Department of Oral and Maxillofacial and Plastic Surgery, Nair Hospital Dental College, Bombay, India.
Oral submucous fibrosis (OSF) is a collagen disorder commonly seen in the Indian subcontinent. A series of 100 patients is presented. All lesions were biopsied. The condition was staged into four categories. Very early and early cases were treated by local injection of triamicinolone acetonide, while advanced cases were treated by surgical intervention. A new surgical technique of a palatal island flap based on the greater palatine artery in combination with temporalis myotomoy and bilateral coronoidectomy was used in 35 cases. A follow-up ranging from 6 months to 31/2 year showed good results.
Int J Dent. 2012 ;2012 :935135 22666254
Department of Oral and Maxillofacial Surgery, Vinayaka Missions Sankaracharya Dental College and Hospital, Salem 636308, India.
Purpose of the study. This study was to evaluate the use of buccal fat pad as an interpositioning material in surgical management of oral sub mucous fibrosis. Materials and methods. A series of 8 cases with proven oral sub mucous fibrosis, with mouth opening less than 20 mm, involving the buccal mucosa were treated surgically in the Department of Oral and Maxillofacial Surgery, College of Dental Surgery, Saveetha University, Chennai. Pedicled buccal fat pad was used as an interpositioning material to cover the raw areas in the oral cavity after incision and release of fibrous bands. Results. In 8 patients, the range of pre operative mouth opening was 3-18 mm (mean 14 mm). As the result of the successful surgical procedure, the size of the intra operative mouth opening was ranged from 25-38 mm (mean 33.25 mm). The patients were discharged 5-7 days after the operation. The range of the mouth opening at this time was 25-36 mm (mean 30.63 mm). The results were evaluated using student's t test and found to be statistically significant. The pedicled grafts took up uneventfull.
A systematic review of medical interventions for oral submucous fibrosis and future research opportunities.
A R Kerr, S Warnakulasuriya, A J Mighell, T Dietrich, M Nasser, J Rimal, A Jalil, M M Bornstein, T Nagao, F Fortune, V H Hazarey, P A Reichart, S Silverman, N W Johnson
New York University College of Dentistry, NY, USA.
Oral Diseases (2011) 17 (Suppl. 1), 42-57 Oral submucous fibrosis (OSF) is a chronic, insidious disease caused by areca nut use, and is associated with both significant morbidity (including pain and reduced oral opening) and an increased risk for malignancy. This systematic review explored and updated the current medical (i.e., non-surgical) interventions available for the management of OSF. Of the 27 published medical interventions, there were four randomized controlled trials. The overall quality of these randomized controlled studies was assessed using the GRADE approach and significant limitations that challenged the conclusions were found. However, this review was valuable in terms of identifying opportunities to provide recommendations for future research, in terms of the populations to research, the types of interventions needed, the types of outcomes to be measured, the study designs needed, and the infrastructure required to conduct studies. The next step is to initiate a pathway for a low-cost research plan leading to the development of a brief protocol for future clinical trials in this field, with an emphasis on conducting studies in regions of the world where OSF is prevalent.
Evid Based Dent. 2010 ;11 (2):56 20577289
Department of Oral and Maxillofacial Pathology, KLE VK Institute of Dental Sciences and Hospital, Belgaum, Karnataka, India.
Data sourcesSearches were made for relevant data using Medline and the International Poster Journal of Dentistry and Oral Medicine online database (see ipj.quintessenz.de).Study selectionMeta-analyses, randomised controlled trials (RCT), clinical trials and other experimental designs were considered.Data extraction and synthesisBecause of heterogeneity of study designs and drugs used, a qualitative synthesis was conducted.ResultsSeventeen publications were identified of which 15 were included. Of these, six were RCT, four were clinical trials/ controlled clinical trials, and five were other types experimental studies. The studies in total involved 1224 patients. The rate of those lost to followup reached 30% in some studies. The drugs used to treat oral submucous fibrosis (OSF) were categorised into steroids, enzymes, cardiovascular drugs, antioxidants, vitamins and microelements.ConclusionsThere are few high-quality studies available and the present drug treatments are in general empirical and treat only symptoms. There is a need for high-quality RCT in this area, especially studies involving combined and sequential therapy.
Oral Maxillofac Surg. 2010 Feb 24;: 20177949
KLE VK institute of Dental Sciences and Hospital, J.N.M.C. Campus, Nehrunagar, Belgaum, 590010, Karnataka State, India, firstname.lastname@example.org.
Oral submucous fibrosis is a disease due to a chronic, insidious change in fibroelasticity, characterized by burning sensation in the oral cavity, blanching, and stiffening of the oral mucosa and oro-pharynx leading to trismus and inability to open the mouth. The symptoms and signs depend on the progression of the lesions and number of affected sites. It is predominantly seen in Indians and other Asians. Once, the disease has developed, there is neither regression nor any effective treatment. It is considered as a pre-malignant stage of oral cancer and reported risk of malignant transformation varies from 2.3-7.6%.The common etiological factor considered for this unremitting disease is use of areca nut; however, the precise pathogenesis still remains elusive and controversial. A wide range of treatment consisting of drug management, surgical therapy, and physiotherapy have been attempted till date; with varying degrees of benefit, but none of them have proved to be a cure for this disease. This field remains open for clinical trials and research. This paper aims to provide an overview on various management modalities available for oral submucous fibrosis.
Department of Prosthodontics, Government Dental College and Hospital, Nagpur, Maharashtra, India. email@example.com
The efficacy of collagen membrane as a biodegradable wound dressing material for surgical defects of oral mucosa: a prospective study.
Department of Oral and Maxillofacial Surgery, Manipal College of Medical Sciences, Pokhara, Nepal. firstname.lastname@example.org
PURPOSE The aims and objectives of this study were to evaluate the efficacy of collagen membrane as a biodegradable wound dressing material for surgical defects of the oral mucosa. MATERIALS AND METHODS Sixty healthy adult patients were included in the study. Purified bovine reconstituted collagen with a dimension of 10 x 10 cm and 0.6 mm thickness was used. This study was confined to secondary defects of the oral mucosa, which occur after excision of premalignant lesions and other conditions, such as benign lesions, reactive proliferations, and incisional biopsy wounds. Only those lesions that were sufficiently large and could not be closed primarily were included in the study. RESULTS The results were evaluated on the day of surgery and in the postoperative period. The usefulness of collagen membrane as an intraoral temporary wound dressing material to promote hemostasis, relieve pain, induce granulation, and assist in rapid epithelialization at the wound site and prevent infection, contracture, scarring, donor-site morbidity, and rejection of graft was evaluated; and finally, the efficacy of collagen membrane was tested by use of chi(2) test and P less than .001, which is a statistically and clinically significant value. CONCLUSION In this study of short duration and small sample, the nature of collagen membrane was observed and was found to be a very suitable alternative to other graft materials mentioned for the repair of defects in the mucous membrane of the oral cavity. Therefore, when used judiciously in a controlled clinical situation, collagen membrane is biologically acceptable to the oral mucosa and is, from the clinical point of view, an excellent wound graft material.
Reconstruction of the buccal mucosa following release for submucous fibrosis using two radial forearm flaps from a single donor site.
Chung-Kan Tsao, Fu-Chan Wei, Yang-Ming Chang, Ming-Huei Cheng, David Chwei-Chin Chuang, Huang-Kai Kao, Joseph H Dayan
Department of Plastic Surgery, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Hsing Street, Kuei-Shan, Taoyuan 33305, Taiwan, ROC. email@example.com
BACKGROUND Oral submucous fibrosis is a collagen disorder affecting the submucosal layer and can severely limit mouth opening. The use of bilateral forearm flaps to fill buccal defects following trismus release has proven to be effective and reliable. However, it requires the sacrifice of radial arteries from both forearms. We have developed a technique that allows for the harvest of two independent flaps from a single forearm donor site. METHODS Two separate flaps are designed on the same radial artery and concomitant vein pedicle. The distal flap is marked in the standard fashion and the proximal skin paddle is designed in the middle third of the forearm, based on septocutaneous branches of the radial artery. The two flaps are elevated and subsequently divided into two independent free flaps. Between June 2004 and June 2007, a total of 16 flaps were harvested from eight donor sites for buccal mucosa defects following trismus release. Improvements in mouth opening and buccal pliancy were evaluated by comparing preoperative and postoperative inter-incisal distance (IID) and maximal mouth capacity. RESULTS All flaps survived completely, and all donor sites were closed primarily, except for one. The mean flap size was 6.6x2.6cm (range: 6x2.5cm-7x3cm), mean pedicle length was 5.7cm, mean ischaemia time was 46min and mean total operating time was 8h 45min. At an average of 19.8 months follow-up, the inter-incisal distance averaged 29.13mm, an increase of 20.88mm compared with the preoperative measurement. The maximal mouth capacity averaged 55.63cc, an increase of 9.38cc compared with the preoperative measurement. CONCLUSION Two independent small flaps can be harvested safely from one radial forearm donor site. This approach is a useful option for reconstruction of bilateral buccal defects, particularly following submucous fibrosis release. The donor-site morbidity is minimal and limited to one forearm.
Using a cross-cheek anterolateral thigh flap for simultaneous correction of trismus and oral cancer.
Division of Plastic Surgery, Department of Surgery, National Cheng-Kung University Medical College and Hospital, 138 Sheng Li Road, 70428 Tainan, Taiwan. firstname.lastname@example.org
Oral cancers in association with trismus are commonly seen in clinical practice. Such a situation deserves special attention as it may complicate the tumour-ablative surgery and interfere with postoperative cancer surveillance. It follows that the simultaneous tackling of oral cancer and trismus should be pursued at any rate. In this presentation, a novel surgical approach using a cross-cheek anterolateral thigh (ALT) flap is introduced. With the special design in length, shape and orientation, this flap is capable of closing a wider defect area, sometimes extending across two functional regions (viz., posterior palate and trigonal area) without resort to two free flaps. As such, complex defects resulting from trismus release and tumour ablation can be readily repaired in a single stage. The advantages of such a technique include abundance in soft-tissue resources, proper flap quality and thickness, reliable blood supply, long and sizeable pedicle, ease in flap inset, need for only one recipient rather than two and the eradication of large area of mucosa that is predisposed to malignant transformation. The favourable outcome implicates that this innovative design could be a viable option in the management of such a clinical problem.
Department of Oral and Maxillofacial Surgery, New Jersey Dental School, Division of Plastic and Reconstructive Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, New Jersey, USA.
DATA SOURCES Searches were made for relevant studies using the Cochrane Oral Health Group Trials Register, Cochrane Central Register of Controlled Trials, Medline, Embase and IndMED (bibliographic database of Indian biomedical journals). There were no language restrictions. STUDY SELECTION Randomised controlled trials were to be selected if they compared surgery, systemic or topical medicines, or other interventions, to manage the symptoms of oral submucous fibrosis (OSF). DATA EXTRACTION AND SYNTHESIS Two authors independently assessed trial quality and extracted trial data. Disagreements were resolved by consultation with a third author. Attempts were made to contact study authors where necessary for clarification and for additional information. Because of limited poor quality data, only a descriptive summary of the results of the included trials was carried out. RESULTS Two trials, involving 87 participants, evaluated either lycopene in conjunction with intralesional injections of a steroid, and pentoxifylline in combination with mouth-stretching exercises and heat. There were no reports of toxicity to the interventions but some side-effects, which were mostly gastric irritation to pentoxifylline, were noted. CONCLUSIONS The lack of reliable evidence for the effectiveness of any specific interventions for the management of OSF is illustrated by the paucity, and poor methodological quality, of trials retrieved for this review.
Artificial dermis as the substitute for split-thickness skin graft in the treatment of oral submucous fibrosis.
Department of Oral and Maxillofacial Surgery, The University of Tokyo, Tokyo, Japan.
OBJECTIVES The aim of this study was to investigate the viability of artificial dermis as a substitute for split-thickness skin graft in the treatment of oral submucous fibrosis (OSF). METHODS The study was conducted on 21 patients who had undergone surgical treatment of trismus caused by OSF. Artificial dermis grafts were used to repair the surgical defects after surgery on the fibrous bands. The changes in the interincisal distances (IDs) were analyzed in the preoperative, intraoperative, and postoperative stages. All the patients were followed up for at least 3 months. RESULTS All the patients habitually chewed betel nuts. The overall success rate was 100% without any or only partial graft loss. There were no reports of immunologic reactions or significant complications. The mean preoperative, intraoperative, and final follow-up IDs were 15.5, 35, and 25 mm, respectively. Evaluation of the changes in the IDs revealed statistically significant differences between the values recorded at the different stages. CONCLUSIONS Artificial dermis may be an alternative to split-thickness skin grafts in patients with OSF with moderate trismus.
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Nair Hospital Dental College, Bombay, India.
An unusual and extremely rare displacement of teeth due to trauma, resulting in cervical space cellulitis with probable secondary complications is presented.
Department of Maxillofacial, Plastic & Oral Surgery, Nair Hospital Dental College, Bombay, India.
True hemihypertrophy involves not only the soft tissues of the body but the hard tissues as well. It may be classified as being total or partial. Total, if an entire side of the body is involved and partial, if only a portion. This report presents 2 cases of true hemifacial hypertrophy in an adult aged 29 years and a child of 12 years. Three-stage reconstruction is described in the older patient.
Department of Maxillofacial Plastic and Oral Surgery, Nair Hospital and Dental College, Bombay, India.
Ossifying fibroma is a slow-growing, benign neoplasm, but some lesions behave aggressively, reaching massive proportions, thus demanding special treatment. The following case report holds particular interest, because of the simultaneous occurrence of an active ossifying-cementifying fibroma in the maxilla and mandible with the maxillary lesion attaining enormous size.
New protocol to prevent TMJ reankylosis and potentially life threatening complications in triad patients.
Department of Oral and Maxillofacial Surgery, Nair Hospital and Dental College, Mumbai, India.
The management of patients with the triad of temporomandibular joint (TMJ) ankylosis, micrognathia and obstructive sleep apnea syndrome is challenging for the oral and maxillofacial surgeon because it involves achieving the desired oral opening, correction of micrognathia, and correction of the obstructed airway. Seven of the authors' triad patients, in whom only the release of ankylosis was performed, developed bradycardia and respiratory distress during postoperative jaw physiotherapy, leading to their non-compliance for active jaw physiotherapy and subsequent reankylosis. This paper suggests a new surgical protocol for the management of patients with the triad, to achieve correction of the obstructed airway, relief of the respiratory distress symptoms, correction of micrognathia and restricted mouth opening. It also provides a logical reason for the occurrence of bradycardia following ankylosis release and its potential role in TMJ reankylosis. It emphasizes that the occurrence of bradycardia in triad patients during jaw exercises is dictated by the severity of their apnea-hypopnea index and the degree of narrowing of their posterior airway space. The recognition and prevention of this by the new protocol is discussed in 7 patients.
C K Bell, D A Goebert, N N Andrade, R C Johnson, J F McDermott, E S Hishinuma, B S Carlton, J A Waldron, G K Makini, R H Miyamoto
Department of Psychiatry, John A Burns School of Medicine, University of Hawai'i, Honolulu 96813, USA.
OBJECTIVE Few studies have examined the use of alternative therapies among adolescents. This study examines the predictors of Native Hawaiian healer preference in the treatment of physical or emotional problems as well as the predictors of healer use. DESIGN This study is a longitudinal cross-sectional design. SETTING The survey was conducted in five high schools in Hawai'i. PARTICIPANTS 1,322 high school students selected preference for and/or use of allopathic or alternative practitioners. MAIN OUTCOME MEASURES Grade level, gender, ethnicity and cultural identity were used to predict healer preference. Healer preference, socioeconomic status and health status were used to predict healer use. RESULTS Identification with the Hawaiian culture was the strongest predictor of healer preference for both Hawaiian and non-Hawaiian adolescents. Mental health was also predictive of healer preference for non-Hawaiians. Healer use by Native Hawaiian adolescents was also predicted by Hawaiian cultural identity. Gender, grade level, and socioeconomic variables were not predictive of healer preference or use. CONCLUSION Cultural identity plays a significant role in the preference and use of alternative practitioners, especially for minority adolescent populations.
Sociocultural and community factors influencing the use of Native Hawaiian healers and healing practices among adolescents in Hawai'i.
Department of Psychiatry, John A. Burns School of Medicine, University of Hawai'i at Manoa, Honolulu 96873, USA. email@example.com
Recently, there has been much emphasis placed on both alternative approaches to health care and the provision of culturally competent care. Despite these trends, few studies have examined the use of alternative therapies on the part of adolescents. Even fewer studies have been done focusing on traditional Hawaiian approaches to health care. This is essential, especially in Hawai'i, where Hawaiians have not attained health parity with other majority ethnic populations, despite significant efforts and funding to achieve this end. This study examines the sociocultural and community factors influencing the use of traditional Native Hawaiian healers and healing practices by adolescents in Hawai'i. The Hawaiian High Schools Health Survey was administered at five high schools on three islands in Hawai'i during the 1993-1994 school year. The sample included 1,321 high school students who preferred either an allopathic or alternative practitioner. Ethnicity, gender, community access, healer preference, health status, level of education, and health insurance status were used to predict healer use and participation in healing practices. Community access and healer preference predicted both healer use and participation in native healing practices. Mental health predicted healer use (i.e., seeing a Native Hawaiian healer in the past six months), but did not predict taking part in native healing practices, such as ho'oponopono and lomilomi. Hawaiian ethnicity, female gender, and a measure of health insurance predicted participation in native healing practices, but not healer use. These results suggest that native healing practices and traditional healers are being used in Native Hawaiian communities and this is perhaps not due to a lack of health insurance. Given the general separation between Western and Native Hawaiian health services, traditional healing practices should be made available in Native Hawaiian communities to see whether a collaboration between Western practitioners and traditional healers can have a greater positive impact on the health of Native Hawaiians, particularly for adolescents.
Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu 96813, USA. firstname.lastname@example.org
PURPOSE This study examines the validity of selected items from the Substance Abuse Subtle Screening Inventory-Adolescent (SASSI-A) version in predicting Diagnostic Interview Schedule for Children (DISC version 2.3) Substance abuse and dependency (SA/D) for Native Hawaiian (i.e., indigenous people of the Hawaiian Islands) and non-Hawaiian adolescents (youth without any Native Hawaiian indigenous ancestry). METHODS 542 students were randomly selected from the larger sample to participate in the DISC administration. Demographic information, SASSI-A scores, and DISC diagnoses were obtained for each student. Univariate and multiple logistic regressions were performed in the prediction of DISC SA/D. RESULTS SASSI-A Factor 1, consisting of three items measuring substance use, was found to have the best utility, accounting for 18.1% of the variance, in predicting DISC SA/D. IMPLICATIONS These results support selected SASSI-A items in screening for SA/D for Native Hawaiian and non-Hawaiian adolescents in Hawaii as compared to other community-based screening instruments for other populations.
Prediction of anxiety disorders using the state-trait anxiety inventory for multiethnic adolescents.
E S Hishinuma, R H Miyamoto, S T Nishimura, D A Goebert, N Y Yuen, G K Makini Jr, N N Andrade, R C Johnson, B S Carlton
Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii-Manoa, Honolulu 96813, USA. email@example.com
The purpose of this study was to determine the validity of the State-Trait Anxiety Inventory (STAI) in predicting DSM-III-R anxiety disorders based on the Diagnostic Interview Schedule for Children (DISC, Version 2.3) and using Asian/Pacific Islander adolescents. An overall prevalence rate of 9.19% for generalized anxiety disorder, overanxious disorder, or social phobia was consistent with past studies. As hypothesized, STAI negatively worded (i.e., Factor 2) items were better predictors than positively stated (i.e., Factor 1) items. The STAI State mean was a better predictor of concurrent DISC anxiety disorders as compared to STAI State Factors I or 2. In contrast, the STAI Trait Factor 2 (negatively worded) composite was the best predictor for nonconcurrent DISC anxiety disorders as compared to STAI Trait Factor 1 or the overall STAI Trait subscale. Satisfactory predictive-validity values were obtained when using the STAI State mean and Trait Factor 2 composite. Implications of these findings are discussed, including using the STAI as a screening measure for ethnically diverse adolescents.
Equivalencies regarding the measurement and constructs of self-esteem and major life events in an Asian/Pacific islander sample.
R H Miyamoto, E S Hishinuma, S T Nishimura, L B Nahulu, N N Andrade, R C Johnson, G K Makini Jr, N Y Yuen, S P Kim, D A Goebert, B S Carlton, C K Bell
Native Hawaiian Mental Health Research Development Program (NHMHRDP), John A. Burns School of Medicine, Department of Psychiatry, University of Hawaii at Manoa, 1356 Lusitana Street, 4th Floor, Honolulu, Hawaii 96813, USA. firstname.lastname@example.org
Construct, scalar, and functional measurement equivalencies of the Rosenberg Self-Esteem Scale (RSES) and Major Life Events checklist (MLE) and the constructs assessed were investigated across groups differentiated on Hawaiian/part-Hawaiian and non-Hawaiian (e.g., Caucasian, Filipino, Hispanic, Japanese, and mixed/2 or more) ethnicity and gender. Initial results from maximum likelihood factoring with promax rotation showed that RSES negatively worded Item 5 loaded with the positively worded Items 1, 2, 4, 6, and 7 on 1 of 2 factors for Hawaiian/part-Hawaiian female participants. Similarly, negatively worded Item 8 and the same positively worded items comprised 1 of 2 factors for non-Hawaiian male participants. For the other 2 Ethnicity x Gender groups, factors were respectively comprised of the 5 positively and 5 negatively worded RSES items. Construct equivalence or simple (2-factor) structure underlying the RSES was indicated across the 4 groups after Items 5 and 8 were excluded from a subsequent factoring procedure. Simple structure showed that Factor 1 comprised the positively worded Items 1, 2, 4, 6, and 7, and the remaining negatively worded Items 3, 9, and 10 loaded on Factor 2. Scalar equivalence of the self-esteem and major life events measures was supported by the statistical nonsignificance of the Major Life Events x Ethnicity x Gender interaction effect in multiple regression models. The consistency in the absolute size and direction of the intercorrelations between overall self-esteem, self-esteem Factors 1 and 2, and major life events variables indicated the functional equivalence of respective measures and constructs assessed. Measurement equivalency findings concerning the RSES and MLE, the constructs measured, and their utility versus caution against their use in multiethnic studies were discussed.
G K Makini Jr, E S Hishinuma, S P Kim, B S Carlton, R H Miyamoto, L B Nahulu, R C Johnson, N N Andrade, S T Nishimura, I R Else
Native Hawaiian Mental Health Research Development Program (NHMHRDP), Department of Psychiatry, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii.
The present study examined protective and risk factors in the prediction of alcohol use for Hawaiian and non-Hawaiian (i.e. Caucasian, Japanese, Filipino,'other') adolescents. Comparable rates of approximately 25% were found for both the Hawaiian and non-Hawaiian samples regarding sometimes drinking too much alcohol. However, Hawaiians reported a statistically significantly higher rate (3.7%) of taking 'a drink in the morning to steady my nerves or to get rid of a hangover' than non-Hawaiians (1.3%). The reason for this is unknown but might indicate a higher rate of dependent alcohol use. The overall results supported the traditional model of protective and risk factors predicting alcohol use (R(2)> 15.0%), with relatively few differences found between the two ethnic groups. Further research is needed in assessing possibly unique cultural variables such as Hawaiian acculturation.
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Expression of transforming growth factor β and its correlation with lipodystrophy in oral submucous fibrosis: An immunohistochemical study.
Department of Oral Pathology and Microbiology, Faculty of Dentistry, Jamia Millia Islamia, Maulana Mohammad Ali Jauhar Marg, Jamia Nagar, Friends Colony, Delhi-110025 INDIA,, email@example.com.
Objective: In our routine review of Oral Submucous Fibrosis (OSMF) biopsies, we observed decreased adipose tissue even though most are from buccal mucosa. Pathogenesis of OSMF has demonstrated the role of Transforming Growth Factor β (TGF β), in causing fibrosis. This study aims to correlate the role of TGF β with loss of adipose tissue in OSMF. Study Design: From our archives, 84 OSMF cases (24 early and 60 advanced OSMF) were screened for adipose tissue. Immunoexpression of TGF β in these cases were investigated. Results: Adipose tissue was seen in 67% of early OSMF and in 13% of advanced cases. Early cases showed more intense TGF β staining of epithelium, fibroblast, macrophages and inflammatory cells than the advanced cases. Conclusion: These findings suggest that TGF β plays a key role in causing lipodystrophy in OSMF and is secreted more during early course of the disease than in advanced stage.
Coronoidectomy, masticatory myotomy and buccal fat pad graft in management of advanced oral submucous fibrosis.
M.D.S. Oral and Maxillofacial Surgery, Gulbarga, Karnataka, India.
The purpose of this study is to evaluate coronoidectomy, masticatory myotomy and buccal fat pad graft in advanced (Stage III-IV) oral sub mucous fibrosis (OSF). 10 patients with clinically and histologically confirmed advanced OSF underwent surgery entailing bilateral coronoidectomy, masticatory muscle myotomy and closure with a pedicled buccal fat pad graft followed by vigorous mouth opening exercises. The result was evaluated using the interincisal distance at maximum mouth opening as the objective outcome measure over a follow up period of 12 months. Results showed a mean interincisal opening of 14.7mm preoperatively and 32.5mm at 12 months postoperatively. Relapse was encountered in one patient who did not cooperate with the postoperative exercise regime. Results suggest this regime is effective.
Department of Oral and Maxillofacial Surgery, Maulana Azad Institute of Dental Sciences, Uttar Pradesh, India.
Oral submucous fibrosis (OSMF) is one of the most poorly understood and unsatisfactorily treated diseases. Various medical and surgical treatments have been used but with limited benefits. However, with advent of lasers, oral surgeons are provided with new modality for treating OSMF. This case report highlights the pioneering effort in treating a moderate case of bilateral OSMF with Erbium Chromium Yttrium Scandium Gallium Garnet (ErCr:YSGG) laser showing promising result during follow-up.
Evid Based Dent. 2011 ;12 (2):43 21701544
Department of Oral and Maxillofacial Pathology, KLE VK Institute of Dental Sciences and Hospital, Belgaum, Karnataka, India.
Pubmed was searched using the term 'oral submucous fibrosis'(OSF). Additional searches of the Indian and Chinese literature were conducted manually. Randomised controlled studies (RCTs), observational studies, or case series reports that included individuals of any age with confirmed diagnosis, by clinical examination and/or biopsy of OSF. Types of interventions included habit intervention, surgical procedures, medical treatments (i.e. systemic, submucosal injection or topical agents), or physical therapy. Primary outcomes were objective change or improvement in maximal jaw opening, subjective change in severity of oral/mucosal burning pain, subjective change in quality of life using any questionnaire, and reduction in the rate of malignant transformation. Studies selected were evaluated independently by three reviewers using a data extraction form. Due to the heterogeneity of the studies synthesis was not conducted. The overall quality of evidence of RCTs for each outcome was assessed and reported using the GRADE approach. 50 studies were identified for inclusion. Only four of these were RCTs. The likely bias associated with these was thought to be high and therefore the authors urged caution in interpreting their conclusions. Interventions included oral pentoxifylline versus multivitamins; oral lycopene, oral lycopene with intralesional corticosteroids or an oral placebo; oral levamisole, an oral antioxidant, or oral levamisole; physiotherapy, injections with combination hyaluronidase/steroids, and a control group. Various objective and subjective outcomes improved with intervention. The current evidence for the benefit of current interventions to manage OSF is weak.
J Cancer Res Ther. ;6 (4):508-10 21358090
Efficacy of alpha lipoic acid in adjunct with intralesional steroids and hyaluronidase in the management of oral submucous fibrosis.
Department of Oral Medicine and Radiology, Yenepoya Dental College, Yenepoya University, Mangalore, India.
Background and Objectives: Oral submucous fibrosis (OSF) is a chronic irreversible condition of the oral mucosa with proven malignant potential. However, till date, there has been a dearth of effective management strategies. This study used alpha lipoic acid, an antioxidant, in oral form to determine if it could be useful in managing OSF patients. Materials and Methods: A case-control study was conducted on 18 patients of OSF (9 cases and 9 controls). The case group was treated using alpha lipoic acid in addition to the intralesional steroid and hyaluronidase injections used in the control group. Results: The cases in the alpha lipoic acid group exhibited better relief of symptoms such as burning sensation of the mucosa and mouth opening, as compared to the controls. The use of alpha lipoic acid along with intralesional steroids and hyaluronidase caused reversal of higher clinical stages to lower ones. Conclusion: The use of an antioxidant, alpha lipoic acid, along with conventional therapy of intralesional steroid injections definitely seems to have a beneficial impact in the management of OSF.
Dermatol Online J. 2009 ;15 (5):13 19624991
Department of Dermatology and Venereology, Hospital de São João, Porto, Portugal. firstname.lastname@example.org
Eyelid lesions frequently are a diagnostic challenge. We report a case of a 46-year-old woman with a 5-year history of yellowish symmetric progressively growing papules on the eyelids, resembling xanthelasma. A skin biopsy was performed that revealed the rare variant of clear cell syringoma. The lesions were treated with CO2 laser and surgical excision; there was no evidence of recurrence after 6 months of follow-up.
Adv Urol. 2008 ;:524392 19043562
A preliminary report on combined penoscrotal and perineal approach for placement of penile prosthesis with corporal fibrosis.
Department of Urology, Kaiser Permanente-Bellflower Medical Center, 9400 East Rosecrans Avenue, Bellflower, CA 90706, USA. email@example.com
Purpose. This paper aims at describing the combined penoscrotal and perineal approach for placement of penile prosthesis in cases of severe corporal fibrosis and scarring. Materials and methods. Three patients with extensive corporal fibrosis underwent penile prosthesis placement via combined penoscrotal and perineal approach from 1997 to 2006. Follow-up ranged from 15 to 129 months. Results. All patients underwent successful implantation of semirigid penile prosthesis. There were no short- or long-term complications. Conclusions. Results on combined penoscrotal and perineal approach to penile prosthetic surgery in this preliminary series of patients suggest that it is a safe technique and increases the chance of successful outcome in the surgical management of severe corporal fibrosis.
A 78-year-old man presenting with synchronous, multifocal and bilateral renal oncocytomas underwent a staged nephron-sparing surgery with removal of six lesions. At 14-month follow-up the renal function was preserved and no recurrent disease was evident. A literature review demonstrated 17 similar cases, treated either with watchful waiting or with complete surgical removal. Reasons to prefer the surgical option are herein substantiated.
Department of Surgical Sciences, Organ Transplantation, Advanced Technologies, University of Catania, Via Guicciardini 6, 95030, Sant'Agata Li Battiati, Catania, Italy. firstname.lastname@example.org
Many surgical procedures have been developed to repair rectovaginal fistulas even if no "procedure of choice" is reported. The authors report a case of relatively uncommon, complex, medium-high post-obstetric rectovaginal fistula without sphincteral lesions and treated with a novel tailored technique. Our innovative surgical management consisted of preparing the neck of the fistula inside the vagina and folding it into the rectum so as to enclose the fistula within two semicontinuous sutures (stapled transanal rectal resection); no fecal diversion was performed. Postoperative follow-up at 9 months showed no recurrence of the fistula.
Consumption of areca quid, cigarettes, and alcohol related to the comorbidity of oral submucous fibrosis and oral cancer.
Faculty of Dental Hygiene, College of Dental Medicine Kaoshiung Medical University, Kaohsiung, Taiwan.
OBJECTIVE Oral submucous fibrosis (OSF) is defined as a precancerous condition, and it is also commonly seen in clinical practice, coexisting with oral cancer. The aim of this study was to identify the effects of areca quid, cigarette, and alcohol on the coexistence of oral cancer and OSF. STUDY DESIGN This is a case-control study. One hundred four histologically confirmed male OSF subjects were included, which consisted of 65 OSF subjects without oral cancer (control group) and 39 OSF subjects with oral cancer (case group). RESULTS The cigarette consumption in the case group was significantly higher than the control group. In drinking habits, the mean consumption of alcohol in the case group was significantly higher than the control group. Logistic regression analysis was used to identify these risk factors. Age and alcohol consumption showed a significant effect, and the odds ratios were 1.07 in age and 1.5 in alcohol consumption. CONCLUSION Alcohol drinking could be a risk factor associated with an increased risk of malignant transformation and coexistence with oral cancer in OSF patients, but cigarette and areca quid were not risk factors in our study. For oral cancer prevention from OSF, more attention should be paid to the importance of public health strategies targeted toward preventing and reducing alcohol consumption.