Oral Submucous Fibrosis(OSMF)
OSMF is a pre- cancerous condition and it occurs predominantly among Indians and even those settled outside India. The causative factors for the occurance of this disease are attributed to areca nut chewing, consumption of hot chilies and genetic predisposition of people of Indian subcontinent. There are more evidences to suspect that areca nut chewing is the main causative factor. OSMF can occur in all parts of oral mucosa.
Diode Laser in Treatment of OSMF
Laser stands for Light Amlification by Stimulated Emission of Radiation. Laser rays are coherent beam of rays that pack lot of energy compared to ordinary light. But the energy delivered can be controlled . There are many applications of Lasers and the characters of Laser rays find many application in surgery. The properties of lasers like reflection, absorption, transmission and scattering are all used for beneficial results in surgery. The Laser can reflect off a surface of the tissue depending on the tissue surface properties and can be absorbed in the tissue cells. In scattering it causes to diffuse the absorption over the large surrounding areas and because of this it is not possible to get precise incision by using this property.
Because of developments in Diode Laser technologies, it has found great applications in surgery due to improved power and precise controllability. It has found great applications in oral surgery practice as well as in other areas. By changing the wavelengths we can control the energy levels and other desired properties that determine incision quality and coagulation parameters.
Diode lasers built with semiconductor materials are portable and very compact in size and can be used in different modes such as pulsed or continuous mode. Diode laser surgery can be successfully used in surgical treatment of OSMF.
LASER PROCEDURE:
The operating team and patient are required to wear the protective eye wear. Ideally 0.3mm diameter cable is used to deliver the beam. Laser hand pieces are used to place the incision at required sites. Incisions are made from the retromolar area to premolar area. These incisions are of 2mm depth to reach the muscle layer while incising only fibrous mucosa and submucosal layer. The same type of incision is done in the region inferior to this starting at a distance one third of the superior incision in the third molar area upto earlier incision made to form the shape of inverted "Y".
Laser beam ideally 5 Watt power is directed. The excision of fibrous bands was followed by forcible separation of mucosa. Bilaterally placed incision was made and then the mouth forced open using Fergusson's mouth gag.
Venier calipers were used to measure the mouth opening. The mouth opening was measured for maxillary and mandibular incisors. The patients are trained on physiotherapy excercise ten days after surgery.
The clinical examination after surgery shows precision in incision and less postoperative edema and pain in patients of all age groups and varying degree of the condition.
The follow up examinations after surgery showed significant improvement in forced mouth opening and later after 10 days and three months these improvements are sustained for spontaneous mouth openeings.
There is no doubt that diode laser surgery is very effective and less invasive technique to treat OSMF and offers great relief to the terrible state the patients suffer because of this disease.
Before Laser Treatment, The limited mouth opening and fibrous buccal mucosa
After Laser Treatment, improved mouth opening and less fibrous buccal soft tissue
