PMC3530755_01
Preoperative view of the patient mouth opening.
CRIM.DENTISTRY2012-628301.001.jpg
PMC3530755_01_CRIM.DENTISTRY2012-628301.001.jpg
fig1
Limited mouth opening at 15 mm and cranial nerves exam is unremarkable except for alter sensation in the buccal branch of V 3 bilaterally (Figure 1).
Low magnification H&E stained histopathological slide showing dense fibrosis of the stroma with infiltration to the skeletal muscular layer and minor salivary glands.
CRIM.DENTISTRY2012-628301.002.jpg
PMC3530755_01_CRIM.DENTISTRY2012-628301.002.jpg
fig2
An incisional biopsy was taken for histopathological evaluation which confirmed the diagnosis of submucous fibrosis infiltrating the muscular layer (Figure 2), after discussion of the clinical findings and treatment options with the patient.
The harvested full skin graft measuring 7 x 7 cm.
CRIM.DENTISTRY2012-628301.003.jpg
PMC3530755_01_CRIM.DENTISTRY2012-628301.003.jpg
fig3
Next attention was made toward the right thigh from which a 7 x 7 cm full thickness skin graft was harvested (Figure 3); using sharp dissection, was done to the level of the subcutaneous fat.
Intraoral views after suturing the graft to the buccal mucosa.
CRIM.DENTISTRY2012-628301.004.jpg
PMC3530755_01_CRIM.DENTISTRY2012-628301.004.jpg
fig4
Next the grafts were sutured into place using 3'0 Chromic Gut restorable sutures in simple interrupted fashion (Figure 4).
Sustained patient mouth opening at one year followup.
CRIM.DENTISTRY2012-628301.005.jpg
PMC3530755_01_CRIM.DENTISTRY2012-628301.005.jpg
fig5
Patient was placed on vigorous mouth opening exercises using Therabite devise. Patient responded well to the treatment regimen and maintained mouth opening at 30 mm after 12 months of treatment with good ability to have a satisfactory masticatory function (Figure 5).