OSF is a disease that involves progressive submucosal fibrosis and severe reduction of mouth opening due to the fibrosis that causes palpable vertical bands in the mucosa. Various modes of treatment have been used with variable rates of success. Mechanical/physical exercise if successful would be the best form of treatment. There is not much information on the long term effects of such mechanical manipulation and their success rates. I would like to know colleagues opinion and experience on this.
Madam,
In oral submucous fibrosis (OSMF), fibrous bands restrict mouth opening for speech and eating. The treatment of OSMF remains unclear, surgical and pharmacological treatments have less success. Few studies have shown that forceful mouth using ice cream sticks for a period of 1 to 3months (physiotherapy) is effective for increasing the oral opening.
I do not think so because the collagen is irreversibly formed and cannot be destroyed. it can increase the inflammation and cause more fibrosis.
Dear Manjunath and Rajan,
Good answers both are correct in my opinion.
The fibrous bands in OSF align themselves in a direction that is vertical and essentially resemble tendons. This alignment is against the forces and in the direction of mouth opening. So I wonder about the efficacy of additional force in the same direction. While it might work in the short term what would be the effect in the long term.
Also is there a difference with the type of exercise. Would blowing be more effective than opening and closing exercises in your opinion and/or experience?
osmf is actually irreversible. but at the initial stages we can reverse condition by hylase(lyse the band)+intralesioanal steroid injection and continues mouth opening excercise.
Very true Sumsum.. OSF is irreversible. Many forms of treatment are tried and among them mouth opening exercises are often mentioned. However, there are not many studies that show the long term effect of the mouth exercises.
In my experience, mouth opening exercises are hopeless as primary treatment, but absolutely vital after surgical release (either with split skin graft, or buccal fat flap). If patient doesn't exercise vigorously from the first postoperative day, all effect is lost and situation becomes even worse in a matter of days. Exercise must go on for at least 1/2 year. Unfortunately, few patients are compliant with that.
Physiotherapeutic exercises are an adjunct in treating OSMF. It cant be mainstay therapy. There is a study in JOPM 2009 which discusses its therapeutic benefits....
We try intra lesional injections of placental extract ( placentrix ) and steroids . And advise mouth opening exercises to help additionally. But as you all agree it is irreversible and any injury to the mucosa can increase fibrosis. Thank you.
this can only give a very modest improvement which is not sustainable
It is not just the vertical alignment of collagen fibres but extensive cross linking / inter locking by excessive copper (from areca nut) in subepithelial tissues which is so refractory to treatment. No well defined data exists as to how much force can be safely used . High end dyanometric studies can be an area of interest to objectively clarify the magnitude of forces for various patient subsets. Any undue force can damage the TMJ or teeth.
Yes Shoaib, Logically it always seem like a good treatment option. Yet there are too many unanswered questions on the ways and extents of the exercise.
I would definitely not consider forceful mouth opening as a possible treatment. However mouth opening and other exercises without the use of force need to be tried or better reported if already done.
Right now there is just this suggestion with no specific report of exercise to be used or outcome to expect.
Oral submucous fibrosis is a potentially malignant disorder mainly caused due to are arecanut chewing due to the presence of tannins and arachiodonic acid which stimulates the production of fibroblasts hence more collagen fibers are produced. The treatment options are medical and surgical.when the mouth opening is very less like one finger breath or very less interincisal distance like less than 20mm ,usually surgical splitting is advised which can be conventional surgical methods or advanced like laser ,electro cautery etc.,forceful mouth opening exercises are advised mainly with mouth gag to promote muscle lengthening following surgery for about five times in a day which helps in improving their interincisal distance for a period of one month after 3weeks following surgery
Thank you Umamaheshwari, I am looking for individual experience with mouth opening exercises, how well did it work, how often and what type of exercise is advised.
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