Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons · 2025
Role of Nasolabial Flap versus Platysma Myocutaneous Flap in Surgical Management of Oral Submucous Fibrosis: A Comparative Study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
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Agrawal Pallavi, Mishra Madan, Singh Gaurav, Mondal Shubhamoy, Kumar Das Manthan
Аннотация
BACKGROUND: Oral submucous fibrosis (OSF) is a chronic, insidious, and potentially malignant condition. The treatment is categorized into nonsurgical and surgical modalities based on the severity of the condition.
PURPOSE: The study purpose was to measure and compare maximum interincisal opening (MIO) between patients treated with extended nasolabial flap (NLF) and platysma myocutaneous flap (PMF) in the surgical management of OSF.
STUDY DESIGN, SETTING, SAMPLE: This was a prospective cohort study conducted on patients attending the outpatient department of the Department of Oral and Maxillofacial Surgery, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow (India). Patients presented with limited mouth opening with palpable intraoral fibrotic bands, histopathologically diagnosed as OSF group III (interincisal opening 15-25 mm) and group IVa (interincisal opening 2-15 mm), and aged 18 years or above were included in this study. Patients with malignant transformation (Khanna and Andrade classification group IVb) with the habit of smoking or chewing tobacco or alcohol consumption, history of radiation, history of previous surgery, use of other drugs, or pathology and who were not fit for the procedure under general anesthesia were excluded from the study.
PREDICTOR VARIABLE: The predictor variable was operative management and subjects were divided into 2 groups using the simple random sampling method. Extended NLF was used in group NLF patients and PMF in group PMF patients.
MAIN OUTCOME VARIABLES: The main outcome variable was functional result and measured using MIO on the 1st day, 3rd day, 7th day, 14th day, 21st day, 1st month, 3rd month, 6th month, and 1st year postoperatively. Secondary outcome variables were intraoperative time, pain, presence of infection, wound dehiscence, postoperative facial scar, and relapse.
COVARIATES: The OSF group variation, age, and sex of the patient were the covariates.
ANALYSES: To determine the difference in frequency of events in different groups, χ2 test was used, and to test the equality of 2 means, one way analysis of variance test was used. The level of statistical significance was set at 0.05 (P value < .05).
RESULTS: A total of 20 patients (14 males and 6 females) were included in this study, with 10 in each group, with the mean age of 34.10 ± 5.40 years. At the 1-year follow-up, it was observed that group NLF had a mean MIO of 35.20 ± 0.63 mm and for group PMF, it was 35.30 ± 0.67 mm (P = .7). The mean intraoperative time for group PMF patients was greater (167.40 ± 4.01 minutes) than for group NLF patients (138.30 ± 3.80 minutes), and the difference was statistically significant (P < .0001). Postoperative facial scar was present in group NLF patients, which gradually became inconspicuous over time, and it was absent in group PMF patients (P < .0001).
CONCLUSION AND RELEVANCE: Maximum interincisal opening achieved in both groups was comparable and statistically insignificant. However, intraoral hair growth and extraoral facial scars were major concern for patients in the NLF group.
PURPOSE: The study purpose was to measure and compare maximum interincisal opening (MIO) between patients treated with extended nasolabial flap (NLF) and platysma myocutaneous flap (PMF) in the surgical management of OSF.
STUDY DESIGN, SETTING, SAMPLE: This was a prospective cohort study conducted on patients attending the outpatient department of the Department of Oral and Maxillofacial Surgery, Sardar Patel Postgraduate Institute of Dental and Medical Sciences, Lucknow (India). Patients presented with limited mouth opening with palpable intraoral fibrotic bands, histopathologically diagnosed as OSF group III (interincisal opening 15-25 mm) and group IVa (interincisal opening 2-15 mm), and aged 18 years or above were included in this study. Patients with malignant transformation (Khanna and Andrade classification group IVb) with the habit of smoking or chewing tobacco or alcohol consumption, history of radiation, history of previous surgery, use of other drugs, or pathology and who were not fit for the procedure under general anesthesia were excluded from the study.
PREDICTOR VARIABLE: The predictor variable was operative management and subjects were divided into 2 groups using the simple random sampling method. Extended NLF was used in group NLF patients and PMF in group PMF patients.
MAIN OUTCOME VARIABLES: The main outcome variable was functional result and measured using MIO on the 1st day, 3rd day, 7th day, 14th day, 21st day, 1st month, 3rd month, 6th month, and 1st year postoperatively. Secondary outcome variables were intraoperative time, pain, presence of infection, wound dehiscence, postoperative facial scar, and relapse.
COVARIATES: The OSF group variation, age, and sex of the patient were the covariates.
ANALYSES: To determine the difference in frequency of events in different groups, χ2 test was used, and to test the equality of 2 means, one way analysis of variance test was used. The level of statistical significance was set at 0.05 (P value < .05).
RESULTS: A total of 20 patients (14 males and 6 females) were included in this study, with 10 in each group, with the mean age of 34.10 ± 5.40 years. At the 1-year follow-up, it was observed that group NLF had a mean MIO of 35.20 ± 0.63 mm and for group PMF, it was 35.30 ± 0.67 mm (P = .7). The mean intraoperative time for group PMF patients was greater (167.40 ± 4.01 minutes) than for group NLF patients (138.30 ± 3.80 minutes), and the difference was statistically significant (P < .0001). Postoperative facial scar was present in group NLF patients, which gradually became inconspicuous over time, and it was absent in group PMF patients (P < .0001).
CONCLUSION AND RELEVANCE: Maximum interincisal opening achieved in both groups was comparable and statistically insignificant. However, intraoral hair growth and extraoral facial scars were major concern for patients in the NLF group.