Comparative Study of Intralesional Triamcinolone Acetonide and Hyaluronidase vs Placental Extract in 60 Cases of Oral Submucous Fibrosis

ABSTRACT Background Oral submucous fibrosis (OSMF) is a common premalignant condition caused by chewing arecanut, betel quid and gutkha with tobacco. Its medical treatment is not yet fully standardized, although the optimal doses of its medical treatment is in the form of triamcinolone acetonide combined with hyaluronidase or intralesional placental extract. Objectives We compared the efficacy of intralesional triamcinolone acetonide combined with hyaluronidase in group A vs placental extract in group B. Design Comparative case series analysis series study with random allocation of 60 patients equally into two groups. Materials and methods Patients of OSMF (60) were randomly allocated into two groups A and B. Group A (n = 30) patients received combination of triamcinolone acetonide (10 mg/ml) + hyaluronidase (1,500 IU) at weekly intervals for 8 weeks. Group B (n = 30) patients received 2 ml of placentrex injection intralesionally at weekly interval for 8 weeks. Treatment outcome was evaluated on the basis of improvement in trismus, oral mucosal pattern and reduction in burning sensation. Results Trismus improvements in group A with combination of triamcinolone acetonide + hyaluronidase were significantly better to that in group B where placentrex was used. No significant difference in results in the two groups were observed as far as improvement in oral mucosal pattern and burning sensation were compared in the two groups. Conclusion Combination of triamcinolone acetonide and hyaluronidase intralesionally is more effective than placental extract intralesionally in treatment of OSMF. But placental extract injections are cost-effective. No side effects were seen in both study groups. How to cite this article Naik SM, Appaji MK, Ravishankara S, Goutham MK, Devi NP, Mushannavar AS, Naik SS. Comparative Study of Intralesional Triamcinolone Acetonide and Hyaluronidase vs Placental Extract in 60 Cases of Oral Submucous Fibrosis. Int J Head Neck Surg 2012;3(2):59-65.

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Effectiveness of Pentoxifylline Therapy for Management of Oral Submucous Fibrosis

Journal of Nepalgunj Medical College ◽

10.3126/jngmc.v19i1.40228 ◽

2022 ◽

Vol 19 (1) ◽

pp. 51-54

Author(s):

Dwarika Prasad Bajgai ◽

Bela Agrawal ◽

Abadhesh Yadav

Keyword(s):

Oral Submucous Fibrosis ◽

Mouth Opening ◽

Burning Sensation ◽

Oral Disease ◽

Medical College ◽

Adjacent Structures ◽

Group A ◽

Submucous Fibrosis ◽

Group B

Introduction: Oral submucous fibrosis is a chronic oral disease characterized by progressive buildup of constricting collagen bands in the cheeks and adjacent structures of the mouth due to chewing of areca nut. This can severely restrict mouth opening and tongue movement causing pain and burning sensation in the mouth. Aims: This study evaluates the efficacy of pentoxifylline in the management of oral submucous fibrosis. Methods: A hospital-based study, conducted in the dental outpatient department of Nepalgunj Medical College from October 2019 to September 2020. Forty-nine patients who were diagnosed histopathologically with oral submucous fibrosis were included. The patients were divided into two groups. In group A, patients were given, 200 mg thrice daily for first 30 days, then dose hiked to 400 mg thrice daily for two more months. Group B patients received treatment with multi-vitamin capsules (B-complex one capsule before sleep daily) for three months. All patients were followed up for six months and were assessed for maximum inter-incisor opening, pain on opening of mouth and burning sensation. Results: There was no statistical difference in mouth opening at baseline and first follow up. The mouth opening was significantly more in group A compared to group B from second follow up which persisted till third follow up (p <0.05). Pain and burning sensation significantly reduced in group A compared to group B from 2nd follow up which persisted till 3rd follow up (p <0.05). Few patients had nausea, dyspepsia and vomiting during treatment in group A which resolved within a few days without the need for cessation of the drug. Conclusion: Pentoxifylline can bring about significant clinical improvements in the symptoms of oral submucous fibrosis like mouth opening, pain and burning sensation, thereby improving the quality of life of the affected individuals.

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Oral submucous fibrosis: a study of qualitative and analytical treatment using intralesional injections: placental extract versus combination of steroid with hyaluronidase

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20202786 ◽

2020 ◽

Vol 6 (7) ◽

pp. 1320

Author(s):

Meena Vishwanath Kale ◽

Ninad Subhash Gaikwad

Keyword(s):

Symptomatic Relief ◽

Oral Submucous Fibrosis ◽

Mouth Opening ◽

Definitive Treatment ◽

Unknown Etiology ◽

Intralesional Injection ◽

Group A ◽

Submucous Fibrosis ◽

Group B ◽

Placental Extract

Background: One of the premalignant conditions in oropharynx is oral submucous fibrosis (OSMF). It is a chronic debilitating condition of unknown etiology leading to fibrosis of mucosa affecting the oropharynx, esophagus and thus causes decreased mouth opening and dysphagia respectively. The disease is of multifactorial etiology with addictions, nutritional, micro elements and antioxidants deficiencies. In India males are more affected than females, due to their stress related excessive, irresponsible chewing habits. The available management is for symptomatic relief and at present there is no definitive treatment is available.Methods: We have studied 60 cases diagnosed with OSMF with mild to moderate restricted mouth opening. Most of patients were between 17 to 55 years of age selected by randomized clinical trial. Its management was divided into 2 groups where group A was treated with a combined intralesional regimen of injection triamcinolone 40mg and hyaluronidase 1500 IU, while group B was treated with injection of 2ml placental extract. Each group has given a single dose intralesional injection per week for six weeks. Results: It was a comparative study of improvement in effectiveness on mouth opening and reduction in burning sensation of oral cavity seen in group A regimen than group B. Those having persistent trismus, needed surgery.Conclusions: No effective treatment available but along with intralesional injection can give symptomatic relief. In addition, cessation of habits, antioxidants oral hygiene helps in improvement of OSMF.

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EFFICACY OF ANTIOXIDANT WITH ALOE VERA GEL VERSUS INTRA-LESIONAL STEROIDS IN THE MANAGEMENT OF ORAL SUBMUCOUS FIBROSIS - A PROSPECTIVE COMPARATIVE STUDY

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v71isuppl-3.7921 ◽

2021 ◽

Vol 71 (Suppl-3) ◽

pp. S526-29

Author(s):

Muhammad Tahir ◽

Asim Abbas ◽

Faiz Ul Hassan Nawaz ◽

Mohsin Raza ◽

Atif Rafique ◽

...

Keyword(s):

Comparative Study ◽

Lipoic Acid ◽

Oral Submucous Fibrosis ◽

Aloe Vera ◽

Mouth Opening ◽

Burning Sensation ◽

Alpha Lipoic Acid ◽

Aloe Vera Gel ◽

Prospective Comparative Study ◽

Submucous Fibrosis

Objective: To compared efficacy of alpha lipoic acid (antioxidant medication) and aloe vera gel together versus intralesional steroids (hydrocortisone) in management of oral submucous fibrosis by evaluating post treatment clinical features of mouth opening and burning sensation. Study Design: A prospective comparative study. Place and Duration of Study: Department of ENT, Combined Military Hospital, Malir Karachi, from Jul 2018 to Mar 2020. Methodology: Twenty-eight patients were involved in the research and were distributed into two groups, I and II. Alpha lipoid acid with aloe vera gel was given in group I and hydrocortisone was given in group II. Burning sensation and mouth opening were recorded both at start and at monthly interval later on for three consecutive months. The data collected were statistically analyzed by using SPSS-22. Results: A significant lessening in burning sensation (p<0.001) and improvement in mouth opening were noticed in both groups. However, comparison between alpha lipoic acid with aloe vera gel group versus hydrocortisone group showed almost similar results. Conclusion: Alpha lipoic acid and aloe vera gel can significantly improve oral submucous fibrosis clinically. So, these can be utilized as an alternative option in cases where intralesional steroid is poorly tolerated or is contraindicated.

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Comparison of Triamcinolone Versus Platelet Rich Plasma Injection for Improving Trismus in Oral Submucous Fibrosis

Journal of Bahria University Medical and Dental College ◽

10.51985/jbumdc2019104 ◽

2019 ◽

Vol 10 (1) ◽

pp. 58-62

Author(s):

Amer Sabih Hydri ◽

Iqbal Hussain Udaipurwala ◽

Nadeem Ahmed Sheikh ◽

Sana Muhammad Sadiq ◽

Sohail Aslam ◽

...

Keyword(s):

Platelet Rich Plasma ◽

Oral Submucous Fibrosis ◽

Treatment Result ◽

Double Blind ◽

Female Ratio ◽

Before And After ◽

Group A ◽

Submucous Fibrosis ◽

The Mean ◽

Group B

Objective: To compare the effect of Triamcinolone versus Platelet Rich Plasma (PRP) injection intraorally for improving trismus in Oral Submucous Fibrosis (OSMF). Study Design and setting: Randomized double-blind comparative study, conducted at ENT department of PNS Shifa Hospital, Karachi from 1st June 2015 to 30th June 2016. Methodology: Eighty patients with trismus due to oral submucous fibrosis were divided randomly into two groups, ‘A’ and ‘B’ of 40 patients each. In Group A, Inj. Triamcinolone 40mg (1 ml) was injected into the sub-mucosal plane in the retro-molar trigone area and into the fibrous bands along the soft palate on multiple sites, weekly for 6 weeks. In group B Inj. PRP 1ml weekly was administered for 6 weeks along the same site. Vernier calipers were used to precisely measure the Maximum Interincisal Distance (MIID) in cms before and after the treatment. Result: There was a male preponderance in the study group with a male to female ratio of 5.1:1. In group ‘A’ mean pretreatment MIID was 2.3±0.7 cms, while in group ‘B’, it was 2.2± 0.5 cms. After completion of 6 weeks treatment the mean MIID improved in group ‘A’ to 3.08 ± 0.8cms, and in group ‘B’ to 3.22± 0.5cms. The mean improvement in MIID in group ‘A’ was 0.783± 0.25cms compared to 1.01± 0.05 cms in group ‘B’ (p < 0.05). Conclusion: Intraoral injection of PRP is more effective than Triamcinolone in improving trismus due to OSMF

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ORAL SUBMUCOUS FIBROSIS

The Professional Medical Journal ◽

10.29309/tpmj/2018.25.07.110 ◽

2018 ◽

Vol 25 (07) ◽

pp. 1005-1012

Author(s):

Aisha Memon ◽

Hassan Shahid ◽

Salman Shafique

Keyword(s):

Oral Submucous Fibrosis ◽

Maxillofacial Surgery ◽

University Hospital ◽

Cross Sectional ◽

Burning Pain ◽

Mucosal Surfaces ◽

Rapid Control ◽

Group A ◽

Submucous Fibrosis ◽

Group B

Objectives: To compare the efficacy of topical Triamcinolone 0.1% withClobetasol 0.05% in the known cases of Oral Submucous Fibrosis presenting with burningsensations. Study Design: Cross sectional hospital based study. Setting: Department ofOral & Maxillofacial Surgery, Isra Dental College, Isra University Hospital, Hyderabad. Period:Six months. Materials and Methods: A sample of 50 patients was selected through nonprobabilitypurposive sampling according to inclusion and exclusion criteria. 50 patients withOral Submucous Fibrosis were divided into two groups, Group A and Group B, each having25 patients. The pain was measured by the visual analog scale on the scale of 1-10. Patientswere divided into Groups ‘A’ (Triamcinolone 0.1%) and ‘B’ (Clobetasol 0.05%). Patients wereadvised to use the gel twice a day for 3 weeks on the affected mucosal surfaces and were alsoadvised to avoid swallowing for some minutes and not to drink or eat for at least 1 hour after theapplication of drug. Patients were recalled for follow up to record any improvements in burningsensations after the application of the drug. Results: It was seen that both topical drugs werebeneficial in controlling the burning pain in Oral Submucous Fibrosis in the 3 weeks duration,however Clobetasol was better than Triamcinolone, as measured by more rapid control of painby week 1. Conclusion: It is concluded that the efficacy of both topical oral drugs were usefulin diminishing pain and decreasing the burning sensations. However, Clobetasol has to someextent better effectiveness in reducing the burning sensation in patients suffering with OralSubmucous Fibrosis.

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Comparison between uses of topical tacrolimus and triamcinolone ointment for the treatment of oral lichen planus.

Update Dental College Journal ◽

10.3329/updcj.v8i1.38407 ◽

2018 ◽

Vol 8 (1) ◽

pp. 17-21

Author(s):

Shaikh Ahmed ◽

Md Rubayet Alam Prodhan ◽

Rifat Rezwana ◽

Jahan Sadia Afroz ◽

Mottakin Ahmad ◽

...

Keyword(s):

Triamcinolone Acetonide ◽

Lichen Planus ◽

Maxillofacial Surgery ◽

Burning Sensation ◽

Oral And Maxillofacial Surgery ◽

Complete Relief ◽

Topical Tacrolimus ◽

Group A ◽

Group B ◽

Oral Lichen

Background: Lichen planus is a chronic mucocutaneous disease with primary or secondary involve- ment of the oral mucosa. In particular in case of erosive lichen planus most of the patients experience no long term symptoms relief of conventional topical treatment such as corticosteroid ointment. Topical tacrolimus applications to mucosal lesions seem to be an alternative treatment approach.Objective: The aim of this study was to compare the efficacy of topical tacrolimus ointment with that of triamcinolone acetonide ointment on patients suffering from oral lichen planus.Study design: This was a clinical trial. Study setting and period: This study was conducted in outpatient department of Oral and Maxillofacial Surgery, Dhaka Dental College in the period between June 2013 to May 2014.Subjects: A total of sixty patients were enrolled. Out of sixty patients thirty patients used topical tacroli- mus 0.03% (Group A) and another thirty patients used topical triamcinolone acetonide( Group B) for the treatment of oral lichen planus.Methods: A total of sixty patients were asked to answer a questionnaire regarding the degree of pain and burning sensation in every two weeks according to visual analogue scale (VAS). In every two weeks change of colour and size and also any side effects of these drugs were assessed. Data were analyzed using Statistical Package for Social Science (SPSS), version 15.0 for windows.Results: At the end of 12th week follow up periods complete relief of pain and burning sensation in group A patients were 100% and in group B it was 30%. There was no side effect in two study group patients.Update Dent. Coll. j: 2018; 8 (1): 17-21

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Effect of Turmeric on Serum Malondialdehyde levels in Oral Submucous Fibrosis

International Journal of Dentistry Research ◽

10.31254/dentistry.2020.5107 ◽

2020 ◽

Vol 5 (1) ◽

pp. 29-33

Author(s):

Tejashree Dashrath Kapgate ◽

◽

Keyword(s):

Lipid Peroxidation ◽

Oral Submucous Fibrosis ◽

Antioxidant Properties ◽

Clinical Signs ◽

Clinical Intervention ◽

Control Group ◽

Betel Nut ◽

Group A ◽

Submucous Fibrosis ◽

Group B

Background: Aspergillus flavous in betel nut secretes aflatoxin i.e. mycotoxin & tobacco which leads to production of free radicals and reactive oxygen species, thus increasing lipid peroxidation. Biological parameter of Lipid peroxidation is malondialdehyde. Hence present study was conducted to evaluate effect of turmeric on increased lipid peroxidation by using serum malondialdehyde levels & as a surrogate outcome on clinical signs & symptoms of oral submucous fibrosis (OSMF). Methods: In this study 270 subjects of which 30 were suffering from OSMF on turmeric with counseling them about stoppage of habit (group A), 30 subjects suffering from OSMF on turmeric without counseling them about stoppage of habit (group B), 30 subjects suffering from OSMF counseled for stoppage of habit but without turmeric medication (group C), 90 cases which were betel-nut habitual without OSMF (group D), 90 cases healthy control group (group E). Results: Statistically significant reduction in Serum MDA levels post treatment group A patients as compared to group B & group C (p<0.05). Mean difference was observed as 9.00 in group A, 3.81 in group B, 2.62 in group C. Conclusion: Increased serum MDA in OSMF can be used as an important marker in early diagnosis, treatment, prognosis and for prevention and clinical intervention of the disease. The antioxidant properties of turmeric reduce the oxidative stress even with effects of areca alkaloids. Serum MDA level was decreased in subjects taking turmeric medication for the period of 4 weeks

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Comparative study of intralesional injection of triamcinolone versus placental extract in cases of oral submucous fibrosis

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20203194 ◽

2020 ◽

Vol 6 (8) ◽

pp. 1504

Author(s):

Ankur N. Dhanani ◽

Alpesh V. Patel ◽

Vijay S. Laungani ◽

Margi H. Patel ◽

Pooja A. Sharma

Keyword(s):

Symptomatic Relief ◽

Oral Submucous Fibrosis ◽

Mouth Opening ◽

Burning Sensation ◽

Intralesional Injection ◽

Oral Ulceration ◽

Therapeutic Modalities ◽

Spicy Food ◽

Submucous Fibrosis ◽

Placental Extract

Background: Oral submucous fibrosis (OSMF) is a common premalignant condition caused by chewing arecanut, betel quid and gutkha with tobacco. One of the important therapeutic modalities is intralesional injection therapy. The most commonly used intralesional agents are placental extract, corticosteroids and hyaluronidase.Methods: Patients of OSMF (30) were randomly allocated and 15 patients were given 1 ml placental extract submucosally in each retromolar trigon weekly for 8 weeks and 15 patients were injected with 40 mg/ml of triamcinolone submucosally on each side weekly for 8 weeks. The mouth opening was measured as the inter-incisor distance by Vernier calliper at maximal active mouth opening by patient at initial visit and every follow up visit and recorded. Treatment outcome was evaluated on the basis of improvement in trismus, oral mucosal pattern and reduction in burning sensation. Results: Out of 30 patients, 27 were males and 3 females. 16 patients (53.33%) were in the age group of 21-30 years. Most of patients in our study had complain of reduced mouth opening and inability to take spicy food which is 93.33% of cases followed by burning sensation in mouth 90%, oral ulceration 83.33%, dryness of mouth 30%, difficulty/pain in swallowing 13.33% and halitosis 2%. 60% of patients mouth opening was improved >10 mm with triamcinolone while in placental extract 26.6%. Symptomatic relief were obtained more with injection placental extract.Conclusions: Triamcinolone injection has more improvement in mouth opening compared to placental extract. It was observed that injection placental extract gives good symptomatic relief in the major symptoms like burning sensation in mouth, inability to take spicy food, oral ulceration compared to injection triamcinolone.

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Assessment of the quality of life and performance status in patients with oral submucous fibrosis in central India

Medicine and Pharmacy Reports ◽

10.15386/cjmed-806 ◽

2018 ◽

Vol 91 (2) ◽

pp. 203-208

Author(s):

Revant H. Chole ◽

Ranjitkumar Patil

Keyword(s):

Quality Of Life ◽

Head And Neck ◽

Performance Status ◽

Oral Submucous Fibrosis ◽

European Organization ◽

Group A ◽

Submucous Fibrosis ◽

And Performance ◽

Group B

Background and aims. Measuring quality of life in patients with oral submucous fibrosis is of utmost importance in assessing treatment outcomes. This study examined the impact of oral submucous fibrosis and its treatment on the quality of life and performance status of persons with oral submucous fibrosis.Methods. Quality of life was measured in patients with oral submucous fibrosis using the European Organization for Research and Treatment of Cancer Quality of Life head and neck 35 Questionnaire (EORTC QLQ-C35); performance status was measured by Performance Status Scale for Head and Neck Cancer Patients (PSS-HN), at four points in time: baseline, one month, two months and three months after start of treatment.Results. At the end of third month Group A and Group B showed 78% and 85% increase in mouth opening respectively. While the burning sensation of oral mucosa was decreased by 72% and 88% in group A and group B respectively (Z>1.96, P<0.05), there were significant differences in patients' quality of life and functioning at three points in time (P < 0.05).Conclusion. The European Organization for Research and Treatment of Cancer Quality of Life head and neck 35 Questionnaire and Performance Status Scale for Head and Neck Cancer Patients can be used successfully in potentially malignant disorders like oral submucous fibrosis. The results in this study will surely be a good guide forother studies on oral submucous fibrosis.

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Comparison of one-year prognosis of patients classified as chronic critical lower limb ischaemia according to TASC II or European consensus definition in the COPART cohort

VASA ◽

10.1024/0301-1526/a000432 ◽

2015 ◽

Vol 44 (3) ◽

pp. 0220-0228 ◽

Cited By ~ 4

Author(s):

Marion Vircoulon ◽

Carine Boulon ◽

Ileana Desormais ◽

Philippe Lacroix ◽

Victor Aboyans ◽

...

Keyword(s):

Medical Treatment ◽

Critical Limb Ischaemia ◽

Limb Ischaemia ◽

Medical Group ◽

Consensus Definition ◽

Transcutaneous Oxygen ◽

European Consensus ◽

Group A ◽

One Year ◽

Group B

Background: We compared one-year amputation and survival rates in patients fulfilling 1991 European consensus critical limb ischaemia (CLI) definition to those clas, sified as CLI by TASC II but not European consensus (EC) definition. Patients and methods: Patients were selected from the COPART cohort of hospitalized patients with peripheral occlusive arterial disease suffering from lower extremity rest pain or ulcer and who completed one-year follow-up. Ankle and toe systolic pressures and transcutaneous oxygen pressure were measured. The patients were classified into two groups: those who could benefit from revascularization and those who could not (medical group). Within these groups, patients were separated into those who had CLI according to the European consensus definition (EC + TASC II: group A if revascularization, group C if medical treatment) and those who had no CLI by the European definition but who had CLI according to the TASC II definition (TASC: group B if revascularization and D if medical treatment). Results: 471 patients were included in the study (236 in the surgical group, 235 in the medical group). There was no difference according to the CLI definition for survival or cardiovascular event-free survival. However, major amputations were more frequent in group A than in group B (25 vs 12 %, p = 0.046) and in group C than in group D (38 vs 20 %, p = 0.004). Conclusions: Major amputation is twice as frequent in patients with CLI according to the historical European consensus definition than in those classified to the TASC II definition but not the EC. Caution is required when comparing results of recent series to historical controls. The TASC II definition of CLI is too wide to compare patients from clinical trials so we suggest separating these patients into two different stages: permanent (TASC II but not EC definition) and critical ischaemia (TASC II and EC definition).

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