This book offers an essential guide to treating trismus due to oral submucous fibrosis (OSMF) – a specific condition involving the mouth that is common in geographical areas where chewing of betel nut and tobacco is prevalent, particularly in Central India.
Based on the editors’ more than two decades of experience employing techniques such as platysma flap and mandibular mucoperiosteal flaps to treat trismus of OSMF, the book will help surgeons who encounter these disorders to create their own management protocols. The initial chapters detail how the authors themselves have dealt with this disorder; the following chapters consist of separate entries, each of which contains clinical photographs and a brief description. Readers can either read the atlas as a textbook, or as a reference work.
The book will benefit practitioners of ENT, head and neck, maxillofacial, dental and plastic surgeries, as well as general surgeons and postgraduate students.
Abstract
Bilateral full thickness naso-labial flaps have been used successfully in three patients to give long-term relief of the severe trismus caused by oral submucous fibrosis. The flaps are set into defects created by incision of the oral mucosa.
The postoperative rehabilitation compared favorably with other methods and we now advocate the technique for all cases of submucous fibrosis requiring correction of severe trismus.
Although a variety of surgical modalities are available for the treatment of OSMF nothing is superior to any existing technique. Nonetheless the choice of treatment largely depends on the site and size of the defect, donor site availability, donor site morbidity, as well as on the ability of patient to withstand time-consuming procedures such as microsurgical free flaps [6]. The nasolabial flaps although widely used are small compared with the defect and the main disadvantage of an extended nasolabial flap is an unpleasant extra oral scar, intra oral hair growth with risk of broadening of the commissure and a pinched appearance of the lips [7].
Platysma myocutaneous flap is a versatile flap that has been used for head and neck reconstruction since more than three decades. It is a versatile flap based on an axial blood supply used for reconstruction of many intra oral defects like cheek mucosae, floor of the mouth etc. We report here a case of Oral submucous fibrosis Grade III treated with a superiorly based Platysma Myocutaneous flap for reconstruction of the post fibrotomy defect. The patient was followed up for a period of one year with excellent functional and aesthetic outcomes.
It is not our intention to review this literature in full here, as surgical interventions are covered elsewhere.13,54 Various grafting techniques include the use of buccal fat pads, tongue flaps, nasolabial flap, and radial forearm flaps.38,55-68 Artificial grafts that promote tissue regeneration have also been advocated in the reconstruction of defects following surgery.69
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