Oral submucous fibrosis

Oral submucous fibrosis is a pre-cancer condition and it occurs predominantly occurs among Indians and even those settled outside India. The causative factors for the occurrence of this disease are attributed to areca nut chewing, tobacco chewing, consumption of hot chilles and genetic predisposition of people of Indian subcontinent. There are more evidences to suspect that areca nut chewing is the main causative factor. Submucous fibrosis can occur in all parts of oral mucosa.

Diode Laser in Treatment of Oral submucous fibrosis:
Laser stands for Light Amplification 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 energy 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 Submucous fibrosis.
 
Laser Procedure:
The operating team and the patient are required to wear the protective eye wear. Ideally 0.3 mm 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 were of 2 mm 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 third distance of superior incision in third molar area up to earlier incision made to form the shape of inverted “Y”.
 
Laser beam with 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.
 
Vernier calipers were used to measure the mouth opening. The mouth opening was measured from maxillary and mandibular incisors. The patients were trained on physiotherapy exercises after ten days after the surgery.
 
The clinical examination after the surgery shows precision in incision and less postoperative oedema and pain in patients of all age groups and varying degree of the condition.
 
The follow up examinations after the surgery showed significant improvement in forced mouth opening and later after 10 days and three months these improvement s were sustained for spontaneous mouth openings.
 
There is no doubt that diode laser surgery is very effective and less invasive technique to treat Submucous fibrosis and offers great relief to the terrible state the patients suffer because of this disease.