Zuali Lalrin, Mohiyuddin S M Azeem, A Sagayaraj, Mohammadi Kouser, Paul Indranil
Otorhinolaryngology and Head and Neck Surgery, Sri Devaraj Urs Medical College, Kolar, IND.
Cureus. 2023 Jun 7;15(6):e40105. doi: 10.7759/cureus.40105. eCollection 2023 Jun.
Oral submucous fibrosis (OSMF) is a premalignant condition prevalent in our country. Juxtaepithelial inflammation with progressive hyalinization of the lamina propria results in stiffness and fibrosis of the oral mucosa, characterised by trismus, ankyloglossia, and a burning sensation. Various methods of treatment have been tried in these cases, which include placental extract injections and the cutting of fibrous bands. In this study, we aim to compare the outcome of intra-lesional placental extract injection with fibrotomy and placental extract gel application in OSMF.
This prospective interventional study included 58 patients clinically diagnosed with OSMF grades II and III at a rural tertiary care hospital between January 2021 and August 2022. The patients were randomised into two groups: group I received 1 ml of intra-lesional human placental extract injection in the submucosal plane of the buccal mucosa and retro-molar trigone (RMT) once a week for five consecutive weeks, and group II was subjected to a transverse division of fibrotic bands in the submucosal plane under general anaesthesia. The surgical wound was left open, and swabs soaked in human-purified placental extract gel were placed in the wound for two hours twice daily until the surgical wound was epithelialized and healed. The patients in both groups I and II were advised to do jaw opening exercises, and weekly follow-up was done. Findings with regard to maximum mouth opening, colour of mucosa, and burning sensation in the oral cavity based on a Likert scale were documented. At the end of five months, the pre-treatment and post-treatment results documented were compared.
All patients were between 20 and 60 years of age and were addicted to chewing areca nuts with tobacco. Bilateral involvement was present in all patients, with extension into the RMT and soft palate seen in 31%. Improvement in mouth opening was between 4 mm and 6 mm in group II, and relief of burning sensation and mucosal colour was better in group I.
Intra-lesional placental extract injections help in the improvement of the mucosa and relief from the burning sensation. Fibrotomy with placental extract gel application is better at relieving trismus in OSMF. Aggressive mouth-opening exercises may improve mouth opening following the above procedures.
口腔黏膜下纤维化（OSMF）是我国一种常见的癌前病变。上皮下炎症伴固有层进行性玻璃样变导致口腔黏膜僵硬和纤维化，其特征为牙关紧闭、舌系带挛缩和烧灼感。针对这些病例已尝试了多种治疗方法，包括胎盘提取物注射和纤维带切断术。在本研究中，我们旨在比较病灶内注射胎盘提取物与纤维切除术及在OSMF中应用胎盘提取物凝胶的疗效。
这项前瞻性干预研究纳入了2021年1月至2022年8月期间在一家农村三级护理医院临床诊断为II级和III级OSMF的58例患者。患者被随机分为两组：第一组在颊黏膜和磨牙后三角（RMT）的黏膜下层每周注射1毫升人胎盘提取物，连续注射五周；第二组在全身麻醉下对黏膜下层的纤维化带进行横向切开。手术伤口敞开，将浸泡在人纯化胎盘提取物凝胶中的拭子每天两次放入伤口两小时，直至手术伤口上皮化并愈合。建议第一组和第二组患者进行张口练习，并每周进行随访。记录基于李克特量表的最大开口度、黏膜颜色和口腔烧灼感的相关结果。在五个月结束时，比较记录的治疗前和治疗后结果。
所有患者年龄在20至60岁之间，均有咀嚼槟榔和烟草的嗜好。所有患者均为双侧受累，31%的患者病变延伸至RMT和软腭。第二组的开口度改善在4毫米至6毫米之间，第一组的烧灼感缓解和黏膜颜色改善更好。
病灶内注射胎盘提取物有助于改善黏膜并缓解烧灼感。应用胎盘提取物凝胶的纤维切除术在缓解OSMF的牙关紧闭方面效果更好。积极的张口练习可能会在上述手术后改善开口度。
