Importance of Coronoidotomy and Masticatory Muscle Myotomy in Surgical Release of Trismus Caused by Submucous Fibrosis

Abstract

Thirty patients with trismus resulting from betel nut chewing-induced oral submucous fibrosis were treated with either fibrotic tissue release only (group I) or fibrotic tissue release in combination with masticatory muscle myotomy and coronoidotomy (group II). The latter procedures were only performed in patients whose intraoperative interincisal distance remained less than 35 mm immediately after submucous fibrous tissue release. There were eight and 22 patients in groups I and II, respectively. In group I patients, the average intraoperative interincisal distance improved from 19.5 mm to 42 mm. In group II patients, the average intraoperative interincisal distance improved from 13.5 mm to 27 mm after fibrotic tissue release and further improved to 40 mm after masticatory muscle myotomy and coronoidotomy. At an average follow-up of 22.1 months (range, 7 to 70 months), the group I and II patients had an average interincisal distance of 41.5 mm (range, 35 to 50 mm) and 32.9 mm (range, 20 to 42 mm), respectively. These results demonstrate the efficacy of submucous fibrotic tissue release in treating trismus resulting from betel nut chewing-induced submucous fibrosis and confirm the role of additional masticatory muscle and coronoidotomy in treating its severe forms.

Bipaddled radial forearm flap for the reconstruction of bilateral buccal defects in oral submucous fibrosis

“…Although the need of routine masticatory muscle myotomy and coronoidotomy is controversial 16 , the present results agree with previous reports showing that they are important in treating advanced oral submucous fibrosis 2,10 . During the follow-up period, a 7.3-mm decrease in mouth opening size was noted, and can be attributed to the poor compliance of some patients and more severe form of the disease in this series.…”

“…In 2001, WEI et al were the first to use free flaps (bilateral small radial forearm flaps) for the reconstruction of buccal mucosa after surgical release of submucous fibrosis with great success 14 . They also emphasized the importance of coronoidotomy and masticatory muscle myotomy and postoperative rehabilitation in the prevention of relapse due to postoperative inactivity and scarring 2,7 . In this paper, a modified technique, free bipaddled radial forearm flap using only one forearm donor site to reconstruct the bilateral exposed buccal defects, is described.…”

“Bilateral Coronoidotomy in Conjunction With Submucous Fibrous Bands Release As A Treatment Modality for Oral Submucous Fibrosis”

“…The importance of coronoidectomy and masticatory muscle myotomy and postoperative rehabilitation was also emphasized by Canniff and Harvey (1986), Khanna and Andrade 14 (1995) followed by Yang-Ming Chang 4 (2004) in the prevention of relapse due to postoperative inactivity and scarring 4,14 .The mean pre-operative interincisal distance (ID) in all ten OSMF cases of our study were 15.2 mm as compared to 7-24 mm (mean: 15.5 mm) in study by Yang-Ming Chang et al and 14.7mm in study by M.C. Kothari et al…”

“…Conservative treatment for initial stages of OSMF includes vitamins, iron supplements, intralesional injections of hyaluronidase, placental extracts and steroids 3 . Submucosal injections of various drugs may produce temporary symptomatic relief 4 but can lead to aggravated fibrosis, pronounced trismus and increased morbidity, from the mechanical injury secondary to insertion of the needle and chemical irritation from the drug 3,5 . Various surgical procedures have been proposed to address trismus by different authors with variable success rates.…”

A Brief Review of Common Oral Premalignant Lesions with Emphasis on Their Management and Cancer Prevention

“…Surgical treatment is indicated in patients with severe trismus and/or biopsy results revealing dysplastic or neoplastic change. Surgical modalities that have been used include simple excision of the fibrous bands, split-thickness skin grafting following bilateral temporalis myotomy or coronoidectomy, and nasolabial flaps and lingual pedicle flaps [30,31].…”