WHO definition for an oral precancerous condition:

Generalised pathological state of the oral mucosa associated with a significantly increased risk of cancer—accords well with the characteristics of OSF.

Etiology:

• Tobacco

• Betel nut

• Nutritional deficiency:- vitamin B complex has been suspected

• Defective iron metabolism

• Bacterial infections

• Collagen disorders

• Immunological disorders

• Genetic susceptible

Clinical features

• Age & gender: Both genders are equally affected with 20 to 40 years the majority but their is slight male prediction because tobacco chewing habit is most seen in men.

• Site predilection: - buccal mucosa & retromolar areas. It also affects soft palate, faucial pillars,uvula,tongue.

 TYPES OF OSMF:

Prodromal symptoms

Early OSF:

It causes a burning sensation and appearance of blisters as well as ulcerations or recurrent inflammation of the oral mucosa. Also, excessive salivation and dryness of mouth can be noticed. Moreover, periods of exacerbation manifested by the appearance of small vesicles in cheeks and palate.

Advanced OSF:

The oral mucosa becomes blanched and slightly opaque and appearance of white fibrous bands. Deviated uvula and soft palate along with dense fibrosis involving tissues around pterygomandibular raphe results in restricted mouth opening.

We are discussing a case of OSMF over here to see the actual presentation of the it clinically.

A 45 year old male patient complains of difficulty in mouth opening and a burning sensation since 5 months. Patient was apparently well 5 months back when he noticed a slight reduction in the mouth opening, which gradually increased in severity to the present state. The patient had difficulty in eating and speaking also.

He had a habit of chewing tobacco (Rajdarbar) 8-10 packets a day for over 5 years but now quit the habit 1 month back.

On Soft tissue examination:

Inspection:

• Inter-incisal distance is 17 mm.

• Buccal mucosa: White blanching is seen on both sides of the buccal mucosa extending from the lip commissure to retro molar area.

• Floor of mouth & Soft palate: blanching is seen.

• Shortening of the uvula is seen.

Palpation:

• Fibrous bands are palpable on both sides of the buccal mucosa runs in a vertical direction.

• Surface is leathery in texture.

Treatment

The most important in the treatment of the OSMF is reduction or even elimination of the habit of areca nut chewing is an important preventive measure.

In mild cases it may be treated with intralesional corticosteroids to reduce symptoms and limit progression.

Moderate to severe cases may require surgical splitting or excision of the fibrous bands followed by lifelong physiotherapy; however, relapse is common. There is limited evidence for various alternative treatments, such as

• Intralesional injection of interferongamma;

• Topical or intralesional proteolytics (e.g., collagenase,hyaluronidase, chymotrypsin, and human placental extract); vitamins and minerals; antioxidants (e.g., lycopene); pentoxifylline; and ayurvedic remedies (e.g.,turmeric).

References:

• Textbook of Oral Pathology- Shafer’s  6^th edition & 8^th edition

• Textbook of Oral Medicine - Burket’s  11^th edition

• People’s Journal of Scientific Research  Vol 1 - July 08
   Oral submucous fibrosis - Current Concepts - M K Gupta, S Mhaske, R Ragavendra & Imtiyaz

• Volume 3 Issue 3, March 2014 International Journal of Science and Research (IJSR)Classification System for Oral Submucous Grading

• International Journal of Oral & Maxillofacial Pathology. 2012;3(2):27-36.Pathogenesis of Oral Submucous Fibrosis-Ramachandran Sudarshan, Rajeshwari G Annigeri, Sree Vijayabala G.

• Rama Univ J Dent Sci 2015 Mar;2(1):24-33 OSMF: ETIOLOGY AND PATHOGENESIS-A REVIEW-Shukla A, Singh A, Srivastava R.

• WHO Bulletin OMS. Vol 72-1994.

• Journal of Medicine, Radiology, Pathology & Surgery -Vol. 1:6 Nov-Dec 2015

By Dr. Shivani Bhandari

_MSM