Oral Sub-mucous Fibrosis-Presented by Dr Sabrina Abbas as a part of Dhaka Dental College, OMS department Weekly Presentation Program

1. Oral Submucous Fibrosis: A
Precancerous Lesion
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2. Presenters:
Dr.Sabrina Farida Chowdhury
Dr.Shanjida Wasima Raka
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3. Precancerous Lesion:
A generalized state associated with a
significantly increased risk of cancer
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4. Premalignant Lesions:
• Leukoplakia(Dysplastic or Speckled)
• Erythroplasia
• Tertiary syphillis
• Oral submucous fibrosis
• Chronic candidosis
• Lichen planus
• Pipe smoker keratosis
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5. Erythroplasia Oral submucous fibrosis
Dysplastic Leukoplakia Tertiary syphillis
High Risk for Malignant
Change
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6. 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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7. Aetiological factors :
• Chewing betel nut, betel leaf
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8. -Panmasala
-Vitamin D deficiency
-Protein Deficiency
- Alcohol
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9. Site:
OSMF affects most part of oral cavity,pharynx and
upper third of the esophagus
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10. Pathogenesis:
Oral Mucosa
Betel Quid
Constant Irritation
Chronic Inflammation
ActivatedT cell and macrophages at the site
Increase in cytokines IL6,TNF,increase in growth factorTGF betaSabrina_Abbas_49DDCH_2017 10

11. Increase in Collagen
production
Decrease in collagen
degradation
Increased collagen(insoluble cross0linking of
insoluble form of collagen)
Fibrosis
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12. 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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13. Staging
Oral 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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14. 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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15. Treatment
• ConservativeTrearment:
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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16.  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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17. 2.Hyaluronidase injection
3.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 Extracts
5.Chymotrypsin
6.Interferon Gamma
7.Immune Milk
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18. 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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19. 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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20. A Case Report on-
Oral Submucous Fibrosis (Group 2)
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21. 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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22. Patient’s Profile:
Name:Monju Das
Age:48years
Sex:Female
Occupation:Home maker
Religion:Hinduism
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23. 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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24. 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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25. • 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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26. 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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27. General examination:
Appearance:Ill looking
Body Built:Average
Co-operation:Co-operative
Decubitus :On choice
Anaemia:Absent
Jaundice:Absent
Pulse:76 beats/min
Blood Pressure:12o/85mm hg
respiratory rate:18 breaths/min
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28. Local Examination
Extraoral Examination:
• Appearance:Anxious
• Lip:Competent
• Limited mouth opening -28mm
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29. 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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30. Palpation:
Fibrous band were palpable on the both side
Measuring the mouth opening:28mm
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31. 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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32. Diagnosis:
upon clinical finding and history,the case was
diagnosed as Oral submucous fibrosis group 2.
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33. 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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34. First Day
15/02/2017
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37. Mouth opening-28mm
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39. Second Day
22-02-2017
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40. Mouth Opening-29mm
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41. Third visit
01-03-2017
Mouth opening:29.5 mm
Fourth visit
09-03-2017
Mouth opening:31mm
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42. FifthVisit
16-03-2017
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45. Mouth opening:34mm
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