Total oral reconstruction for cancers associated with advanced oral submucous fibrosis.

The progression of submucous fibrosis to oral cancer is well established. This condition in an advanced stage causes progressive trismus. Oral cancers associated with severe submucous fibrosis (interincisor distance [IID] < or = 1.5 cm) require bilateral buccal mucosal reconstruction after tumor excision. After wide excision of the tumor, a regional flap is used to reconstruct the buccal mucosal loss on that side. The opposite buccal mucosa, afflicted by advanced submucous fibrosis, is released at the same time to open the mouth and is resurfaced by an ipsilateral, inferiorly based nasolabial flap. This helps to rehabilitate the oral cavity completely and to prevent the recurrence of trismus. In 18 months, 12 patients underwent total reconstruction of intraoral tumors associated with submucous fibrosis. The average preoperative IID was 0.875 cm. All patients had inferiorly based, two-stage nasolabial flaps for submucous fibrosis reconstruction. The average pain-free postoperative IID was 3.13 cm.

Cancer control efforts in the Indian subcontinent.

The Indian subcontinent in South Asia occupies 2.4% of the world land mass and is home to 16.5% of the world population. At present, it is roughly estimated that approximately 1 million new cancer cases per annum will be recorded and at any given time there will be 3 million cancer patients in India. Nevertheless, cancer is not a frequent disease for the Indian population. Cancer statistics demonstrate that cancers frequently observed in India are lifestyle dependent, with offending factors such as tobacco usage, low socio-economic status, multiple pregnancies and poor sexual hygiene. These factors are closely related to the population living in rural surroundings and they are targets for cancer prevention. Low socio-economic status and low literacy rates ensure that most patients are diagnosed at an advanced stage of the disease. It is very difficult for these patients to achieve a cure and they are always treated by palliative care with much cost and morbidity. Therefore, it is reasonable to postulate that the strategy for cancer control in India should be focused on health education for the rural population and the creation of an infrastructure for cancer management. These systems with appropriate low-cost technology might be able to be duplicated as a model for developing countries with low capital inputs.