Conservative management of Oral Submucous Fibrosis in early and intermediate stage

To evaluate the efficacy of combined intralesional injection of Hyaloronidase and Triamcinolone with third molar removal in early and intermediate stage (Stage II & III) of Oral Submucous Fibrosis (OSMF) for improvement in mouth opening and hypersensitivity to food.

48 patients in stage II & III OSMF were selected for the study. All the third molars were extracted in each patient followed by 6-8 doses of combined intralesional injection of Hyaloronidase and triamcinolone at 10 days interval targeting the fibrotic bands. Mouth opening and improvement in hypersensitivity to food was noted by numerical grading. The patients were followed for one year at regular intervals. The data was expressed as mean ± SD, and a probability (p) value of <0.05 was considered significant.

The initial mouth opening in Stage II patients (n = 27) was 30 ± 3.0 mm and in Stage III patients (n = 21) was 19 ± 3.5 mm and the increase in mouth opening at the end of treatment was 11.3 ± 1.9 mm and 10.2 ± 2.3 mm respectively. The mean improvement in hypersensitivity to food in both the groups was 2.9 and 2.2 respectively.

There is significant improvement in grade II patients in mouth opening and hypersensitivity to food. Grade III patients show variable improvement or no improvement wherein surgery becomes the only option. Third molar extraction helps in reducing inflammation and fibrosis in the retromolar region thus easing in mouth opening. This combined approach for moderately staged OSMF can be proposed as a viable conservative modality.