Comparison of Coronoidectomy With Coronoidotomy for Improving Maximum Incisal Opening in Patients With Oral Submucous Fibrosis

 

TAKE-HOME MESSAGE

  • A randomized controlled trial was conducted to compare coronoidectomy with coronoidotomy to improve mouth opening in oral submucous fibrosis (OSMF) patients. A total of 32 OSMF patients with grade III (moderately advanced with an interincisal opening between 15 and 25 mm) and grade IVa (advanced cases with 15 mm or less incisal opening) were randomized into two groups of 16 to undergo either coronoidectomy (surgical removal of the coronoid process) or coronoidotomy (surgical detachment of the coronoid process). Significant mouth opening was achieved in both groups, and the maximal incisal opening in both groups was comparable (approximately 30 mm in coronoidectomy group and 29 mm in coronoidotomy group at 1 year). The authors found a statistically significant difference in duration of surgery and volume of blood loss, with coronoidotomy requiring much less time (approximately 2 hours vs 3.5 hours) and leading to much less blood loss (approximately 90 mL vs 393 mL) compared with coronoidectomy.

  • Besides the cessation of betel quid and areca nut usage, release of fibrous bands, and physical therapy, moderate and advanced cases of OSMF may benefit from adjunct coronoidotomy with mouth opening outcomes comparable to those achieved with coronoidectomy and with less operating time and blood loss.
–  Satish S. Kumar, DMD, MDSc, MS    
PURPOSE

In the management protocol of the oral submucous fibrosis (OSMF), multiple studies have advocated that an additional step of coronoidectomy or coronoidotomy helps achieve better and more consistent postoperative results. But, there are no studies that validate if one has an advantage over the other. This study aimed to compare the outcome of the coronoidectomy with coronoidotomy for OSMF cases.

METHODS

A randomized controlled trial was designed in patients with OSMF requiring operative intervention. Patients were randomized into 2 groups based on a computer-generated randomization table: group I coronoidectomy and group II coronoidotomy. The primary predictor variables were the 2 different adjunct surgical steps - coronoidectomy and coronoidotomy. The primary outcome variable was the postoperative maximum incisal opening (MIO). Secondary outcome variables were duration of surgery and blood loss.

RESULTS

The study sample was composed of 32 patients (16 each group). Both the groups were comparable in terms of demographic profile. The MIO after surgery was comparable throughout the study between the groups. Repeated measures analysis of variance for comparison of mouth opening within the group showed that there was a significant improvement in postoperative MIO in both the groups (group I P value <.001 and group II P value 0.004). A statistically significant difference was found in the duration of the surgery (3.5 ± 0.73 hours vs 2.06 ± 0.87 hours) and blood loss (393 .75 ± 278.6 mL vs 90.62 ± 58.36 mL) with the shorter time and less blood loss in coronoidotomy compared with coronoidectomy. All these cases were followed for 1 year.

CONCLUSIONS

Coronoidotomy as an adjunctive treatment in OSMF provides comparable treatment outcome in terms of MIO compared with coronoidectomy with the added advantage of shorter operating time and less blood loss.

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