Ramadass T, Manokaran G, Pushpala Shekar Meher, Narayanan Nithya, Kulkarni Girish N
Department of ENT, Apollo Hospitals, Greams Lane off, Greams Road, 600006 Chennai, ; Department of and Head and Neck Surgery, Apollo Hospitals, Greams Lane off, Greams Road, 600006 Chennai.
Indian J Otolaryngol Head Neck Surg. 2005 Apr;57(2):99-102. doi: 10.1007/BF02907659.
The oral submucous fibrosis (OSMF) has been managed earlier by various medical and surgical modalities but none of these methods is found to give relief to these patients. Hence, a new method has been developed by us. Patients, who reported with pallor of the palate cheek, oropharyn and the tonsils, due to the fibrosis, leading on to mild, moderate to severe trismus, were given a good long-term rehef by this surgical method. This study involved 60 patients between 1979 and 2000 with a female-to-male ratio of 1∶3 with age ranging from 13 to 60 years suffering from the disease. The surgical method adopted in these cases used a single staged rotation tongue pedicle flap on either side from the dorsum of the tongue sutured to the raw area in the cheek without morbidity. In a 7-year follow up, we found the patients did not develop further fibrosis and the tongue flaps remained intact. The quality of life improved considerably and buccal mucosa is pink throughout the follow-up period. The modalities of treatment adopted are varied. Many tried the retro molar excision of the bands, which did not give long-term results. Others used excision of the whole fibrotic area with skin grafting, which also failed. Some have tried muscle pedicle flap from outside with postoperative morbidity and failure. Some surgeons have tried fat grafts in the cheek region (Yeh, Int J Oral Maxillo facial Surg 1996; 25; 130). The experience of the others who used versatile, vascular tongue flaps in the oral cavity after cancer clearance, prompted us to attempt this new technique in the present series with gratifying results. This is a break through in the surgical management of OSMF, where other treatment modalities failed.
口腔黏膜下纤维化（OSMF）早期曾采用多种医学和外科治疗方法，但发现这些方法均无法缓解患者的症状。因此，我们开发了一种新方法。因纤维化导致腭部、颊部、口咽部及扁桃体苍白，并进而发展为轻度、中度至重度牙关紧闭的患者，通过这种手术方法获得了良好的长期缓解效果。本研究纳入了1979年至2000年间的60例患者，男女比例为1∶3，年龄在13岁至60岁之间，均患有该疾病。这些病例所采用的手术方法是在舌背两侧采用单阶段旋转舌蒂瓣，将其缝合至颊部的创面上，且无并发症发生。在7年的随访中，我们发现患者未出现进一步的纤维化，舌瓣保持完好。生活质量有了显著改善，在整个随访期间颊黏膜均呈粉红色。所采用的治疗方式多种多样。许多人尝试过磨牙后带切除术，但未取得长期效果。其他人采用切除整个纤维化区域并植皮的方法，也失败了。一些人尝试从外部采用带肌蒂瓣，但术后出现并发症且手术失败。一些外科医生在颊部区域尝试过脂肪移植（Yeh，《国际口腔颌面外科杂志》1996年；25卷；第130页）。其他医生在口腔癌切除术后使用多功能血管化舌瓣的经验，促使我们在本系列研究中尝试这种新技术，并取得了令人满意的结果。这是OSMF外科治疗的一项突破，此前其他治疗方式均告失败。
