, Streltsova NN, Sekisova MA (2009). Effect of omega-3 fatty acids on the serum lipid profile and microcirculation in patients with metabolic syndrome and hypertensive disease. Klin Med, 87, 37-41.
Din JN, Archer RM, Scott A, et al (2013). Effect of ω-3 fatty acid supplementation on endothelial function, endogenous fibrinolysis and platelet activation in male cigarette smokers. Heart, 99, 168–74