ORIGINAL ARTICLE Immediate versus delayed aggressive physical therapy following buccal fat pad interposition in oral submucous fibrosis—a prospective study in Central India Chandrashekhar Bande 1 & Pawan Dawane 1 & M K Gupta 1 & Mayur Gawande 1 & Vijay Rode 1 Received: 25 April 2016 /Accepted: 9 September 2016 # Springer-Verlag Berlin Heidelberg 2016 Abstract Purpose Oral submucous fibrosis is a disease of an Indian subcontinent with obscure aetiology and poorly treated with varying signs and symptoms. OSMF occurs at any age but is most commonly seen in teenagers and adults in the age ranging between 16 and 35 years. A number of surgical treatments have been used for the treatment of oral submucous fibrosis with unpredictable results. Patients and method In this study, 220 patients were ran- domly divided into two groups with mouth opening less than 16 mm and evaluated with immediate and delayed aggressive physiotherapy with buccal fat pad interposi- tion after fibrotomy. Group A( n = 110) patients underwent aggressive mouth opening exercise from the next postoperative day while in group B (n = 110), pa- tients underwent physiotherapy 7th day postoperatively. Pain and discomfort, mucosalization, infection, flap de- hiscence and necrosis were noted. Patients were follow- ed for 1 year on a regular interval basis. Results At the end of 1-year follow up, the post- operative mean mouth opening in group A was 38.63 mm and 34.19 mm in group B. In group A, the immediate physiotherapy results in mild to moderate pain and discomfort to the patients as compared to no apparent pain in the group B. The mean mucosalization time in group A and group B was 4.2 and 5.1 weeks, respectively. Postoperatively, all patients achieve satis- factory mouth opening. Conclusion Immediate aggressive physiotherapy yields a comparatively superior result than delayed physiotherapy with respect to mouth opening in 1 year of follow-up. Keywords Oral submucous fibrosis . Buccal fat pad . Immediate aggressive physiotherapy . Delayed physiotherapy Introduction Oral submucous fibrosis is a disease of an Indian sub- continent of obscure aetiology which involves the oral cavity, including pharynx and seldom the larynx [1, 2]. The first case was reported among Indian population by Joshi [3], and it has high prevalence of the disease in India. It is established pre-cancerous condition [4]. The disease is of unknown aetiology till date, and the main aim of treatment is symptomatic relief [5]. A number of treatment modalities including nutritional supplement, physiotherapy, injections of steroids and placental ex- tract have been used with inconsistent results. In the advanced stage, surgical treatment is considered as a last treatment modality of the disease entity when there is severe trismus with very less mouth opening. Surgical option gives not only symptomatic relief from trismus but also provides intraoral accessibility for malignant transformation changes [6]. We have compared the im- mediate and delayed physiotherapy in 220 patients * Chandrashekhar Bande drcrbande@yahoo.co.in 1 Swargiya Dadasaheb Kalmegh Smruti Dental College And Hospital, Nagpur, India Oral Maxillofac Surg DOI 10.1007/s10006-016-0580-3