LAUSR

Oral submucous fibrosis (OSMF) is an oral potentially malignant lesion characterized by inflammation and progressive fibrosis of the submucosal tissues, resulting in marked rigidity and trismus [1]. Severe trismus and pain due to common dental diseases resulting from poor oral hygiene are the usual reasons for patients to seek surgical intervention. Surgical intervention ranges from buccal band release/fibrotomy, muscle stripping, myotomy, and coronoidectomy to reconstruction with skin graft, buccal fat pad, or nasolabial flap. A commonly faced problem post-reconstruction is cheek or flap biting in the posterior teeth region which can lead to flap necrosis or cheek ulceration. This may be attributed to decreased cheek pliability and edema post-surgery which is further complicated by trauma from occlusion. Many of the OSMF patients have sunken cheeks with reduced cheek fullness and poor pliability of tissues. Once the cheek biting starts, the inflammation increases and the edematous tissue faces further trauma leading to a vicious cycle. We usually ask the patient to blow cheeks in addition to vertical active mouth opening exercises postoperatively. Despite this lot of our patients report with cheek biting and ulcerations in posterior cheek mucosa. We routinely extract third molars in our cases, but the last standing teeth start impinging the inflamed mucosa, which are usually the second molars. In our experience, this not only delays the soft-tissue healing, but decreases patient compliance during postsurgery exercises, as well. Various solutions have been proposed in literature including TMJ Trainers [2], Borle’s appliance [2], and modified oral screen [3]. These appliances are made after taking dental impressions and use acrylic for fabrication. We faced similar problems in our post-surgical patients and hereby proposed the use of a very simple, fast, and easy to fabricate alternative using an elastomeric polyvinylsiloxane (PVS) putty impression material to fabricate an oral shield. This is a two-component system with a base and a catalyst which is mixed wearing vinyl gloves and adapted in form of a screen in the posterior buccal and retromolar region with close adaptation to the teeth. Particular care should be taken to extend the shield beyond the last standing tooth and this is done by pre-contouring the putty. Then, the patient is asked to close mouth and cheek/ lip molding movements are done and the material is allowed to set. This shield can be made on either or both the sides as per the requirement. The patient is asked to wear it at all times except during eating food (Fig. 1a, b). Since the material adapts well to the cheek and retromolar region and is relatively soft and elastic in nature compared to acrylic, the compliance in wearing the appliance is much better. Also the lack of any metallic component or bar in the esthetic region improves the compliance. Another significant advantage is that there is no need of making dental impressions which might be an inconvenience due to limited mouth opening or pain. This & Shruti Khatana [email protected]