Print this page Email this page Users Online: 190
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2013  |  Volume : 7  |  Issue : 2  |  Page : 85-86

Diode laser in submucous fibrosis: A case series with successful outcome


Super Specialty Clinic, Pune, Maharashtra, India

Date of Web Publication3-Jan-2014

Correspondence Address:
Dattaprasad P Dadhe
Super Specialty Clinic, 1315, Sadashiv Peth, Pune - 411 030 Maharashtra
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0976-2868.124271

Rights and Permissions
  Abstract 

Oral submucous fibrosis is a premalignant condition which affects the submucosal layer of oral mucous membrane. Trismus is the most severe presentation of this disease which jeopardizes the nutrition status of the individual. To achieve the adequate mouth opening, the complete release of fibrotic tissue is essential. However, incising the fibrotic tissue with a conventional blade or electrocautery can cause bleeding, delayed healing, and recurrence of fibrosis. In this study, we have used diode laser for the fibrotomy with satisfactory results and disease-free follow-up of 1 year.

Keywords: Diode laser, oral submucous fibrosis, trismus


How to cite this article:
Garde JB, Dadhe DP, Rajkumar S, Deshmukh V. Diode laser in submucous fibrosis: A case series with successful outcome. J Dent Lasers 2013;7:85-6

How to cite this URL:
Garde JB, Dadhe DP, Rajkumar S, Deshmukh V. Diode laser in submucous fibrosis: A case series with successful outcome. J Dent Lasers [serial online] 2013 [cited 2017 Sep 19];7:85-6. Available from: http://www.jdentlasers.org/text.asp?2013/7/2/85/124271


  Introduction Top


Oral submucous fibrosis is a premalignant condition which affects the submucosal layer of oral mucous membrane. The common etiology is the habit of betelnut chewing, which is common in Indian subcontinent. Clinically it presents trismus, dysphagia, xerostomia, and burning mouth. [1] Furthermore, in 1.9-10% cases, it can lead to oral malignancy. [2]

To achieve adequate mouth opening, the complete release of fibrotic tissue is essential. However, incising the fibrotic tissue with a conventional blade or electrocautery can cause further fibrosis, therefore, we have used diode laser to incise the buccal mucosa. [3]


  Materials and Methods Top


Nine patients with oral submucous fibrosis presenting with mouth opening less than 6 mm were treated with fibrotomy bands with diode laser under general anesthesia [Figure 1] Fibrotic bands in the region of the bilateral buccal mucosae and the pterygomandibular raphe were palpated and a linear transbuccal incision made with laser. Brisement forces applied using Heister's mouth gag bilaterally which resulted in rupture of the fibers and satisfactory mouth opening of 40 mm [Figure 2]. The third molars were removed; any plunging cusp ground with bur. The mucosal defect was allowed to heal by secondary intention.

Postoperatively, the patients were given rigorous physiotherapy in the form of jaw-stretching exercises as well as nutritious diet. Patients were followed-up for 1 year to assess recurrence of the submucous fibrosis and response to treatment and relapses noted.
Figure 1: Preoperative mouth opening

Click here to view
Figure 2: Intraoperative image showing application of brisement forces after fibrotomy

Click here to view



  Results Top


Over the 2 years period, a total of nine patients with oral submucous fibrosis were treated at our college. All the patients were male with the mean age of 36 years. The preoperative mouth opening was less than 6 mm in all the patients. Postoperatively, the patients were followed-up monthly for 1 year and assessed for recurrence of oral submucous fibrosis and any malignant ulcer. Complete epithelialization of the mucosal defects occurred in approximately 4 weeks in all cases. There was slight reduction in the mouth opening after 7 days probably because of the spasm of the muscles which responded well to the mild skeletal muscle relaxants.

No major complications were encountered in this study. No case in this study suffered from the recurrence as well as any malignant change during the period of the study.


  Discussion Top


Oral submucous fibrosis is a chronic condition which is progressive and can affect the lifestyle of the patient to the great extent. It is also a premalignant condition affects people of southeast Asian origin. The condition was prevalent in the days of Sushruta (2500-3000 BC) where he labeled it as "Vidari". Later the condition was first described by Schwartz in 1952 while examining five Indian women from Kenya, to which he evolved the term 'atrophica idiopathica mucosae oris'. The disease has been extensively studied by Pindburg and others. [4]

The disease is characterized by the fibrosis of the connective tissue in the region of buccal mucosa, pterygomandibular raphe, and rima oris which causes trismus.

Traditional instruments for fibrotomy like blade and electrocautery can cause intense tissue damage resulting in to the recurrence of fibrosis.

Diode laser has favorable features like good hemostatic properties and flexibility of the probe which makes it useful in the limited access; especially in trismus. [5] The incision through the fibers is precise with minimal damage to the adjacent tissue. Therefore, the healing is rapid even without any graft or biological dressing. The operating time is less and the entire procedure is carried out intraorally without leaving any extraoral scar. Due to the minimal morbidity associated with this procedure, better patient compliance is experienced by us. Also the procedure can be repeated if required.


  Conclusion Top


The fibrotomy with diode laser is an effective method with several advantage over the traditional methods and can safely be done in the patients with advanced stage of oral submucous fibrosis.

 
  References Top

1.Joshi SG. Submucous fibrosis of the palate and pillars. Indian J Otolaryng 1953;4:110.  Back to cited text no. 1
    
2.Pindburg JJ. Oral submucous fibrosis: A review. Ann Acad Med Singapore 1989;18:603-7.  Back to cited text no. 2
    
3.Shah A, Sunanda R, Rasaniya V, Patel S, Vakade M. Surgical management of oral submucous fibrosis with the "Opus-S" diode laser. J Oral Laser Appl 2005;5:37-43.  Back to cited text no. 3
    
4.Pindburg JJ, Sirsat SM. Oral submucous fibrosis. Oral Surg Oral Med Oral Pathol 1966;22:764-79.  Back to cited text no. 4
    
5.Chhaya VA, Sinha V, Rathor R, Modi N, Rashmi GS, Parmar V, et al. Oral submucus fibrosis surgical treatment with CO 2 laser. World Articles Ear Nose Throat 2010;3.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Materials and Me...
Results
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed2529    
    Printed48    
    Emailed0    
    PDF Downloaded272    
    Comments [Add]    

Recommend this journal