Maintenance of Increased Mouth Opening in Oral Submucous Fibrosis Patient Treated with Nasolabial Flap Technique

Oral submucous fibrosis (OSMF) is an insidious chronic disease affecting any part of the oral cavity and sometimes the pharynx with epithelial atrophy leading to stiffness of the oral mucosa, causing trismus and inability to eat. However, a more serious complication of this disease is the risk of the development of oral carcinoma. A case of OSMF reported with initial interincisal mouth opening; 8？mm which was treated surgically with nasolabial flap technique followed by active mouth opening exercises for 6 months with Hister’s jaw exerciser. The patient could maintain mouth opening of 32？mm at the end of 18-months followup. The patient was observed closely for any malignant changes in the oral cavity. 1. Introduction Oral submucous fibrosis (OSMF) is an insidious chronic disease affecting any part of the oral cavity and sometimes the pharynx. Although occasionally preceded by and or associated with vesicle formation, it is always associated with juxtaepithelial inflammatory reaction followed by a fibroelastic change of the lamina propria, with epithelial atrophy leading to stiffness of the oral mucosa, causing trismus and inability to eat [1]. OSMF has a high rate of morbidity because it causes progressive inability to open the mouth, resulting in inability to eat and consequent nutritional deficiencies [2]. Mortality rate is significant because it transforms into oral cancer, particularly squamous cell carcinoma at a rate of 7%–30% [2]. Management includes cessation of habit and surgical release of fibrous bands followed by forceful opening of the mouth by coronoidectomy and coverage of surgical defects with nasolabial flap and postoperative active jaw physiotherapy for 6 months [3]. Surgery may induce scar tissue which reduces mouth opening due to scar contraction in mouth closing muscles [4]. Relapse is a common complication that occurs after surgical release of the oral trismus caused by OSMF [5]. A variety of jaw opening devices have been used to treat trismus [6]. The purpose of this paper is to report a definite treatment approach that combines surgery with active physiotherapy to improve the jaw opening and to prevent relapse. Small effort has been made in the present study aiming to endure adequate, functional disease free mouth opening and to detect any developing malignant change at its earliest. 2. Case Report A 24-year-old male patient from India reported with a complaint of increasing difficulty of mouth opening and mastication for the previous 3 years. The patient had a habit of chewing betel nuts four times a day for 5 to 6 years. He