ORAL submucous fibrosis: comparison of different treatment modalities

Oral submucous fibrosis [OSMF] is a chronic, insidious, fibrotic disease that predominantly affects people of South-East Asian origin. The majority of patients present with an intolerance to spicy food, rigidity of lip, tongue and palate leading to varying degrees of limitation of mouth opening and tongue movement. The use ofareca nut has been strongly implicated as the principal etiological factor in the pathogenesis of OSMF which involves cytokine mediated collagen synthesis and deposition and reduced collagen degradation. Various modalities have been proposed for the management of OSMF. Aimed primarily at increasing oral opening, surgical treatments have been hampered by relapse and medical agents have yielded limited success. In this prospective comparative study we tested a hypothesis that a combination ofintralesional steroid and oral antioxidant would prove to be of maximal efficacy than either of the two agents used alone. Forty five patients with a clinical and histologic diagnosis of OSMF were randomly divided into three treatment groups of fifteen patients each. Patients in group [A] received monthly intralesional injections of methylprednisolone acetate, those in group [B] were put on daily lycopene supplements while the ones in group 'C' received monthly intralesional injections of methylprednisolone acetate and concurrently were put on daily lycopene supplements as well. Mouth opening values for patients showed an average increase of 3.46 mm, 2.46 mm and 7 mm for groups A, B and C respectively. The difference in mouth openings at the end of treatment was found to be statistically insignificant between groups A and B [p > 0.05], significant between groups A and C [p < 0.05] while it was very significant between groups B and C [p < 0.01]. We therefore conclude that the most favorable response in terms of clinical efficacy was derived from the combination ofintralesional steroid and oral antioxidant therapy in patients abstaining from areca nut habit and indulging in rigorous physiotherapy. We further suggest that this modality may be used as a frontline therapy for the pharmacologic and physiotheraputic management of oral submucous fibrosis

Comparison of silastic and acrylic interpositioning for the treatment of temporomandibular joint ankylosis

The aim of this study was to compare the treatment outcome of thirty unilateral temporomandibular joint [TMJ] ankylosis cases treated in Pakistan Institute of Medical Sciences [PIMS], Islamabad within four years by either silastic or acrylic interpositional arthoplasty. Patients having bilateral TMJ ankylosis, age less than 16 years, coronoidectomy required during procedure, already operated cases and medically compromised patients were excluded from the study. Pre and post-operative assessment was done by thorough history, physical examination and radiographic evaluation [OPG and CT scan] to determine the cause of ankylosis, the maximal inter-incisal opening, complications including infection, presence of facial nerve paralysis and recurrence rate. The maximal inter-incisal opening in the pre-operative period ranged from 0-11mm and was recorded at a mean of 32.7+/-5.8mm for cases treated with silastic interposition and 29.5+/-6.8mm for the ones treated with acrylic one year after surgery. Infections, swelling, pain and nerve injuries were reported in both the groups post-operatively. Both silastic and acrylic were found to be statistically similar in terms of maximal inter-incisal opening, complications and recurrence rates. Recurrence was observed in only one patient treated by acrylic inter-positioning. Silastic however demonstrated itself to be a better choice in terms of handling and patient tolerability

Myositis ossificans traumatica of lateral and medial pterygoid muscles: a case report

A 19 years male patient came to the Oral and Maxillofacial Surgery outpatient department with chief complaint of progressively reducing mouth opening for the past four months. History, clinical and radiological examination strongly suggested it to be a rare case ofmyositis ossificans traumatica which was subsequently confirmed histopathologically. The patient was managed by extirpation of the ossified left lateral and medial pterygoid muscles with inter positioning of split thickness temporalis muscle and fascia flap and post-operative mouth opening exercises. Satisfactory mouth opening was achieved. However recurrence relapse was noted soon after