Oral Submucous Fibrosis

DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY A Case Report on

ORAL SUBMUCOUS FIBROSIS

Submitted by

SAYED NABI AHAMED

ORAL SUBMUCOUS FIBROSIS INTRODUCTION: It is a chronic and high-risk precancerous condition. The condition was prevalent in the days of Sushruta (600 BC), a great practitioner of ancient medicine labeled this condition as ‘Vidhari’. After the lapse of many years, Schwatz (1952) was the first person to bring this condition to limelight. He described this condition as ‘Atrophia idiopathic mucosa oris’

DEFINITION: An insidious chronic disease affecting any part of the oral cavity and sometimes pharynx and is associated with juxtaepithelial inflammatory reaction followed by fibroelastic changes in lamina propria, with the epithelial atrophy leading to stiffness of oral mucosa and causing trismus and inability to eat.

ETIOLOGY:  Betel-nut chewing  Excessive use of chillies  Lime used in betel nut chewing  Tobacco usage  Nutritional deficiency  Defective iron metabolism  Bacterial or viral infections  Psychological stress  Immunological factors  Genetic factors STAGES OF ORAL SUBMUCOUS FIBROSIS:  Stage of stomatitis and vesiculation  Stage of fibrosis  Stage of sequelae and complication.

HISTOPATHOLOGY:  Variable degree of cellular atypia.  Hyperkeratinized, atropic epithelium.  Marked irregular epithelial stratification, nuclear pleomorphism and intercellular edema.  Underlying connective tissue shows hyalinization.  The stromal blood vessels are dilated and congested. LABORATORY INVESTIGATIONS:  Routine blood examination.  Scanning and transmission electron microscopy.  Biopsy.

MANAGEMENT: Restriction of habit / behavioural therapy. Medicinal therapy.  B complex preparation  Corticosteroids  Placental extract  Hyaluronidase  Vitamin E Surgical treatment.  Excision of fibrous bands followed by use of tongue flap  CO2 laser surgery  Cryosurgery  Oral physiotherapy  Diathermy

CASE REPORT Name

:

Vajravel

Age

:

40 years

Sex

:

Male

Occupation

:

Farmer

O.P. No.

:

21470

Address

:

Erugaloor,

Kattur,

Sangakiri,

Salem. CHIEF COMPLAINT Patient complains of loosening of tooth in right upper and lower back region for the past

HISTORY OF PRESENT ILLNESS Patient was apparently normal before 1 year and then he developed pain and loosening of tooth in right upper and lower back region and restricted mouth opening on both sides of the cheek region. PAST MEDICAL HISTORY Diabetes Hypertension Cardiovascular problems Drug allergy history Bleeding disorder

No

relevant

PAST DENTAL HISTORY Undergone

extraction

due

to

pain

two

months before. HISTORY OF DRUG ALLERGY No relevant history FAMILY HISTORY No relevant history PERSONAL HISTORY Marital status

: Married

Brushing habit : Brushes with brush and paste

Deleterious habits: Smoking / alcohol

: Nil

Tobacco chewing

: Had the habit before one

year CLINICAL EXAMINATION GENERAL EXAMINATION Built

:

Moderately built

Temperature

:

Afebrile

Pulse

:

75/min

GAIT

:

Normal

Posture

:

Normal

Clubbing

:

Absent

EXTRA-ORAL EXAMINATION Growth Swelling Sinus Fistula

No abnormalities detected

TMJ Facial pain LYMPH NODE EXAMINATION: Right submandibular lymphnode is palpable of size 1x1 cm which is single in number, tender, mobile in nature and soft in consistency.

INTRA-ORAL EXAMINATION Mouth opening : Restricted Restriction of tongue movement Restricted jaw movement HARD TISSUE EXAMINATION No. of teeth : 14 Dental caries : 48 Missing teeth : 11, 12, 13, 14, 15, 16, 24, 25, 26, 27, 28, 43, 35, 37, 38, 43, 46, 47 Root stump : Nil Mobility : Grade I in 42, 31, 32 Grade II in 18, 41, 23

Stains : Generalised Attrition : Generalised Erosion : Absent Abrasion : Absent Generalized hard and soft deposits present SOFT TISSUE EXAMINATION Gingiva: Colour : Reddish pink Contour : Bulbous marginal gingiva and blunt interdental papilla Texture : Stippling absent Position : Generalised recession

Labial mucosa :

No abnormalities detected

Buccal mucosa :

It is blanched, fibrotic bands

present

during palpation. Aggravating

sensation upon

burning consumption of

spicy foods. Tongue Floor

: of

the

Depapillated tongue mouth

:

No

abnormalities

detected Soft palate shrunken

:

Uvula appears to

SUMMARY Patient named Vajravel of age 40 years came to the dental OP with a complaint of loosening of tooth in right upper and lower back region and restricted mouth opening on both sides of the cheek region. He had undergone treatment for oral submucous fibrosis one month before. On extra oral examination right submandibular lymphnode is palpable of 1x1 cm, which is single in number, tender, mobile in nature and soft in consistency. On intra oral examination buccal mucosa is blanched, fibrotic bands present during palpation and aggravating burning sensation upon

PROVISIONAL DIAGNOSIS ORAL SUBMUCOUS FIBROSIS INVESTIGATION Biopsy FINAL DIAGNOSIS ORAL SUB MUCOUS FIBROSIS TREATMENT PLAN Stop habit of tobacco chewing. Medically: Cap. Antoxid 0-0-1 7 days Multivitamin supplement Intralesional injection of corticosteroids. Surgically: Excision of fibrous bands.

FRONTAL VIEW

BUCCAL MUCOSA – LEFT

BUCCAL MUCOSA - RIGHT

DEPAPILATED TONGUE

SHRUNKEN UVULA