Submucous Fibrosis
Oral Submucous Fibrosis is a precancerous condition that's a result of tobacco chewing.
Best Treatment options for Submucous Fibrosis/Oral Lesions in India
What is a Submucous Fibrosis/Oral Lesions?
Oral Submucous Fibrosis is a precancerous condition that's a result of tobacco chewing. It is a complex disease resulting in marked rigidity of mucosa of the mouth and an eventual inability to open the mouth.
It usually starts from the posterior part of the inside of the mouth cavity & spreads outwards and can involve the whole of the mouth.
Since it is a precancerous condition, it can transform into oral cancer. If it happens, it can cause bigger problems and health issues for the person.
Stages of Submucous fibrosis
Initially, Submucous fibrosis starts with inflammation, followed by fibrosis & blanching of the oral mucosa. In the advanced stage of this disease, restricted mouth opening is seen which is also called TRISMUS due to the formation of fibrous bands.
Repercussions of Submucous fibrosis
This results in problems like bad oral hygiene, defective speech, and difficulty in chewing & swallowing food. It also leads to thickened lips appearance. Fibrosis in the oral mucosa may lead to thickened cheeks which lose their flexibility.
Symptoms of Oral Submucosal fibrosis
- Dryness of the mouth.
- It decreases mouth opening.
- Decreased protrusion of the tongue.
- Repeated ulceration.
- Stiff lips if fibrosis extends anteriorly to the lips.
- Burning sensation of the oral mucosa.
- This can lead to Nasal intonation of the voice.
- Can lead to Restricted movements of the soft palate causing speech defects
Characteristic Features of Oral Submucous Fibrosis
- Dental staining.
- Blanching of oral mucosa.
- Intra-oral redness.
- Decreased mouth opening
- Burning sensation of the oral mucosa.
- Restricted tongue movement
- In advanced cases may lead to oral cancer.
Grades of OSMF
- Grade I - Burning sensation present. No fibrotic bands.
- Grade II - Burning sensation present. Fibrous bands are present. The mouth opening is between 26 to 35mm.
- Grade III - Blanching of the oral mucosa. Involvement of tongue. The mouth opening is between 6 to 25mm.
- Grade IV - Fibrosis of lips. The mouth opening is less than 5mm.
Diagnostic Features used at kayakriti
- Blanching of oral mucosa which may be localized or diffused in the oral cavity.
- Tough & leathery texture of the oral mucosa.
- Palpable fibrous bands.
What are the Cause of submucosal fibrosis?
Tobacco in the form of chewable tobacco or smoking is the leading cause of Oral Submucous Fibrosis.
How can you prevent Submucosal fibrosis?
- Health education regarding the cessation of tobacco usage.
- Oral Cancer Screening by health care providers.
How can you get it treated - Oral Submucosal fibrosis?
Treatment of Oral Submucous Fibrosis solely depends on the stage at which it is being detected.
- At an early stage, it is reversible with the help of medications & cessation of adverse habits. A meticulous routine needs to be followed for the maintenance of oral hygiene & stop the spread of disease.
- In advanced cases, surgical intervention is required. Excision of mucosal bands and coverage with grafting/flaps is the surgical treatment advised in advanced cases.
Mostly in Grade I & II- Medicinal management is advised.
And in the case of Grade III & IV- Surgical Intervention may be used.
What can you expect during Medical Therapy
Anti-inflammatory, oxygen radical scavenging & antifibrotic drugs are majorly used.
During the early inflammatory phase of Submucous Fibrosis, corticosteroids are of potential benefit. It has also been treated with hyaluronidase, chymotrypsin and collagenase, pentoxifylline, iron, and lycopene among others. All of them have a limited role in the treatment of Oral submucosal fibrosis.
What can you expect during Surgical Intervention?
Surgically, excision of fibrous bands is done & interpositional grafts/ flaps are important to retain the increased mouth opening. Various procedures & graft materials have been utilized for the same.
What are the steps during the surgical procedure?
- Excision of fibrotic bands using scalpel or lasers.
- Additional intraoperative procedures like cutting the coronoid process & cuts in masticatory muscle
- Coverage of mucosal defect using flaps, grafts & collagen membranes.
- Post-operative good physiotherapy, dietary supplementation & other medications are advised.
Different surgical procedures
1) Primary Excision
The fibrotic bands formed in the buccal mucosa, tongue & soft palate are excised. This method done alone has been recorded to have given good results in not-so-severe cases.
2) Conservative Adjunctive Surgical Procedures
Detachment of the coronoid process from muscle attachment (coronoid-ostomy) or intentional sectioning of the coronoid process (coronoid-ectomy) is done quite routinely in cases where adequate mouth opening cannot be established with excision of the fibrotic bands alone. It is one of the most common adjunctive surgical procedures for primary excision of the bands.
3) Interpositional Grafts & Flaps
Interpositional grafts & flaps are to be used in areas of surgical excision of bands to maintain the mouth opening to prevent relapse-
- Skin Grafting
- Local Flaps.
- Distant Flaps.
In the case of a local flap, a well-vascularized tissue is harvested from the area of the face or head & neck region and is transposed to the oral cavity by pedicle attachments.
In case of a distant flap, donor sites in the forearm & thigh give away free flaps which are anastomosed in the recipient area with microsurgical techniques.
Benefits of Grafts/Flaps
Its use is supportive & protective regarding post-operative healing.
Prosthesis
Prosthetic devices for the maintenance of post-operative oral openings are also advisable. It guides the healing tissues for post-operative functioning & acts as a graft stabilizing device.
Recovery after Submucous Fibrosis Surgery
Post-Operative care in Submucous fibrosis
- The most important point in post-operative surgical care is the extensive physiotherapy that follows. It is an integral part of maintaining mouth opening achieved postoperatively.
- The complete cessation of tobacco consumption in any form is of prime importance or else the situation may be reversed even after surgery.
- Physiotherapy with wooden ice cream sticks or mouth openers advised by Dr. Amit Agarwal from the fifth post-operative day at least 5 times a day for the next 6 months is recommended.
- Mouth opening is measured at continuous intervals- 1 week, 1 month, 6 months, 1 year & 2 years.
Shaping dreams through
Know your surgeon better
Best plastic surgeon, Dr. Amit Agarwal is an American Board Certified, extensively trained, and best Plastic & Aesthetic surgeon in Lucknow. He is the Chief Plastic Surgeon heading the Department of Plastic, Microvascular, and Craniofacial surgery at Vivekananda Polyclinic and Institute of Medical Sciences, Lucknow, U.P, India. He maintains a busy practice at Avadh and Nishat Hospital and his own center - Kayakriti Plastic Surgery & Dental Center. He was formerly a Consultant in the Department of Plastic Surgery and Burns at the prestigious SGPGI, Lucknow.
MS, DNB (General Surgery) MCh, DNB (Plastic Surgery),
MNAMS, FACS, FICS, FRCS (Edinburgh, UK)
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Three pillars of kayakriti
Privacy
We believe your experience with us should be comfortable and hassle-free to make it one of your best lifetime experiences for yours. We, here at the clinic, take full precautions to maintain your privacy in any manner. We also provide a staff who will receive you from the gate and take you to the chamber directly if you demand.
Trust
Our Surgeon is highly qualified and internationally certified with a team of skilled staff to perform any surgical or non-surgical treatment on your body.
Safety
When you plan to undergo any surgery you should always keep in mind that it's your body and it's a surgery. We, here always keep your safety a priority and will never recommend you to undergo any such procedure which is not safe for you. We also provide you with a detailed description of the complications which may occur after the surgery during the consultation as it's a surgical procedure so there may be some complications depending on the way your body reacts.
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Frequently Asked Questions
If you have flat or small breast and you want to improve your breast and hip contour ratio then you are a good candidate for it. The answer will be best provided after the first consultation with Dr Amit Agarwal.
Acute pain will be there for almost a week which gradually reduces and there will be soreness and swelling which may take up to 3 weeks to subside.
You can join your work and daily routines after a week of the procedure and can start exercising after 3 weeks of it.
Yes, you have to wear it round the clock unless we suggest you to remove it.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
This surgery does not affect the ducts or the areas of the breast involved in milk production. Thus, it does not affect the breast feeding.
Kayakriti Plastic Surgery & Dental Center
D-43, Near Punjab National Bank, Rajajipuram, Lucknow, Uttar Pradesh - 226017, India
Phone No. +919695940009, +919695940006
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