|Year : 2013 | Volume
| Issue : 2 | Page : 85-86
Diode laser in submucous fibrosis: A case series with successful outcome
Janardan B Garde, Dattaprasad P Dadhe, Suryavanshi Rajkumar, Vikramsinh Deshmukh
Super Specialty Clinic, Pune, Maharashtra, India
|Date of Web Publication||3-Jan-2014|
Dattaprasad P Dadhe
Super Specialty Clinic, 1315, Sadashiv Peth, Pune - 411 030 Maharashtra
Source of Support: None, Conflict of Interest: None
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 May 26];7:85-6. Available from: http://www.jdentlasers.org/text.asp?2013/7/2/85/124271
| Introduction|| |
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.  Furthermore, in 1.9-10% cases, it can lead to oral malignancy. 
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. 
| Materials and Methods|| |
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 2: Intraoperative image showing application of brisement forces after fibrotomy|
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| Results|| |
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|| |
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. 
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.  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|| |
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|| |
|1.||Joshi SG. Submucous fibrosis of the palate and pillars. Indian J Otolaryng 1953;4:110. |
|2.||Pindburg JJ. Oral submucous fibrosis: A review. Ann Acad Med Singapore 1989;18:603-7. |
|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. |
|4.||Pindburg JJ, Sirsat SM. Oral submucous fibrosis. Oral Surg Oral Med Oral Pathol 1966;22:764-79. |
|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. |
[Figure 1], [Figure 2]