DEFINITION
Oral submucous fibrosis (OSMF) is an oral pre-cancerous condition characterized by inflammation and progressive fibrosis of the submucosal tissues resulting in marked rigidity and trismus (Difficulty in jaw opening)
PATHOPHYSIOLOGY
It occurs at any age but is most commonly seen in young adults between 25 and 35 years (2nd–4th decade).
The onset of this disease is insidious and is often 2–5 years of duration. Increased prevalence is due to increased use and popularity of commercially prepared areca-nut and tobacco products – gutkha, pan masala, flavored supari.
The malignant transformation rate (Prevalence of turning into cancer) of OSMF was found to be 7.6%. Areca-nut (betel-nut) chewing is one of the most common causes of it. Out of all arecoline is the main agent. Arecaidine is an active metabolite in fibroblast stimulation and proliferation, thereby inducing collagen synthesis. With the addition of slaked lime (Ca[OH] 2) to areca-nut, Nutritional deficiencies.
Deficiency of iron (anemia), Vitamin B-complex, minerals, and malnutrition are promoting factors that disturb the repair process of the inflamed oral mucosa, thus leading to deranged healing and resultant scarring and fibrosis. The resulting atrophic oral mucosa is more susceptible to the effects of chilies, betel-nuts, and other irritants
TREATMENT
The treatment of OSMF depends on the degree of disease progression and clinical involvement.
At early stages, stopping habits and nutritional supplements are done.
At moderate stages, conservative treatment such as intralesional injections along with medical treatment is provided.
At advanced stages, surgical interventions are needed.
Cessation Of Habit
The stoppage of habits such as betel quid, areca-nut, and other local irritants, spicy and hot food, alcohol, and smoking through education and patient motivation. All affected patients should be educated and warned about the possible malignant transformation.
Supplementary Care
Diet rich in iron, vitamins, and minerals should be advised to patients with OSMF.
Antioxidants
Carotenoids (lycopene) induce stimulation of the immune system or direct action in tumor cells.
Steroid therapy, placental extracts, and chymotrypsin
Steroids also act by reducing inflammatory responses. Steroid ointment and intralesional dexamethasone injection are generally used.
Hyaluronidase
It acts by breaking down hyaluronic acid, lowering the viscosity of intracellular substances, and decreasing collagen formation. It produces a burning sensation and trismus
Turmeric
Turmeric powder provides benzopyrene-induced stimulated production of micronuclei in circulating lymphocytes. It also acts as an excellent scavenger of free radicals.
Physiotherapy
Muscle stretching exercises for the mouth are helpful in preventing further reduction in mouth opening. Forceful jaw opening exercise is with mouth gag or heisters jaw opener.
Diathermy, ultrasound, lasers: Microwave diathermy
Cryosurgery
It is the method of locally destroying the abnormal tissue by freezing it in situ and applying liquid nitrogen or argon gas.
Surgical Treatment
In patients with severe trismus, surgical intervention is done which includes simple excision of fibrotic bands with reconstruction using a buccal fat pad and split-thickness graft along with temporalis myotomy and coronoidectomy. The surgery is performed under general anesthesia intubation techniques have also been used.
