Comparison of intralesional hydrocortisone and hyaluronidase injection to surgical repair in manging the oral submucous fibrosis: A prospective clinical study

Background: One of the most prevalent and common premalignant disorders having high potential to turn into malignancy is Oral submucous fibrosis (OSMF). OSMF is associated with the chewing of betel quid and is commonly seen in India with a mean prevalence of 13% and a range of 0-4% based on the geographical areas. Objective: The present study was conducted to compare and assess the effectiveness of two treatment methods to treat OSMF of different grades to assess signs and symptoms and improvement of mouth opening. Also, the study compared intralesional hyaluronidase with Dexamethasone to Z- plasty surgery concerning efficacy and mouth opening improvement. Material and Method: The study included a total of 88 subjects with OSMF with varied grades. The study subjects were within the age range of 20-40 years and the mean age of 27.6±4.68 years. The subjects were divided into two groups where subjects of Group I were treated with iron and nutritional supplements in addition to Hyaluronidase and Dexamethasone as an intralesional injection, topical Triamcinolone Acetonide 0.1%., and Placentrex, whereas, Group II subjects were treated with nasolabial flap repair and Z-plasty. At preoperative assessment and the postoperative follow-up of 1 and 3 months, pallor, oral mucosal blanching, painful ulcerations, burning sensation, and mouth opening were assessed and compared. Result: Systemic as well as local therapy including iron and nutritional supplements with the injection of Dexamethasone, Hyaluronidase, and topical Triamcinolone Acetonide 0.1% caused significant improvement in subjects with OSMF. In Grade III subjects, where non-surgical treatment was not effective, surgical therapy showed acceptable results with highly significant mouth opening. Significant reduction in discomfort and severity was seen with pallor, mucosal blanching, painful ulcers, and burning sensation seen in few subjects. Conclusion: The present study concludes that surgical as well as conservative management therapy helps in reducing the intensity and grading of OSMF. Also, counseling to break habits in students can decrease OSMF prevalence