ORAL SUBMUCOUS FIBROSIS - efficacy of conservative management with Hydrocortisone &Hyaluronidase against Dexamethasone & Hyaluronidase against Triamcinolone & Hyaluronidase

Oral sub mucous fibrosis is a chronic debilitating disease of the oral cavity characterized by inflammation and progressive fibrosis of the sub mucosal tissues (lamina propria and deeper connective tissues). Oral sub mucous fibrosis results in marked rigidity and an eventual inability to open the mouth. The buccal mucosa is the most commonly involved site, but any part of the oral cavity can be involved, even the pharynx. The condition is well recognized for its malignant potential and is particularly associated with areca nut chewing, the main component of betel quid. Betel quid chewing is a habit practiced predominately in Southeast Asia and India. Objectives of our study was to study the efficacy of intraoral injections of steroids; hydrocortisone, dexamethasone, triamcinolone along with Hyaluronidase and assess and compare the extent of clinical improvement. A prospective randomized study was conducted on 30 cases of oral sub-mucous fibrosis reporting to the department of ENT, in a tertiary care hospital, for a period of one and half year from 1st October 2012 to 30th April 2014.The complete data was collected from the patients in a case record form by taking history of illness, detailed clinical examination and relevant investigation. Patients were divided into three groups of 10 each randomly and were given intraoral injections in the reteromolar trigone. Patients in Group A were treated with hydrocortisone and hyaluronidase, Group B with dexamethasone and hyaluronidase, and Group C with triamcinolone and hyaluronidase at weekly intervals for 12 weeks. Treatment outcome was evaluated on the basis of improvement in symptoms, signs and clinical improvement. Majority of our patients had excellent results when compared to the initial symptoms, Burning sensation showed excellent results in all the three groups A, B, C with 100%,90%,and 100% improvement. There was relief from ulceration and vesiculation of 100% of cases in group A and C, compared with 75% in group B. Decrease in fibrous bands was seen in 90% of patients in group C, compared to 80% and 66.6% in group A and B respectively. While 90% of patients in group C had good improvement in mouth opening, only 77.7% had improvement in group A & B. Overall results were very significant in group C (95%) and then group A (87%) compared to group B (80%). The malady of sub-mucous fibrosis is one of the most poorly understood and unsatisfactorily treated diseases. This is mainly because an exact etiology has not been identified, although considerable data has been accrued over the years in support of the role of areca nut. Symptoms such as burning sensation in the oral cavity and progressive difficulty in mouth opening can be disturbing and distressing to the patient. Innumerable modalities of treatment have been tried ranging from vitamin supplements, topical steroid applications to sub-mucosal steroid injections. We recommended a combination of multi vitamins, iron and topical triamcinolone gel, daily massage of the affected area, along with sub-mucosal injections of steroids and hyaluronidase. This achieved a good results.