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Management of Oral Submucous Fibrosis with Injection of Hyaluronidase and Dexamethasone in Grade III Oral Submucous Fibrosis: A Retrospective Study.

James L, Shetty A, Rishi D, Abraham M - J Int Oral Health (2015)

Bottom Line: It is resistant and progressive affecting the entire oral cavity that sometimes causes a gradual reduction in mouth opening that may even extend up to the pharynx.However, a combination of steroids and topical hyaluronidase shows better long-term results than either agents used individually.Definite reduction in burning sensation, painful ulceration and blanching of oral mucosa and patient followed up for an average of 9 months.

View Article: PubMed Central - PubMed

Affiliation: Professor, Department of Oral Medicine and Radiology, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru, Karnataka, India.

ABSTRACT

Background: Oral submucous fibrosis (OSMF) is a chronic debilitating and potentially malignant condition of the oral cavity. It is resistant and progressive affecting the entire oral cavity that sometimes causes a gradual reduction in mouth opening that may even extend up to the pharynx. Although the medical treatment is not completely systematized, optimal doses of its treatment with local injection of corticosteroids with hyaluronidase or placental extract is effective to some extent. However, a combination of steroids and topical hyaluronidase shows better long-term results than either agents used individually. To evaluate the efficacy of dexamethasone and hyaluronidase in the treatment of Grade III OSMF.

Materials and methods: A total of 28 patients diagnosed with OSMF were treated in Sri Rajiv Gandhi College of Dental Sciences for a time period of 9 months, by obtaining the patient's consent and with the approval of the institution's research ethical committee. They were treated by administering an intralesional injection of dexamethasone1.5 ml, hyaluronidase 1500 IU with 0.5 ml lignocaine HCL injected intralesionally biweekly for 4 weeks.

Results: Improvement in the patient's mouth opening with a net gain of 6 ± 2 mm (92%), the range being 4-8 mm. Definite reduction in burning sensation, painful ulceration and blanching of oral mucosa and patient followed up for an average of 9 months.

Conclusion: Injection of hyaluronidase with dexamethasone is an effective method of managing Grade III OSMF and can possibly eliminate the morbidity associated with surgical management.

No MeSH data available.


Related in: MedlinePlus

(a and b) Comparison of groups before and after treatment.
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Figure 2: (a and b) Comparison of groups before and after treatment.

Mentions: The study was conducted on 28 patients with OSMF who attended as outpatients in the Department of Oral Medicine and Radiology and Department of Oral and Maxillofacial Surgery, with Grade III OSMF in the Institute of Sri Rajiv Gandhi College of Dental sciences, Bengaluru for a span of 9 months. This study was carried out after obtaining the patient’s consent and with the approval of the Institution’s Research Ethical Committee. Clinical diagnosis of OSMF was based on symptoms of burning sensation in the mouth on consumption of spicy or hot food, dryness of mouth, presence of vesicles oral ulcers in the mouth, and restriction of mouth opening were observed. Patients who were medically compromised and those who received previous treatments were not included in the study. Of 28 patients, the number of male subjects were 18 and female subjects were 10. The patients were informed about the condition and its precancerous potential and were instructed to discontinue the use of are canut with tobacco. Their history of personal habits with regard to frequency of chews, duration of use and symptoms like burning sensation and mouth opening were recorded. The burning sensation was assessed using visual analogue scale marked from 0 to 10 where 0 indicates no burning sensation and 10 indicates maximum burning sensation. Extraorally, the patient’s mouth opening was measured with reference to interincisal points between upper and lower incisor teeth, the maximum mouth opening was assessed with geometric divider and metallic scale. Intraorally, the findings like blanching of oral mucosa, presence of vesicles and ulcers, palpable bands, limitation of tongue movement were observed. The patients were grouped based on their age: 21-30 (Group I), 31-40 (Group II), 41-50 (Group III) and 51-60 (Group IV). 12 patients belonged to age group 21-30 where 8 were males and 4 were females, 7 patients 31-40 where 4 were males and 3 were females, 6 patients 41-50 where 4 were males and 2 were females and 3 patients 51-60 group where 2 were males and 1 was female. The patients were administered hyaluronidase 1500 IU mixed in 1.5 ml of dexamethasone and 0.5 ml of lignocaine HCL injected intralesionally biweekly for 4 weeks. Outcome assessment was done by measuring postoperative mouth opening each week and burning sensation using a visual analogue scale, (Graph 1a and b).


Management of Oral Submucous Fibrosis with Injection of Hyaluronidase and Dexamethasone in Grade III Oral Submucous Fibrosis: A Retrospective Study.

James L, Shetty A, Rishi D, Abraham M - J Int Oral Health (2015)

(a and b) Comparison of groups before and after treatment.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4588796&req=5

Figure 2: (a and b) Comparison of groups before and after treatment.
Mentions: The study was conducted on 28 patients with OSMF who attended as outpatients in the Department of Oral Medicine and Radiology and Department of Oral and Maxillofacial Surgery, with Grade III OSMF in the Institute of Sri Rajiv Gandhi College of Dental sciences, Bengaluru for a span of 9 months. This study was carried out after obtaining the patient’s consent and with the approval of the Institution’s Research Ethical Committee. Clinical diagnosis of OSMF was based on symptoms of burning sensation in the mouth on consumption of spicy or hot food, dryness of mouth, presence of vesicles oral ulcers in the mouth, and restriction of mouth opening were observed. Patients who were medically compromised and those who received previous treatments were not included in the study. Of 28 patients, the number of male subjects were 18 and female subjects were 10. The patients were informed about the condition and its precancerous potential and were instructed to discontinue the use of are canut with tobacco. Their history of personal habits with regard to frequency of chews, duration of use and symptoms like burning sensation and mouth opening were recorded. The burning sensation was assessed using visual analogue scale marked from 0 to 10 where 0 indicates no burning sensation and 10 indicates maximum burning sensation. Extraorally, the patient’s mouth opening was measured with reference to interincisal points between upper and lower incisor teeth, the maximum mouth opening was assessed with geometric divider and metallic scale. Intraorally, the findings like blanching of oral mucosa, presence of vesicles and ulcers, palpable bands, limitation of tongue movement were observed. The patients were grouped based on their age: 21-30 (Group I), 31-40 (Group II), 41-50 (Group III) and 51-60 (Group IV). 12 patients belonged to age group 21-30 where 8 were males and 4 were females, 7 patients 31-40 where 4 were males and 3 were females, 6 patients 41-50 where 4 were males and 2 were females and 3 patients 51-60 group where 2 were males and 1 was female. The patients were administered hyaluronidase 1500 IU mixed in 1.5 ml of dexamethasone and 0.5 ml of lignocaine HCL injected intralesionally biweekly for 4 weeks. Outcome assessment was done by measuring postoperative mouth opening each week and burning sensation using a visual analogue scale, (Graph 1a and b).

Bottom Line: It is resistant and progressive affecting the entire oral cavity that sometimes causes a gradual reduction in mouth opening that may even extend up to the pharynx.However, a combination of steroids and topical hyaluronidase shows better long-term results than either agents used individually.Definite reduction in burning sensation, painful ulceration and blanching of oral mucosa and patient followed up for an average of 9 months.

View Article: PubMed Central - PubMed

Affiliation: Professor, Department of Oral Medicine and Radiology, Sri Rajiv Gandhi College of Dental Sciences, Bengaluru, Karnataka, India.

ABSTRACT

Background: Oral submucous fibrosis (OSMF) is a chronic debilitating and potentially malignant condition of the oral cavity. It is resistant and progressive affecting the entire oral cavity that sometimes causes a gradual reduction in mouth opening that may even extend up to the pharynx. Although the medical treatment is not completely systematized, optimal doses of its treatment with local injection of corticosteroids with hyaluronidase or placental extract is effective to some extent. However, a combination of steroids and topical hyaluronidase shows better long-term results than either agents used individually. To evaluate the efficacy of dexamethasone and hyaluronidase in the treatment of Grade III OSMF.

Materials and methods: A total of 28 patients diagnosed with OSMF were treated in Sri Rajiv Gandhi College of Dental Sciences for a time period of 9 months, by obtaining the patient's consent and with the approval of the institution's research ethical committee. They were treated by administering an intralesional injection of dexamethasone1.5 ml, hyaluronidase 1500 IU with 0.5 ml lignocaine HCL injected intralesionally biweekly for 4 weeks.

Results: Improvement in the patient's mouth opening with a net gain of 6 ± 2 mm (92%), the range being 4-8 mm. Definite reduction in burning sensation, painful ulceration and blanching of oral mucosa and patient followed up for an average of 9 months.

Conclusion: Injection of hyaluronidase with dexamethasone is an effective method of managing Grade III OSMF and can possibly eliminate the morbidity associated with surgical management.

No MeSH data available.


Related in: MedlinePlus