Abstract
Various management modalities have been studied for oral submucous fibrosis (OSMF), including intralesional injections of corticosteroids with hyaluronidase, placental extract, collagenase, oral antioxidants, nutritional supplements, pentoxifylline, stem cell therapy and muscle relaxants. Given the high prevalence of OSMF in India, we aimed to evaluate the efficacy of combination therapy. A randomized controlled study included participants suffering from symptoms suggestive of OSMF. Group A was the control group which received intralesional triamcinolone and hyaluronidase injections while Group B was the study group which received oral muscle relaxant along with intralesional injections. Patients were assessed for burning sensation of oral cavity, trismus and clinical staging of oral mucosa at beginning of the study and at 4th and 8th week of the study. In group A, eight patients (28.6%) and 16(57.1%) patients showed complete improvement of burning sensation of oral cavity at 4th and 8th week respectively. In group B 6(23.1%) patients and 15(57.7%) patients had complete remission at 4th and 6th week respectively. The grade of trismus was reduced to 2 in 15 (53.6%) patients and to 1 in 12 (42.9%) patients in group A at 8th week. In Group B, 24 (92.3%) patients showed improvement in trismus to grade 1 and 2 (7.7%) patients had grade 2 trismus at the end of 8 weeks. In group A, the clinical staging improved to 1 in 19(67.9%) patients, to stage 2 in 3(10.7%) patients and 6(21.4%) patients showed complete remission. In group B, 14(53.8%) patients reverted to normal clinical appearance, 10(38.5%) patients to stage 1 and only 2(7.7%) patients showed no much improvement. In conclusion, addition of oral muscle relaxant with combination of intralesional steroids and hyaluronidase injection has better outcome than intralesional injections alone.