Comparative Analysis of Collagen Membrane, Buccal Fat Pad and Split- Thickness Skin Graft in the Surgical Management of Oral Submucous Fibrosis- A Retrospective Study

Abstract

Background: Oral Submucous Fibrosis (OSMF) is a chronic, progressive, and potentially malignant oral disorder predominantly associated with areca nut chewing. It causes burning sensation, mucosal rigidity, and trismus, significantly impairing oral function. In advanced cases, surgical intervention with suitable reconstruction is required. This study compares the clinical outcomes of collagen membrane grafts, buccal fat pad (BFP) flaps, and split-thickness skin grafts (STSG) in the surgical management of OSMF.

Methods: A retrospective comparative study was conducted on patients with clinically and histopathologically confirmed OSMF who underwent surgical release of fibrotic bands followed by reconstruction using collagen membrane, BFP flap, or STSG. Patients were evaluated for inter-incisal mouth opening, burning sensation (VAS scale), mucosal healing, complications, and patient satisfaction. Follow-up was carried out at 1 week, 1 month, 3 months, and 6 months. Statistical analysis was performed using ANOVA and paired t-test, with p < 0.05 considered significant.

Results: All three techniques demonstrated significant improvement in mouth opening and reduction in burning sensation. The BFP group showed superior postoperative mouth opening (34.2 ± 2.1 mm), faster healing, and minimal complications. Collagen membrane grafts provided satisfactory results with ease of use and absence of donor site morbidity, though postoperative mouth opening was slightly less (30.4 ± 2.3 mm). STSG achieved adequate mouth opening (32.1 ± 2.6 mm) but was associated with longer healing time, donor site morbidity, and one relapse case.

Conclusion: Among the techniques compared, the buccal fat pad flap provided the most favorable outcomes, balancing healing, functional recovery, and patient comfort. Collagen membranes represent a promising alternative, particularly in patients where donor site morbidity must be avoided. Split-thickness skin grafts, though effective, carry higher morbidity and should be reserved for select cases. Future multicentric studies with larger cohorts and advanced biomaterials may further refine reconstructive strategies in OSMF surgery.