Surgical Management of Oral Submucous Fibrosis: A Systematic Review

Abstract

ABSTRACT:
Background: Oral submucous fibrosis is a chronic disorder mainly caused to areca nut intake which clinically has typical features like limited mouth opening and fibrous bands. OSMF has an increased risk for malignant transformation into oral squamous cell carcinoma. There are no standard options for surgical management of OSMF, so a methodological assessments of different surgical with their differences is necessary.

Objective: To systematically review different surgical treatments of OSMF and their efficacy, clinical results, and restrictions of various surgical treatments and therefore generating evidence-based review.

Methods: Using relevant keywords, a detailed search was performed in PubMed, Cochrane Library, and Scopus databases with emphasis on surgical techniques and their quantitative results. Studies assessing the methods including Buccal Fat Pad (BFP), Nasolabial Flap (NLF), Laser-Assisted Surgery, Palatal Island Flap, Split Skin Grafting (SSG), and Tongue Flaps are included. According to PRISMA guidelines data were collected to ensure reproducibility and transparency in the review.

Results: This systematic review summarizes the various surgical techniques for managing Oral Submucous Fibrosis (OSMF), depending on the severity of the condition. for mild-to-moderate cases, Buccal Fat Pad (BFP) grafting is highly effective with postoperative mouth opening of 20–25 mm and less than 10% recurrence rates. For severe fibrosis, Nasolabial Flap (NLF) is suited but with aesthetic concerns like scarring and intraoral hair growth. Laser-Assisted Surgery is a minimally invasive alternative with post operative mouth opening of 15–20 mm, faster recovery and less than 10% recurrence rate. In advanced fibrosis, Palatal Island Flap is most effective surgical procedure with post op mouth opening of 33–36 mm and functional improvements, while Split Skin Grafting (SSG) poses higher complications and high recurrence rate gives post op mouth opening of 15–20 mm. For extensive cases robust results are seen with Tongue Flaps with less complications, and long-term efficacy and 33–38 mm of mouth opening, These findings from the review suggest a case centric surgical treatment methods based on the severity.

Conclusion: Based on this evidence-based review different stages, different degrees of fibrosis and patient centric approaches are better surgical treatment of OSMF. BFP grafting and laser surgery are advised in early stages whereas advanced cases need NLF, Palatal Island Flap, SSG, and Tongue Flap. Developing a refined techniques and uniform procedures need long term and multicentric studies.