Oral Submucous Fibrosis

Oral Submucous Fibrosis DEFINITION (WHO):Oral submucous fibrosis (OSF) is a slowly progressive chronic fibrotic disease of the oral cavity and oropharynx, characterized by fibroelastic changes and inflammation of the mucosa, leading to a progressive inability to open the mouth, swallow, or speak.

ETIOPATHOGENESIS:-OSF is regarded as a premalignant condition, and many cases of oral cancer have been found coexisting with submucous fibrosis. -Even though the etiopathology is incompletely understood, several factors are believed to contribute to the development of OSF, including general nutritional and vitamin deficiencies and hypersensitivity to certain dietary constituents such as chilli peppers, chewing tobacco, etc. -Primary factor The habitual use of betel and its constituents, which include: The nut of the areca palm (Areca catechu). The leaf of the betel pepper (Piper betle). Lime (calcium hydroxide).

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These reactions may be the result of either direct stimulation from exogenous antigens like Areca alkaloids or changes in tissue antigenicity that may lead to an autoimmune response. It occurs almost exclusively in inhabitants of Southeast Asia, especially the Indian subcontinent. The inflammatory response releases cytokines and growth factors that promote fibrosis by inducing the proliferation of fibroblasts, upregulating collagen synthesis and downregulating collagenase production.

CLINICAL FEATURES :Prodromal Symptoms(Early OSF): •

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Burning sensation of the mouth,during consumption of spicy foods. Appearance of blisters especially on the palate. Ulceration or recurrent generalized inflammation of the oral mucosa. Excessive salivation. Dryness of mouth (xerostomia). Altered taste sensations. Small vesicles in the cheek and palate. Focal vascular dilatation(Petechiae) due to hypersensitivity of oral mucosa towards some external irritant like arecanut products.

Advanced Symptoms:-

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The mucosa appears blanched and opaque with the appearance of fibrotic bands that can easily be palpated. The bands usually involve the buccal mucosa, soft palate, posterior pharynx, lips, and tongue. Gradually, patients develop a stiffening of the mucosa, with a dramatic reduction in mouth opening and with difficulty in swallowing and speaking.

HISTOLOGIC EXAMINATION: •

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Reveals severely atrophic epithelium with complete loss of rete ridges. Varying degrees of epithelial atypia may be present. The underlying lamina propria exhibits severe hyalinization, with homogenization of collagen. Cellular elements and blood vessels are greatly reduced.

MANAGEMENT:•

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The reduction or even elimination of habit of arecanut chewing. Nutritional support: - high protein and calories, for vitamin B complex and other vitamins and minerals. Immunomodulatory Drugs: - Local and systemic applications of glucocorticoids. Physiotherapy: - Measures such as forceful mouth opening and heat therapy.

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Local Drug Delivery: - Submucosal injected steroids and hyaluronidase, oral iron preparations, and topical vitamin A and steroids are some of the agents that are used. In severe cases, surgical intervention is the only treatment:- Measures such as forcing the mouth open and cutting the fibrotic bands have been used, but it can cause more fibrosis and disability.

PROGNOSIS: -The use of an oral stent as an adjunct to surgery to prevent relapse has also been studied. -OSF is considered to be a premalignant condition. -In a 17-year follow-up study in India, oral cancer developed in 7.6% of patients with submucous fibrosis. -The malignant transformation rate for submucous fibrosis was 4 to 13%.

REFERENCES -SHAFER’S TEXTBOOK OF ORAL PATHOLOGY 5TH EDITION.

-BURKET’S ORAL MEDICINE, DIAGNOSIS & TREATMENT 10TH EDITION.