Edward Chengchuan KO
ko.edward.kaseizen@gmail.com
ko.edward.kaseizen@gmail.com
Division of Oral and Maxillofacial Surgery, Kaohsiung Medical
University Hospital, Kaohsiung, TAIWAN
Dept. of FUJISOFT Cartilage and Bone
Regeneration, Tissue Engineering, The University of Tokyo, Tokyo, JAPAN
Backgrounds
Submucous fibrosis, is associated with the use of betel nut-slake lime
preparations. This entity may be severe and produce a significant limitation of
jaw opening. It is thought to be due to the Areca catecha component in the
betel nut, which is known specifically to stimulate collagen synthesis. Marx RE
advocates that the only two effective approaches to submucous fibrosis are (I)
no treatment with follow-up and discontinuation of the betel
nut-slake lime habit (behavior modification), and (2) total excision with soft
tissue myocutaneous or free microvascular flaps transposing viable elastic
skin. Approaches using injections of steroids,
chymotrypsin, hyaluronidase or alcohol, and surgeries using mucosal or
nonvascularized split-thickness skin grafts have not only been ineffective but
have often worsened the condition with added scar tissue. Headache over the
bilateral temporal areas might also limit the effect of post-operative mouth
opening exercise. Since the expression of the mucosa actually is determined by
the signal from the underlying connective tissue, most the skin graft would
eventually become scar. With high morbidity of the recipient site of vascularized
free flap, we actually could not agree with Marx’s protocol.
Protocol
My protocol is
(1) Coronoidotomies
(2) Stripping off the temporalis muscle and tendon from the ramus
(3) few multiple tiny incisions
(4) Autogenous fat grafting
(5) Mouth opening exercise
(6) intraoperative and postoperative botulism toxin injection
(7) post-op acupuncture.
(1) Coronoidotomies
(2) Stripping off the temporalis muscle and tendon from the ramus
(3) few multiple tiny incisions
(4) Autogenous fat grafting
(5) Mouth opening exercise
(6) intraoperative and postoperative botulism toxin injection
(7) post-op acupuncture.
Results and Perspectives
Postoperative result according to this new protocol shows
satisfactory regarding the mouth opening dimension as well as the elasticity of
the soft tissue. Limited numbers of patients made no statistical conclusion as
far. Multicenter studies might be required. Further molecular marker studies shall
be investigated as well.
Keywords: trismus, submucous fibrosis, oral submucous fibrosis, coronoidotomy, mouth opening exercise, autogenous fat grafting, botulism toxin injection, acupuncture
Keywords: trismus, submucous fibrosis, oral submucous fibrosis, coronoidotomy, mouth opening exercise, autogenous fat grafting, botulism toxin injection, acupuncture
