Systematic Review

The effectiveness of interpositional grafts in surgical management of advanced oral submucous fibrosis (OSMF): a systematic review with meta-analysis

¹ Department of Oral and Maxillofacial Surgery, Government Dental College and Hospital, Nagpur, Maharashtra, 440003, India
² Dean, Government Dental College and Hospital, Nagpur, Maharashtra, 440003, India

^* Correspondence: mehak.kataria1997@gmail.com

Received: 3 September 2024
Accepted: 16 January 2025

Abstract

Background: The management of OSMF aims to alleviate the signs and symptoms, such as burning sensation and release of the fibrotic bands to assist oral opening. Surgical excision of the fibrotic bands is the best choice in the treatment of advanced OSMF. Interpositional grafts are used to cover the raw surgical defects following the fibrotic bands' excision. They can be local (tongue flap, palatal island flap, buccal fat pad, nasolabial flap, and temporalis fascia flap) or distant (abdominal dermal fat graft, anterolateral thigh flap). This systematic review was conducted to evaluate which type of interpositional graft is effective in the surgical management of advanced oral submucous fibrosis. Material and method: A Literature search was performed in 12 electronic databases for articles published between 2000, and August 31, 2023. Two reviewers independently reviewed the articles. Ten articles (Non randomized controlled trial (NRCT)-5 and randomized controlled trial (RCT)-5) were selected based on the inclusion criteria. For NRCTs, Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies and ROB b tool for RCT were used to evaluate the risk of bias. Results: Ten studies were selected based on the inclusion and exclusion criteria. It included; 5 NRCTs and 5 RCTs. Meta-analysis was performed, and the mouth opening was greater in subjects treated with nasolabial flap than other flap designs at sixth month and 12th month follow up. However, the difference between the two groups was statistically non-significant (p = 0.19). The Buccal Fat pad flap also shows successful results but not statistically significant. Conclusion: The observations of this review can help enhance awareness among the healthcare professionals, and clinicians about recommending nasolabial flap as an interpositional graft in advanced OSMF cases making the best use of its advantages.