Oral submucous fibrosis (OSMF) is a chronic, progressive condition characterized by fibrosis (thickening and hardening) of the mucosa (lining) of the mouth, particularly the oral cavity, pharynx, and upper esophagus. It is commonly associated with the habitual chewing of betel quid, which contains areca nut, tobacco, and slaked lime.
Surgery is not typically the first-line treatment for OSMF but may be considered in advanced cases where conservative measures have been ineffective or when there are significant functional impairments or complications. The goals of surgery in OSMF are to release fibrotic bands, improve mouth opening (trismus), and address any associated complications such as dysphagia (difficulty swallowing) or speech difficulties.
Several surgical techniques may be employed in the management of OSMF:
- Fibrotomy: Fibrotomy involves releasing fibrotic bands or strictures in the oral mucosa to improve mouth opening. This may be performed using conventional surgical techniques or laser-assisted procedures.
- Tissue Excision: In cases where there are localized fibrotic lesions or areas of severe fibrosis, surgical excision may be necessary to remove the affected tissue. This can help alleviate symptoms and improve function.
- Z-plasty: Z-plasty is a surgical technique used to release scar tissue and improve mobility in areas of contracture. It involves making Z-shaped incisions to redistribute tension and lengthen the tissue.
- Tissue Grafting: In cases of extensive mucosal fibrosis or scarring, tissue grafting may be performed to replace the damaged tissue with healthy tissue from another part of the body. This can help restore function and improve oral hygiene.
- Adjunctive Procedures: In addition to surgical interventions, adjunctive procedures such as physiotherapy, speech therapy, and dietary modifications may be recommended to optimize outcomes and prevent recurrence.
It’s important to note that while surgery can be beneficial in improving symptoms and function in some cases of OSMF, it may not always be curative, and there is a risk of recurrence, especially if the underlying causative factors, such as betel nut chewing, are not addressed. Therefore, a multidisciplinary approach involving oral and maxillofacial surgeons, otolaryngologists, dentists, and other healthcare professionals is often necessary to provide comprehensive care to patients with OSMF. Additionally, regular follow-up and long-term monitoring are important to assess treatment effectiveness and manage any complications or recurrence.
