Oral Submucous Fibrosis: Clinical Features, Diagnosis, and Treatment Options

Oral Submucous Fibrosis: Clinical Features, Diagnosis, and Treatment Options

Describe clinical feature and treatment of submucous firosis.

Answer. OSMF is defined as “An insidious chronic disease affcting any part of oral cavity and sometime pharynx.

Although occasionally preceded by and/or associated with vesicle formation, it is always associated with juxta-epithelial inflammatory reaction followed by firoelastic changes in lamina propria, with epithelial atrophy leading to stiffess of oral mucosa and causing trismus and inability to eat.” —Pindborg (1966)

“Symptoms Of Oral Submucous Fibrosis”

Submucous fibrosis Clinical Features

• It occurs during 20 to 40 years of age.
• Most commonly involved sites are buccal mucosa,retromolar area, uvula, soft palate, palatal fauces, tongue,lips, pharynx and esophagus.
• Onset of disease is insidious or develop over the period of 2 to 4 years.
• Initially the patient complains of burning sensation in the mouth, particularly during taking hot and spicy foods.
• It is often accompanied or followed by the formation of multiple vesicles over the palate or ulcers or inflammatory reactions in other parts of oral mucosa.
• There can be either excessive salivation or deceased salivation (xerostomia) along with recurrent stomatitis.
• Patients also develop a defective gustatory sensation.
• In the initial phases of the disease, palpation of the mucosa elicits a “wet-leathery” feeling.

“Risk Factors For Developing Oral Submucous Fibrosis”

• Petechial spots may also be seen in the early stages of the disease over the mucosal surfaces of tongue, lips and cheek, etc.
• Oral mucous membrane is very painful upon palpation at this stage.
• One of the most important characteristic features of oral submucous firosis is the gradual stiffning of the oral mucosa with progressive reduction in the mouth opening.
• Stiffness of the oral mucosa and the subsequent trismus develops gradually within a few years after the development of the initial symptoms.
• In the advanced stage of OSF, the oral mucosa losses its resiliency to a great extent and it becomes blanched and stiff Severe trismus develops at this stage.
• Because of stiffess of the lips and the tongue patients are unable to blow whistles or even blow out a candle.

“Understanding The Causes Of Oral Submucous Fibrosis”

• Oral mucosa is symmetrically affcted on both sides of the mouth and it shows extreme pallor.
• Oral submucous firosis often causes a blanched opaque (white marble-like) appearance of the mucosa, on which,there may be occasional presence of leukoplakic or erythroplakic patches.
• Palpation of the mucosa often reveals many vertical white firous bands on the inner aspect of the cheek.
• Patients of OSMF often develops diffilty in deglutition,referred pain in the ear or deafness and nasal intonation of voice.
• Depapillation of the tongue with recurrent or sometimes persistent glossitis occurs. Later on the tongue becomes stif and shows restricted movements.
• Uvula become ’ bud—like” or hockey stick shaped or become shrunken.

Submucous fibrosis Treatment

Submucous fibrosis  Supportive treatment

• Diet rich with the vitamins along with iron preparation should be given to the patient.
• IM injection of Iodine B complex is given to the patient.
• During early phase low doses are given and later on high doses are effctive.
• Local injection of hydrocortisone in the lesional area is of value.
• Intralesional injection of hyaluronidase can be given.
• Systemically 100 mg/day of hydrocortisone is effctive in reducing the burning sensation.
• 2 mL injection of placentrex intralesional is effctive.
• Lycopene as an antioxidant should be given to the patient.
• Vitamin E along with hyalurodinase and dexamethasone is effctive.
• Intralesional injection of interferon-gamma helps in increment in mouth opening.

“The Role Of Biopsies In Detecting Oral Submucous Fibrosis”

Submucous fibrosis Surgical treatment

Conventional Surgery:

• Tongue mucosa as a graft: The fibrous bands are excisioned and tongue mucosa as a flp is used.
• Implantation of fresh human placenta can be done following the surgical excision of firous bands.
• Fibrotic bands are excisioned and nasolabial flp is taken for reconstruction.
• Bilateral palatal flp is taken for generally covering of exposed area.

“Comprehensive Overview Of Oral Submucous Fibrosis Symptoms”

Submucous fibrosis Laser:

• Patient should be incorporated with general anesthesia. CO 2 LASER incise the buccal mucosa and vaporizes mucosal connective tissue.

Cryosurgery: It helps in providing the relief from the local lesions.