ORAL SUBMUCOUS FIBROSIS

INTRODUCTIONOral sub mucous fibrosis (or OSF) is a chronic, complex ,irreversible, highly potent pre-cancerous condition characterized by juxta-epithelial inflammatory reaction and progressive fibrosis of the sub mucosal tissues (lamina propria and deeper connective tissues).

ETIOLOGYHabitual chewing of Dried products such as paan masala and gutkha have higher concentrations of areca nut and appear to cause Oral sub mucous fibrosis. Other factors responsible for the disease are:

Excessive consumption of red chiles. Immunological diseases. Extreme climatic conditions. Prolonged deficiency to iron and vitamins in the diet.

The pathogenesis is due to:

Clonal selection of fibroblast

Stimulation of fibroblast proliferation.

By fibrogenic cytokines.

By decreased secretion of collagenase.

Deficiency in collagen phagocytosis.

By stabilization of collagen.

CLINICAL FEATURES

Clinical features of the disease include:

Decreased mouth opening and tongue protrusion Recurrent ulceration. Burning sensation of the oral mucosa aggravated by spicy food. Restriction of the movement of the soft palate. A budlike shrunken uvula. Pain in the ear or deafness. Nasal intonation of voice. Thinning and stiffening of the lip. Xerostomia.

Blanching in the left Buccal mucosa Ulceration of tongue Bud like shrunken uvula

HISTOPATHOLOGY

A. STRUCTURAL & MICROSTRUCTURAL CHANGES

Hyperplasia (early stage) Atrophy (advanced stage).

Early oral sub mucous fibrosis Advanced stage with fibrosis of lamina propria

Lesions involving palate show orthokeratosis. Lesions involving buccal mucosa show parakeratosis.

B. SUBEPITHELIAL CHANGES

On the basis of the histo pathological appearances of stained (H & E) sections, the surgical specimens from Oral sub mucous fibrosis can be grouped into four clearly definable stages: very early, early, moderately advanced, and advanced. These stages are based not only on the amounts and nature of the sub epithelial collagen, but also on the following criteria taken together:

Presence or absence of edema.

Physical state of the mucosal collagen.

Overall fibroblastic response (No. of cells & age of individuals cells).

State of the blood vessels.

Predominant cell type in the inflammatory exudates.

MANAGEMENT1. NUTRITIONAL SUPPORT.

2. IMMUNOMODULATORY DRUGS.

3. PHYSIOTHERAPY.

4. LOCAL DRUG DELIVERY.

5. COMBINED THERAPY.

6. SURGICAL MANAGEMENT.