Abstract
Introduction
A prospective study was conducted to find out an effective alternative in the form of non-vascularized abdominal dermal fat graft (ADFG) and to compare its efficacy with the vascularised nasolabial flap (NLF) for the treatment of oral submucous fibrosis (OSMF).
Method
Comparative study comprising of 30 patients with Grade 3 and 4A OSMF, randomly divided into 2 groups: Group A (ADFG) and Group B (NLF). They were evaluated for mouth opening (MO), graft uptake, time taken for mucosalization, pain, intercommissure distance (ICD), scar, duration of surgery (DOS), patient satisfaction and thickness of masseter muscle on ultrasonography.
Findings.
At 6 months, MO improved by 22.4 and 36.2 mm in Group A and Group B, respectively. There was statistically significant difference (p < 0.05) seen for the values between the groups for all the parameters except for ICD and VAS score, which was statistically insignificant (p > 0.05). Intraoral hair growth, facial scar, orocutaneous fistula and commissure tear was seen in Group B. Complete necrosis of graft followed by recurrence was seen in three cases in Group A.
Conclusion
NLF holds better as compared to ADFG in the management of OSMF. However, the cornerstone of success remains habit cessation and aggressive physiotherapy. The limitations of the study are small sample size and short duration of follow-up.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Pindborg JJ, Sirsat SM (1966) Oral submucous fibrosis. Oral Surg Oral Med Oral Pathol 22(6):764–779. https://doi.org/10.1016/0030-4220(66)90367-7
More CB, Gavli N, Chen Y, Rao NR (2018) A novel clinical protocol for therapeutic intervention in oral submucous fibrosis: an evidence-based approach. J Oral MaxillofacPathol 22(3):382–391
Yeh CJ (1996) Application of the buccal fat pad to the surgical treatment of oral submucous fibrosis. Int J Oral Maxillofac Surg 25(2):130–133. https://doi.org/10.1016/s0901-5027(96)80058-0
Borle RM, Nimonkar PV, Rajan R (2009) Extended nasolabial flaps in the management of oral submucous fibrosis. Br J Oral Maxillofac Surg 47(5):382–385. https://doi.org/10.1016/j.bjoms.2008.08.019
Chow S, Shao J, Wang H. 2008 Sample size calculations in clinical research. 2nd Ed. Chapman & Hall/CRC Biostatistics Series. p 89
More CB, Gupta S, Joshi J, Varma SN (2012) Classification system for oral submucous fibrosis. J Indian Acad Oral Med Radiol 24(1):24–29
Fearmonti R, Bond J, Erdmann D, Levinson H (2010) A review of scar scales and scar measuring devices. Open Access J plast Surg 10:254–363
Gachabayov M, Latifi R (2019) Patient satisfaction following thyroidectomy in surgical mission: a prospective study. Gland Surg 8(4):385
Prajapati K, Chawda J, Thakkar M, Gajera N, Thakkar R, Thakkar J (2021) Oral submucous fibrosis in North Gujarat: a demographic study. Int J PrevClin Dent Res 8(1):9
PAYMASTER JC (1956) Cancer of the buccal mucosa; a clinical study of 650 cases in Indian patients. Cancer 9(3):431–435
Srivastava R, Jyoti B, Pradhan D, Siddiqui Z (2019) Prevalence of oral submucous fibrosis in patients visiting dental OPD of a dental college in Kanpur: a demographic study. J Family Med Prim Care 8(8):2612–2617. https://doi.org/10.4103/jfmpc.jfmpc_465_19
Kumar NG, Thapliyal GK (2012) Free dermal fat graft for restoration of soft tissue defects in maxillofacial surgery. J Maxillofac Oral Surg 11(3):319–322. https://doi.org/10.1007/s12663-012-0358-6
Kholakiya Y, Jose A, Rawat A, Nagori SA, Jacob S, Roy choudhury A. (2020) Surgical management of oral submucous fibrosis with “Seagull-nasolabial flap” combined with short-term oral pentoxifylline for preventing relapse. J Stomatol Oral Maxillofac Surg 121(5):512–516. https://doi.org/10.1016/j.jormas.2019.12.015
Kshirsagar R, Chugh Modi A, Rai A (2010) Bilateral inferiorly based nasolabial flaps for the management of advanced oral submucous fibrosis. J Maxillofac Oral Surg 9(1):22–26. https://doi.org/10.1007/s12663-010-0008-9
Tauro D (2009) A unique melolabial flap in the surgical management of oral submucous fibrosis- “the sea gull flap”-an experience with 85 cases. I J Oral Maxillofac Surg 38(5):508. https://doi.org/10.1016/J.IJOM.2009.03.400
Bellini E, Grieco MP, Raposio E (2017) The science behind autologous fat grafting. Ann Med Surg (Lond) 24:65–73. https://doi.org/10.1016/j.amsu.2017.11.001
Mashiko T, Yoshimura K (2015) How does fat survive and remodel after grafting? ClinPlast Surg 42(2):181–190. https://doi.org/10.1016/j.cps.2014.12.008
Gupta S, Patel MAR, Haneef M, Ahmed S, Arshi J (2021) Bilateral nasolabial flap and Buccal fat pad flap for reconstruction of fibrotomy defect in surgical management of stage III/IV oral submucous fibrosis (OSMF)–a comparative study. J Oral Med Oral Surg Oral Pathol Oral Radiol 7(2):112–118. https://doi.org/10.18231/j.jooo.2021.022
Rai A, Datarkar A, Rai M (2014) Is buccal fat pad a better option than nasolabial flap for reconstruction of intraoral defects after surgical release of fibrous bands in patients with oral submucous fibrosis? A pilot study: a protocol for the management of oral submucous fibrosis. J Craniomaxillofac Surg 42(5):e111–e116. https://doi.org/10.1016/j.jcms.2013.07.006
Anehosur V, Singh PK, Dikhit PS, Vadera H (2021) Clinical evaluation of buccal fat pad and nasolabial flap for oral submucous fibrosis intraoral defects. Craniomaxillofac Trauma Reconstr 14(3):196–200. https://doi.org/10.1177/1943387520962264
Wolford LM, Morales-Ryan CA, Morales PG, Cassano DS (2008) Autologous fat grafts placed around temporomandibular joint total joint prostheses to prevent heterotopic bone formation. Proc (BaylUniv Med Cent) 21(3):248–254. https://doi.org/10.1080/08998280.2008.11928404
Kantanen DJ, Closmann JJ, Rowshan HH (2010) Abdominal fat harvest technique and its uses in maxillofacial surgery. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 109(3):367–371. https://doi.org/10.1016/j.tripleo.2009.09.037
Agarwal M, Gupta DK, Tiwari AD (2011) Extended nasolabial flaps in the management of oral submucous fibrosis. J Maxillofac Oral Surg 10(3):216–219. https://doi.org/10.1007/s12663-011-0236-7
Yadav AO, Vanza BH, Borle RM, Joglekar KA (2013) Custom made protective appliance for oral submucous fibrosis. J Maxillofac Oral Surg 12(4):472–474. https://doi.org/10.1007/s12663-012-0406-2
Devathambi JR, Aswath N (2013) Ultrasonographic evaluation of oral submucous fibrosis and masseteric hypertrophy. J Clin Imaging Sci 3(Suppl1):12. https://doi.org/10.4103/2156-7514.124057
Chakarvarty A, Panat SR, Sangamesh NC, Aggarwal A, Jha PC (2014) Evaluation of masseter muscle hypertrophy in oral submucous fibrosis patients -an ultrasonographic study. J ClinDiagn Res 8(9):ZC45–ZC47. https://doi.org/10.7860/JCDR/2014/8892.4857
Acknowledgments
I thank Dr Dheeraj Kalra for his useful statistics and suggestions.
Funding
This study was not supported by any funding.
Author information
Authors and Affiliations
Contributions
JK did all preoperative preparations, history taking, post-operative care, proper follow up, maintained the records & prepared the first draft of the manuscript along with subsequent editing & formatting, JD and SA performed the surgeries, drafted the study conception & design & reviewed the entire paper critically for important intellectual content, revision & editions, UB reviewed the paper & suggested editions accordingly. PD & AN positively contributed to write the paper.
Corresponding author
Ethics declarations
Conflict of interest
None of the authors have any conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kania, J., Dhuvad, J., Anchlia, S. et al. Abdominal Dermal Fat Graft Versus Nasolabial Flap in Oral Submucous Fibrosis: A Randomized Clinical Trial. J. Maxillofac. Oral Surg. (2022). https://doi.org/10.1007/s12663-022-01741-2
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s12663-022-01741-2