Oral Submucous Fibrosis, Pre malignant
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i presented in my class, BDS 3rd year, in Hamdard University Karachi, Pakistan.Haris Mehmood.
Transcript of Oral Submucous Fibrosis, Pre malignant
ORAL SUBMUCOUS FIBROSIS
Haris MehmoodBDS-III
DEFINITIONOSF is chronic disease of oral cavity
characterized byInflammation and progressive fibrosis of
submucosal tissues
Resulting in inability to open the mouth (Trismus)
It is a pre malignant condition
Obscure (unclear)
Betel Quid or pan
Diet (Spice or Chillies)
Components of Betel Quid
Areca nut Biologically active alkaloids
Arecholine, Arecaidine, arecolidine, guvacoline, guvacine, flavonoids, tannins, catechins.
Copper
TobaccoSlaked limeCatechu
Nutritional DeficienyVitamin B complex deficiencyIron deficiency
derange the repair of the inflamed oral mucosa, leading to defective healing and resultant scarring.
Genetic predisposition
Arecoline, a substance found in betel nuts, stimulates the production of collagen by fibroblasts, producing a pale, marble-like appearance in the tissues
Tannins from areca nut causes:Activation of fibroblastCross linking of collagen peptide chainsInhibition of collagen degradationInflammation
Cytokine and growth factor production fibrosis
Areca nut contain copper that induces Lysyl oxidase activity.
upregulate collagen synthesis by fibroblastsFacilitate its cross linkingInhibit its degradation
(Ref: Research letters, The Lancet. www.hawaii.edu)
Eating chillies: Hypersenstivity reaction to capsaicin
Typically affect Buccal mucosaLipsRetromolar areaSoft palateTongue
Occasional InvolvementPharynxEsophagus
Oral tissues are affected symmetrically
Burning sensationWhile chewing spicy foods
Blanching of mucosaimpairment of local vascularity because of
increasing fibrosis and results in a marble-like appearance.
small vesicles form after they eat spicy food:an allergic reaction to capsaicin.
Vesicles rupture to form ulcers
Fibrous band Lips
thickrubbery difficult to retract
CheeksThick and rigidAbsence of puffed out appearance when patient blows or
whistle Tongue
Restriction of movementBlanching or Fibrosis of ventral mucosaDepapillation
Soft palate Uvula
Shruken
Tight vertical bands in buccal mucosa , labial mucosa and soft palate are palpable
Restricted mouth opening (TRISMUS)Less than 20mm is considered severe.
Areas appear white (smooth, thin and atrophic)Marble like Pallor is due to underlying fibrosis
and ischemiaIncreased salivationChange of gustatory sensationHearing loss due to stenosis of the eustachian
tubesDryness of the mouthNasal tonality to the voiceDysphagia to solids (if the esophagus is involved)
Lab Studies
No specific laboratory tests are available for OSF. Some OSF studies report the following laboratory findings:
Decreased hemoglobin levelsDecreased iron levelsDecreased protein levelsIncreased erythrocyte sedimentation rateDecreased vitamin B complex levels
Oral Biopsy
EPITHELIUMEpithelial atrophy Epithelial atypiaEpithelial dysplasia (10 to 15 % cases of
biopsy)Sub epithelial vesiclesHyperkeratosisLoss of rete pegs
Hyperkeratotic epithelium
Lamina PropriaFibrosislarge fibroblastsAvascular (blood vessels obliterated or
narrowed)Chronic inflammatory infiltrateHyalinization (translucent)Homogenization of collagen bundlesFibroblasts are markedly diminished in number
Collagenization of sub epithelial tissue
Medical Care
The treatment of patients with OSF depends on the degree of clinical involvementEarly stage: Cessation of habit is suficientModerate-to-severe OSF is irreversible
Treatment includes the following:Intra lesional steroid HylarunidaseIFN gamma
Surgical CareIndication:
Severe trismusBiopsy reveal dysplastic or neoplastic change
Simple excision of the fibrous bandsSplit-thickness skin grafting
ConsultationENT specialistPlastic surgeon
DIETReduce exposure to risk factors such as betel
quidCorrect nutritional deficiencies, such as iron
and vitamin B complex deficiencies
ACTIVITY:
Muscle stretching exercises for the mouth may be helpful to prevent further limitation of mouth movements
Prognosis depends upon the stage of tissue damage.
Fibrosis often recurs.Regular follow up is important.Malignant change is reported to be about 5-8
percent.
Special Concerns
Watch for signs that indicate malignant change, which include the following:An unhealing ulcer in the lesionLesion undergoing red changes (erythroplakia)A burning sensation in the mouthAn exophytic massA lump in the neckDifficulty in chewing, swallowing, or speaking
GOOD PROGNOSIS
