Oral Sub-mucous Fibrosis : A Precancerous Lesion
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Transcript of Oral Sub-mucous Fibrosis : A Precancerous Lesion
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Oral Submucous Fibrosis: A Precancerous Lesion
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Presenters:Dr.Sabrina Farida Chowdhury
Dr.Shanjida Wasima Raka
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Precancerous Lesion:A generalized state associated with a significantly increased risk of cancer
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Premalignant Lesions:• Leukoplakia(Dysplastic or Speckled)• Erythroplasia• Tertiary syphillis• Oral submucous fibrosis• Chronic candidosis• Lichen planus• Pipe smoker keratosis
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Erythroplasia Oral submucous fibrosis
Dysplastic Leukoplakia Tertiary syphillis
High Risk for Malignant Change
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Oral Submucous Fibrosis:
It is a chronic progressive scarring disease in which oral mucosa becomes fibroric, immobile and contracts progressively causing limitation of opening of mouth.• It is predominantly seen in people of Asian descent• Malignanttransformation rate for osmf is 7 to 13 parcent
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Aetiological factors :• Chewing betel nut, betel leaf
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-Panmasala
- Vitamin D deficiency -Protein Deficiency - Alcohol
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Site:OSMF affects most part of oral cavity,pharynx and upper third of the esophagus
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Pathogenesis: Oral Mucosa
Betel Quid
Constant Irritation
Chronic Inflammation
Activated T cell and macrophages at the site
Increase in cytokines IL6,TNF,increase in growth factor TGF beta
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Increase in Collagen production
Decrease in collagen degradation
Increased collagen(insoluble cross0linking of insoluble form of collagen)
Fibrosis
Oral Submucous Fibrosis
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Clinical Features:-Symmetrical fibrosis develops in buccal mucosa,soft palate or inner aspect of lips.-fibrosis occur and results in extreme pallor-the fibrous bands are pale-white in colour and palpable mostly-limited mouth opening-intolerance to spicy food-Hearing loss due to stenosis of Eustachian tube
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StagingOral submucous fibrosis is clinically divided into three stages:• Stage 1: Stomatitis• Stage 2: Fibrosis• a- Early lesions, blanching of the oral mucosa• b- Older lesions, vertical and circular palpable fibrous bands in and
around the mouth or lips, resulting in a mottled, marble-like appearance of the buccal mucosa
• Stage 3: Sequelae of oral submucous fibrosis• a- Leukoplakia• b- Speech and hearing deficits
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Group Classification:
• Group 1: Earliest stage, no limitation in mouth opening and interimcisal distance is greater than 35mm• Group 2:Interincisal distance is of 26-35mm• Group 3:Moderately advanced case with Interincisal distance of 15-
25mm• Group 4A:Trismus is more severe,interincisal distance is less than
15mm and there is extensive fibrosis of all oral mucosa• Group 4B:more advanced withpremalignant or malignant change
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Treatment
• Conservative Trearment:Motivation and Counseling:-Assurance-Proper education regarding this disease to be given to the patient-encourage to discontinue the habit of chewing betel nut/leaf.-minimizing consumption of spicy foods
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Supportive care:-Vitamin,iron and mineral diets to be adviced to the patient with OSMF-maintaining proper oral hygiene
Medical Managemnt:1.Interlesional steroid
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2.Hyaluronidase injection3.Combination of both steroid and hyaluronidase has shown better long term result than the agent alone(0.5 ml intralesional injection of Hyaluronidase 1500 IU and 0.5 ml of injection Hydrocortisone acetate 25 mg/ml in each buccal mucosa once a week alternatively for 4 weeks or more as per condition)4.Placental Extracts5.Chymotrypsin6.Interferon Gamma7.Immune Milk
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Oral Physiotherapy:-Muscle stretching exercises
-forceful opening of mouth by sticks ballooning of mouth,hot water gargling
-forceful mouth opening with mouth gag and acrylic surgical screw
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Surgical Intervention:In the trismus group stage 3 and stage 4-• -Wide surgical exicision of the affected tissues
including the underlying buccinators muscle together with skin grafting can be carried out• Release of the fibrous band with temporalis muscle
myotomy may be perfomed/
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A Case Report on- Oral Submucous Fibrosis (Group 2)
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A 48 years old lady with the complaints of limited mouth opening and burning sensation while having spicy food visited the Oral and Maxillofacial department,Dhaka Dental College and Hospital.
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Patient’s Profile:Name:Monju DasAge:48yearsSex:FemaleOccupation:Home makerReligion:Hinduism
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Chief Complaints:
• Whitish lesion in inner cheek and palate for 8-9months• Restricted mouth opening since 4-5 months• Burning sensation while taking spicy foods
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Clinical Examination:
• History of Present illness:According to the statement of the patient,she was reasonable well 9 months back.Then she developed whitish lesion on both sided buccal mucosa,retromolar area and palate.Initially there was no pain or any other difficulty.But later she started experiencing limited mouth opening along with burning sensation while spicy food intake.
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• History of past illness-Nothing associated with this condition
Personal History:History of Habit of chewing betel nut with leaf for last 20yearsFrequency:8/9 times/day
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Family History:She has two sons.There is no significant familial history associated with current condition
Drug/Allergy history:N/C
Socio-economic status:She belongs to a middle class family.
Immunization History:immunized per EPI scheduel
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General examination:Appearance:Ill lookingBody Built:AverageCo-operation:Co-operativeDecubitus :On choiceAnaemia:AbsentJaundice:AbsentPulse:76 beats/minBlood Pressure:12o/85mm hgrespiratory rate:18 breaths/min
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Local ExaminationExtraoral Examination:• Appearance:Anxious• Lip:Competent• Limited mouth opening -28mm
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Intraoral Examination:Inspection:-Blanched white pale mucosal lesion extending from buccal mucosa to the retromolar area on both side involving the soft palate-stained teeth-gingival recession
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Palpation:Fibrous band were palpable on the both side
Measuring the mouth opening:28mm
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Diagnosis:
• No laboratory tests can confirm the presence of this pre-cancerous condition.• However, some recent researches show that OSF patients are
likely to have decreased hemoglobin, iron, protein and vitamin B complex levels in the blood. The erythrocyte sedimentation rate is also believed to increase in these patients.• At present, modern diagnostic tools like ultrasonography and x-ray
are being used
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Diagnosis:upon clinical finding and history,the case was diagnosed as Oral submucous fibrosis group 2.
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Treatment:-Adviced to discontinue habit of chewing betel nut/betel leaf
-Adviced to avoid hard and spicy food
-medical Management:Inject. Interlesional steroid at the lesion site
-instruction of proper oral hygiene maintainance
-supportive treatment:vitamin,iron was prescribed.
-adviced to perform facial exercises
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First Day15/02/2017
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Mouth opening-28mm
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Second Day22-02-2017
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Mouth Opening-29mm
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Third visit01-03-2017
Mouth opening:29.5 mmFourth visit09-03-2017
Mouth opening:31mm
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Fifth Visit16-03-2017
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Mouth opening:34mm
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