Oral submucous fibrosis—New dimensions in surgery

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.