ORAL submucous fibrosis: comparison of different treatment modalities

ABSTRACT

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