Mehrotra Divya, Pradhan R, Gupta Shalini
Department of Oral & Maxillofacial Surgery, Chhatrapati Shahuji Maharaj Medical University, Lucknow, India.
Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2009 Mar;107(3):e1-10. doi: 10.1016/j.tripleo.2008.12.012.
Oral submucous fibrosis has been a scourge of southeastern Asia and its residents since time immemorial. Scores of medicinal agents, singly and in combination, have been tried with not very encouraging results. In this study, therefore, we have restricted ourselves to different surgical modalities in the management of this condition and have tried to lay down indications of each surgical procedure.
A total of 100 patients of oral submucous fibrosis were included in this study and randomly allocated to different surgical groups, 25 patients per group. After excision of fibrous bands, group I had buccal fat pad graft, group II had tongue flap, group III had nasolabial fold flap, and group IV had split skin graft for correction of mucosal defect created after incising the fibrous bands.
Mean preoperative mouth opening was 14.82 (SD 4.38) mm and ranged between 4.00 and 25.00 mm. Statistically there was no significant difference among the 4 groups (P = .996). Mean postoperative mouth opening at 1 week was 35.79 (3.53) mm, ranging between 24.00 and 42.00 mm. Mean postoperative mouth opening at 1 month in group I was 36.36 (2.64) mm, in group II 35.36 (29) mm, in group III 35.64 (2.94) mm, and in group IV 35.80 (3.24) mm. Total score for pain, esthetics, and function at 1 month after surgery was highest (11.29) in group I, indicating better results.
The results were very encouraging, and we were able to lay down specific indications for each procedure. However, we believe buccal fat pad rotation is superior to other procedures, because it offers ease of surgery, can be performed under local anesthesia as a day care procedure, shows little postoperative morbidity, and has good patient acceptance, and there appear to be no contraindications to its use.
口腔黏膜下纤维化自古以来一直是东南亚地区及其居民的一大祸害。人们已经单独或联合试用了大量药物，但结果并不十分令人鼓舞。因此，在本研究中，我们将研究局限于该病症治疗中的不同手术方式，并试图明确每种手术方法的适应证。
本研究共纳入100例口腔黏膜下纤维化患者，并随机分配到不同的手术组，每组25例。切除纤维条索后，第一组采用颊脂垫移植，第二组采用舌瓣，第三组采用鼻唇沟瓣，第四组采用中厚皮片移植，以修复切开纤维条索后造成的黏膜缺损。
术前平均开口度为14.82（标准差4.38）mm，范围在4.00至25.00mm之间。四组之间在统计学上无显著差异（P = 0.996）。术后1周平均开口度为35.79（3.53）mm，范围在24.00至42.00mm之间。第一组术后1个月平均开口度为36.36（2.64）mm，第二组为35.36（2.9）mm，第三组为35.64（2.94）mm，第四组为35.80（3.24）mm。术后1个月时，第一组疼痛、美观和功能的总分最高（11.29），表明效果更好。
结果非常令人鼓舞，我们能够明确每种手术方法的具体适应证。然而，我们认为颊脂垫旋转优于其他手术方法，因为它手术操作简便，可在局部麻醉下作为日间手术进行，术后发病率低，患者接受度好，而且使用该方法似乎没有禁忌证。
