Oral submucous fibrosis: a study of qualitative and analytical treatment using intralesional injections: placental extract versus combination of steroid with hyaluronidase
Keywords:Hyaluronidase, Oral submucous fibrosis, Placental extract, Triamcinolone, Trismus
Background: One of the premalignant conditions in oropharynx is oral submucous fibrosis (OSMF). It is a chronic debilitating condition of unknown etiology leading to fibrosis of mucosa affecting the oropharynx, esophagus and thus causes decreased mouth opening and dysphagia respectively. The disease is of multifactorial etiology with addictions, nutritional, micro elements and antioxidants deficiencies. In India males are more affected than females, due to their stress related excessive, irresponsible chewing habits. The available management is for symptomatic relief and at present there is no definitive treatment is available.
Methods: We have studied 60 cases diagnosed with OSMF with mild to moderate restricted mouth opening. Most of patients were between 17 to 55 years of age selected by randomized clinical trial. Its management was divided into 2 groups where group A was treated with a combined intralesional regimen of injection triamcinolone 40mg and hyaluronidase 1500 IU, while group B was treated with injection of 2ml placental extract. Each group has given a single dose intralesional injection per week for six weeks.
Results: It was a comparative study of improvement in effectiveness on mouth opening and reduction in burning sensation of oral cavity seen in group A regimen than group B. Those having persistent trismus, needed surgery.
Conclusions: No effective treatment available but along with intralesional injection can give symptomatic relief. In addition, cessation of habits, antioxidants oral hygiene helps in improvement of OSMF.
Aziz SR. Oral submucous fibrosis: an unusual disease. J N J Dent Assoc. 1997;68(2):17-9.
Lal D. Diffuse Oral Submucous Fibrosis. J All India Dent Assoc. 1953;26:1-3.
Paymaster JC. Cancer of the buccal mucosa. A clinical study of 650 cases in Indian patients. Cancer. 1956;9(3):431-5.
Shieh DH, Chiang LC, Lee CH, Yang YH, Shieh TY. Effects of arecoline, safrole, and nicotine on collagen phagocytosis by human buccal mucosal fibroblasts as a possible mechanism for oral submucous fibrosis in Taiwan. J Oral Pathol Med. 2004;33(9):581‐7.
Canniff JP, Harvey W, Harris M. Oral submucous fibrosis: its pathogenesis and management. Br Dent J. 1986;160(12):429‐34.
Haque MF, Meghji S, Khitab U, Harris M. Oral submucous fibrosis patients have altered levels of cytokine production. J Oral Pathol Med. 2000;29(3):123-8.
Trivedy CR, Warnakulasuriya KA, Peters TJ, Senkus R, Hazarey VK, Johnson NW. Raised tissue copper levels in oral submucous fibrosis. J Oral Pathol Med. 2000;29(6):241‐8.
Arakeri G, Brennan PA. Oral submucous fibrosis: an overview of the aetiology, pathogenesis, classification, and principles of management. Br J Oral Maxillofac Surg. 2013;51(7):587‐93.
Jayanthi V, Probert CS, Sher KS, Mayberry JF. Oral submucosal fibrosis: a preventable disease. Gut. 1992;33(1):4-6.
Guruprasad R, Nair PP, Singh M, Singh M, Singh M, Jain A. Serum vitamin c and iron levels in oral submucous fibrosis. Indian J Dent. 2014;5(2):81‐5.
Wang YP, Wu YC, Cheng SJ, Chen HM, Sun A, Chang JY. High frequencies of vitamin B12 and folic acid deficiencies and gastric parietal cell antibody positivity in oral submucous fibrosis patients. J Formos Med Assoc. 2015;114(9):813‐9.
More CB, Das S, Patel H, Adalja C, Kamatchi V, Venkatesh R. Proposed clinical classification for oral submucous fibrosis. Oral Oncol. 2012;48:200-2.
Pindborg JJ, Bhonsle RB, Murti PR, Gupta PC, Daftary DK, Mehta FS. Incidence and early forms of oral submucous fibrosis. Oral Surg Oral Med Oral Pathol. 1980;50(1):40-4.
Dionne KR, Warnakulasuriya S, Zain RB, Cheong SC. Potentially malignant disorders of the oral cavity: current practice and future directions in the clinic and laboratory. Int J Cancer. 2015;136(3):503‐15.
Shih YH, Wang TH, Shieh TM, Tseng YH. Oral Submucous Fibrosis: A Review on Etiopathogenesis, Diagnosis, and Therapy. Int J Mol Sci. 2019;20(12):2940.
Gupta J, Shrinivasan SV, Daniel JM. Efficacy of betamethasone, placental extract and hyaluronidase in the treatment of OSMF: a comparative study. E J Dentistry. 2012;2(1):132-5.
Rajendran R. Oral submucous fibrosis. J Oral Maxillofac Pathol. 2003;7:1-4.
Tilakaratne WM, Ekanayaka RP, Herath M, Jayasinghe RD, Sitheeque M, Amarasinghe H. Intralesional corticosteroids as a treatment for restricted mouth opening in oral submucous fibrosis. Oral Surg Oral Med Oral Pathol Oral Radiol. 2016;122(2):224‐31.
James L, Shetty A, Rishi D, Abraham M. Management of oral submucous fibrosis with injection of hyaluronidase and dexamethasone in grade III oral submucous fibrosis: a retrospective study. J Int Oral Health. 2015;7(8):1-4.
Daga D, Singh RK, Pal US, Gurung T, Gangwar S. Efficacy of oral colchicine with intralesional hyaluronidase or triamcinolone acetonide in the Grade II oral submucous fibrosis. Natl J Maxillofac Surg. 2017;8(1):50‐4.
Shah PH, Venkatesh R, More CB, Vassandacoumara V. Comparison of Therapeutic Efficacy of Placental Extract with Dexamethasone and Hyaluronic Acid with Dexamethasone for Oral Submucous Fibrosis - A Retrospective Analysis. J Clin Diagn Res. 2016;10(10):63-6.
Katharia SK, Singh SP, Kulshreshtha VK. The effects of placenta extract in management of oral submucous fibrosis. Indian J Pharmacol. 1992;24:181-3.
Srikrishna NK, Kumar V. Role of Physiotherapy in the Management of Oral Submucous Fibrosis: A Case Control Study. Int J Contemporary Med Res. 2019;6(1):22-4.
Kumar KK, Saraswathi TR, Ranganathan K, Devi UM, Elizabeth J. Oral submucous fibrosis: a clinico-histopathological study in Chennai. Indian J Dent Res. 2007;18(3):106-11.
Aziz, Shahid R. Coming to America: Betel nut and oral submucous fibrosis. J Am Dent Association. 2010;141(4):423-8.
Mathew AL, Pai KM, Sholapurkar AA, Vengal M. The prevalence of oral mucosal lesions in patients visiting a dental school in Southern India. Indian J Dent Res. 2008;19(2):99-103.
Singh M, Niranjan HS, Mehrotra R, Sharma D, Gupta SC. Efficacy of hydrocortisone acetate/hyaluronidase vs triamcinolone acetonide/hyaluronidase in the treatment of oral submucous fibrosis. Indian J Med Res. 2010;131:665-9.
Goswami R, Gangwani A, Bhatnagar S, Singh D. Comparative study of oral nutritional supplements Vs. intralesional triamcinolone and hyaluronidase in oral submucous fibrosis. Int J Med Res Rev. 2014;2(2):114-8.