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).
 • 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, up-
regulating collagen synthesis and down-
regulating collagenase production.

CLINICAL FEATURES :-
Prodromal Symptoms(Early OSF):

• 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:-
• 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:
• 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:-
• 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.
 • 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.