Oral Sub Mucous Fibrosis by aseem
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Transcript of Oral Sub Mucous Fibrosis by aseem
•Chronic disease of Oral cavity / Pharynx / Esophagus
•Preceded by vesicle formation
•Associated with juxta-epithelial inflammatory reaction
•Fibro-elastic changes of the lamina propria, epithelial
Atrophy stiffness of the oral mucosa
•Causing Trismus
•PINDBORG / SIRSAT (1966)
• Shushrutha (600 B.C) - Vidari
• Schwartz (1952) - Atrophia idiopathica (tropica) Mucosae
Oris
• SG Joshi (1953) - “Oral sub-mucous fibrosis”.
• Su PI (1954) - "Idiopathic Scleroderma of mouth”
• Paymaster (1956) – Pre-Malignant
• SE Asia / India
• 0.2 – 0.5 % Prevalence
• 2nd to 4th decade
• M > F (2.3:1) ???? F > M (3:1)
• Malignant Transformation @ 7.6%
CHRONIC IRRITATION Red Chilies (CAPSAICIN)
Betel Leaf (TANNIC ACID)
Slaked Lime Tobacco
(N-NITROSONORNICOTINE) Areca Nut (ARECOLINE / ARECADINE GUVACOLINE / GUVACINE ISOGUVACINE)
NUTRITIONAL DEFICIENCY (B12 / Fe)
INFECTIONS (Bacterial)
CONNECTIVE TISSUE DISEASE (SSc / RA)
INHERITED (HLA-A10 / B7)
MULTIFACTORIAL PATHOGENESIS
ARECANUT TOBACCO LIME VOLATILE OILSVOLATILE LIQUIDS
TANNIN& AFLOTOXIN
ARECOLINE
DEGRADATIONOF COLLAGEN
INCREASED SYNTHESIS OF COLLAGEN
MECHANICAL TRAUMA
CHEMICAL BURN HYPERSENSITIVITY
ALTERED IMMUNITYGENETIC
REDISPOSITION
FIBROBLAST FORMATION
IRREVERSIBLE FIBROSIS
CARCINOMAEXPOSURE CONTINOUS
GRADING (JV Desa 1957 <R> Pindborg (1989)
Stage I : Stage of stomatitis , Vesiculation,
Hyperpigmentation and mucosal petechiae
Burning sensation in the mouth
Inability to eat spicy food
Reduced Mouth Opening
Sunken Cheeks / Malar Prominence
Vesicles rupture Superficial ulcers
Stage ll : Stage of fibrosis
(A) EARLY - blanching or Oral Mucosa
(B) LATE - b- Older lesions, vertical /circular
palpable fibrous bands in and around the
mouth or lips mottled, marble-like
appearance of the buccal mucosa
Stage III : Stage of sequelae / Complications (A) Leukoplakia (25%)
(B) Speech / Hearing Defects
Group I: No mouth opening limitations with an interincisal distance (IID) > 35mm
Group II: IID 26-35 mm
Group III: Moderately advanced case IID 15-26 mm + Fibrotic bands at Soft palate
Group IVA: Trismus is severe, IID < 15mm and extensive fibrosis of all the oral mucosa
Group IVB: Disease is most advanced, with premalignant and malignant changes throughout the mucosa
Oral White Lesions
CandidiasisOral LPRASWhite Sponge NevusMorsicatio Buccarum / LinguarumLinea AlbaLeukoplakia
INTRA-ARTICULAR
Internal derangement of TMJ / meniscus displacement
Fracture / TMJ Disloc
Traumatic synovitis
Arthritis (Septic / OA / Inflamm)
Ankylosis
Acute infections of the oral tissues(Odontogenic infection / Quinsy / Mumps)
Tetanus
Local Malignancy
Systemic sclerosis
Drug associated dyskinesia
Psychotic disturbances, hysteria
INVESTIGATIONS
Increased ESR
Anemia
High eosinophil count
Hypergammaglobulinaemia
Lower serum vitamin A levels
HISTOPATHOLOGY
Atrophic Oral epithelium
Loss of rete pegs
Epithelial atypia
Hyalinization of collagen
Fibroblasts decreased
Blood vessels obliterated
MANAGEMENT
1. Behavioral therapy
2. Medicial therapy
3. Surgical therapy
4. Oral Physiotherapy
Behavioral Therapy
RESTRICTION : Betel Quid / Guthka / Pan
Masala / Chillies ; Counselling regarding
Malignant potential
Other irritants should be removed
Nutritional supplements
Diet
MEDICAL THERAPY
• Hyaluronidase (IL)
• Steroids (topical / IL)
• Placental Extract (topical)
• IFN – Gamma
• Lycopene 16mg/day Oral
• Pentoxifylline 400mg TDS Oral
• Fluorouracil (topical)
• Levamisole 150mg OD for 3 weeks
• Dapsone 75 mg daily X 90 days
SURGICAL TREATMENT
• Fibrotomy
• Temporalis Myotomy / Flap Sx
• Laser treatment (KTP-532)