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osmf.pptx Oral h prosthodontics impla h na
- 1. Case Presentation Presented By: Dr. Tamanna Jamwal 2nd year Resident OMFS Department of Oral & Maxillofacial Surgery Guided By: Dr. Vikas Kunwar Singh Sir Professor and HOD Dept. of OMFS, MGDCH
- 2. Patient Details Patient Name: Santosh Age/ Gender: 21/F Vitals: B.P.: 128/72mmHg SpO2: 98% Temperature: Afebrile
- 3. Chief Complain Patient reported to the department of oral & maxillofacial surgery with chief complain of reduced mouth opening and burning sensation since 3-4 years.
- 4. Past Medical History Patient had the H/O Autoimmune Heamolytic Anemia, for which she underwent the treatment and stopped the treatment 1 year before. H/O blood transfusion 1 year back. No h/o HTN/ DM/ TB/ Cough/ Breathing difficulty/ Fever present.
- 5. Past Dental History Patient had no H/O any dental procedure.
- 6. Personal History Patient gave the H/O supari chewing since 6-7 years. ( 1-2 packet daily)
- 7. On Examination SYMPTOMS- Reduced mouth opening Burning Sensation upon consumption of spicy foodstuff. Dryness of mouth Difficulty in swallowing SIGN- B/L Blanching of oral mucosa B/L fibrous bands present (vertical) Trismus Restricted tongue movement Depapillation of tongue Inability to blow/whistle
- 8. Diagnosis Oral Submucous Fibrosis (Grade 3) with Autoimmune Heamolytic Anemia.
- 9. Investigations Haematological: Routine blood Investigations Viral Markers COVID-19 RT-PCR - Negative HRCT- CORAD- 2
- 10. Treatment Plan Fibrotomy and coverage of defect with buccal fat pad and amniotic membrane.
- 13. Procedure Patient shifted to OT intubated, painted and draped. Releasing incision from angle of the mouth to RMT region bilaterally. Blunt dissection was carried out through the buccinator muscle B/L to reach the buccal extension of the buccal fat pad. The buccal fat pad was then gently teased into the defect, taking care not to rupture its delicate capsule
- 14. Adequate volume of the graft was harvested to ensure tension-free closure. 3-0 Vicryl was used to suture the graft to the periphery of the defect on the right side and posteriorly on left side. The left anterior region defect was sutured with Lyophilized (Freeze-dried) Amniotic Membrane. Hemostasis achieved.
- 15. Discussion By Pindborg JJ & Sirsat S.M- OSMF is an insidious chronic disease affecting any part of the oral cavity and sometimes the pharynx. Although, occasionally preceeded by and/or associated with vesicle formation, it is always associated with juxta epithelial inflammatory reaction, followed by a fibroelastic change of the lamina propria, with epithelial atrophy leading to stiffness of the oral mucosa and causing trismus and inability to eat.
- 18. Classification Pindborg JJ 1989 Stage I- Stomatitis; erythematous mucosa, vesicles, ulcers, petechiae Stage II- Fibrosis in healing vesicles and ulcers; blanching, palpable bands, mottled marble like appearance Stage III- Sequelae of OSMF; Leukoplakia, speech and hearing deficit
- 19. Lai DR 1995 Based on interincisal distance Group 1- >35mm Group 2- between 30 and 35mm Group 3- between 20 and 30mm Group 4- <20mm Haider SM (2000) Clinical stage: Stage I: faucial bands only StageII: faucial and buccal bands Stage III: Faucial, buccal and labial bands
- 20. Treatment 1. Restriction of habits 2. Corticosteroids 4. Hyaluronidase 3. Placental Extracts 5. Nutritional support 6. Physiotherapy 7. Surgical treatment: cutting the fibrotic bands resulted in more fibrosis and disability. Excision of fibrotic tissues and covering the defect with split thickness skin, fresh human amnion or buccal fat pad (BFP) grafts have been applied to treat OSMF.
- 21. Various types of grafts are available, from mucosal autografts to allogenic collagen membranes, split skin grafts with following limitations such as donor site morbidity, intensity of pain, difficulty in harvesting, infection and rejection of grafts Human amniotic membrane (AM) is the innermost layer of the fetal membrane and is composed of three layers: an epithelial monolayer, a thin basement membrane, and the thick stroma that is similar to the oral mucosa.
- 22. AM has been shown to have anti-inflammatory and antimicrobial effects in addition to antifibroblastic and antiangiogenic effects, and it has been reported to reduce scarring. AM can also produce a wide array of growth factors, provide a healthy new substrate suitable for re-epithelialization, and promote epithelial healing