Oral submucosa fibrosis ( OSMF or OSF ) is a chronic, complex, premalignant (1% risk of transformation) oral condition, characterized by epithelial inflammatory reactions juxta and progressive fibrosis of the submucosal tissue (lamina propria and deeper connective tissue). As the disease develops, the jaw becomes stiff until the person can not open his mouth. This condition is remotely related to oral cancer and is associated with betel or betel nut, a habit similar to chewing tobacco, practiced mainly in Southeast Asia and India, since thousands of years ago.
Video Oral submucous fibrosis
Symptoms
In the early phase of the disease, the mucosa feels rough with a palpable fibrotic band. At an advanced stage, the oral mucosa loses its strength and becomes pale and stiff. The disease is believed to begin in the posterior part of the oral cavity and gradually spread outward.
Other features of the disease include:
- Xerostomia
- Repeat reperation
- Ear or deaf pain
- Nose sound intonation
- Limitations of soft palate movements
- The youngest little uvula
- Thins and tightens lips
- Oral mucosa pigmentation
- Dry mouth and burning sensation
- Decreased mouth opening and tongue protrusion
Maps Oral submucous fibrosis
Cause
Dry products such as masala paan and gutkha have higher pinang concentrations and appear to cause disease. Other causes include:
- Immunologic disease
- Extreme climatic conditions
- Prolonged shortage of iron and vitamins in the diet
Pathogenesis
"Exposure to arecane (Arecacatechu) containing tobacco products (ANCP/T) is currently believed to lead to OSF in individuals with genetic immunology or predisposing nutrients to disease."
This hypersensitivity reaction produces a juxta-epithelial inflammation that results in increased fibroblastic activity and decreased fiber damage. Fibroblasts are phenotypically modified, and the fibers formed are more stable, resulting in thicker bundles that progressively become less elastic. once the original loose fibrous tissue is replaced by ongoing fibrosis, the movers of the mouth tissue are reduced, there is a loss of flexibility and reduced mouth opening.
These collagen fibers can not be degraded and phagocytic activity is minimized.
According to a recent cross sectional study, the time taken to restore salivary pH to baseline after chewing the arecrane-containing mixture was significantly longer in OSF users with comparison with unaffected users.
Diagnosis
Classification
Oral submucous fibrosis is clinically divided into three stages:
- Stage 1: Stomatitis
- Stage 2: Fibrosis
- a- Early lesions, pale oral mucosa
- b- Older lesions, sensitive vertical and circular fibrous bands in and around the mouth or lips, produce a mottled buccal-like mucosal appearance
- Stage 3: Oral submucous sequela fibrosis
- a- Leukoplakia
- b- speech and hearing deficit
Khanna and Andrade in 1995 developed a group classification system for trismus surgical management:
- Group I: The earliest stage without mouth opening with an interventional distance greater than 35 mm.
- Group II: Patients with an interstrisal distance of 26-35 mm.
- Group III: Medium case with an interstrisal distance of 15-26 mm. The fibrotic bands are visible on the soft palate, and the pterygomandibular rapib and anterior fauces are present.
- Group IVA: Severe trismus, with interventis spacing less than 15 mm and extensive fibrosis of all oral mucosa.
- Group IVB: The most severe disease, with pre-malignant and malignant changes throughout the mucosa.
Treatment
Biopsy screening though it is necessary not mandatory most dentists can visually inspect the area and proceed with the appropriate treatment.
Treatments include:
- Abstentions from chewing areca nut (also known as pinang) and tobacco
- Minimize the consumption of spicy foods, including chili
- Maintain proper oral hygiene
- Supplement diet with foods rich in vitamin A, B complex, and C and iron
- Hot liquids like tea, coffee
- Exit alcohol
- Use a dental surgeon to round out sharp teeth and extract third molar
Treatment also includes the following:
- The prescription of hydrocortisone chewing pellets (Efcorlin); one pellet that should be chewed every three to four hours for three to four weeks
- 0.5 ml intructional injection of Hyaluronidase 1500 IU mixed in 1 ml of Lignocaine into every buccal mucosa once a week for 4 weeks or more under conditions
- 0.5 ml intralesi injection Hyaluronidase 1500 IU and 0.5 ml injection Hydrocortisone acetate 25 mg/ml in each buccal mucosa once a week or for 4 weeks or more as per condition
- Delivery of submucosal hydrocortisone 100 mg once or twice daily depends on the severity of the disease for two to three weeks
- Subcutaneous injection of human chorionic gonadotropin (Placentrax) 2-3 ml per sitting twice or thrice a week for three to four weeks
- Surgical treatment is recommended in cases of progressive fibrosis when the interincisor spacing becomes less than 2 cm (0.79 inches). (Multiple folding incisions deep into the mucosa, submucosa and fibrotic tissue and sewing gaps or dehiscence made by mucous grafts obtained from the tongue and Z-plasty.In this procedure several z-shaped incisions are made into fibrotic tissue and then sewn in more fashion straight.)
- Pentoxifylline (Trental), a methylxanthine derivative having vasodilation properties and increased mucosal vascularization, is also recommended as adjunctive therapy in the routine management of oral submucous fibrosis.
- IFN-gamma is an antifibrotic cytokine that alters the synthesis of collagen and helps in OSF.
- Colchicine tablet 0.5Ã, mg twice daily
- Lycopene, 16 mg daily helps improve OSF
Treatment of patients with oral submucosal fibrosis depends on the level of clinical involvement. If the disease is detected at a very early stage, the cessation of habit is sufficient. Most patients with oral submucous fibrosis present with moderate to severe disease. Severe severe submucous fibrosis can not be altered. Oral submucosal fibrosis is being reversible with habitual cessation and open mouth exercises. Current modern medical care can make the mouth open to the normal minimum level of 30 mm mouth opening with the right treatment.
Epidemiology
The incidence of the disease is higher in people from certain parts of the world including Southeast Asia, South Africa and the Middle East.
Stem cell therapy for oral submucosal fibrosis
Recently scientists have proven that intralesional injection of autologous marrow stem cells is a safe and effective treatment modality in oral sub mucosal mucosa. It has been proven that spinal cord stem injection induces angiogenesis in the lesion area which in turn decreases the rate of fibrosis resulting in a significant increase in mouth opening.
History
In 1952, T.Sheikh coined the term distrophica idiopathica mucosa oris to describe the oral fibrosing disease he found in five Indian women from Kenya. S.G. Joshi then created oral submucosal fibrosis (OSF) for the condition in 1953.
See also
- Skin condition
References
External links
Source of the article : Wikipedia
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