Oral submucous fibrosis

Oral submucous fibrosis is a chronic, progressive, scarring, high risk, potentially malignant disorder of the oral mucosa.It is characterized by mucosal rigidity of varying intensity due to fibroelastic transformation of the juxta epithelial layer. This results in restricted mouth openingMalignant transformation rate 8%

EtiologyPrecise etiology not knownSuspected multifactorialVarious factors considered are:Arecanut (Pan masala)Nutritional deficiencyAuto immuneGenetic (HLA DR3)

Clinical featuresSymptomsProgressive inability to open mouthBurning sensation to spicy food consumptionRelative loss of auditory acuity (due to stenosis of the opening of eustachian tube)

SignsEarly signs: Vesicles , petechiae, melanosis, xerostomia Blanching of mucosa (pale marble like appearance)Loss of elasticity and suppleness of oral mucosaRestriction in mouth opening when tongue is involved its protrusion may be impaired. Loss of papillae.Submucosal palpable fibrous bands in the buccal mucosa, soft palate and labial mucosaShortening of uvula

Staging Clinical staging1: Faucial bands only2: Faucial and buccal bands3: Faucial, buccal and labial bands

Functional stagingA: Mouth opening > = 20 mmB: Mouth opening 11 to 19 mmC: Mouth opening

Differential diagnosisEasy clinical diagnosis SclerodermaAnemia-pale mucosa with pigmentationLeukoplakiaScarring due to thermal or chemical burn

ManagementStop habitMild cases: Intralesional injection of cortico steroids (Betamethasone 4mg/ml)Surgical splitting or excision of bandsIntra lesional injection of interferon gammaMiscellaneous medication that have been triedMultivitamin supplementsPlacental extract (intra lesional injection)Hyaluronidase ,1500 iu (intra lesional injection)

Prognosis Does not regress completely even with habit cessation Mild cases show improvement with steroid injectionsRequires continuous monitoring for malignant transformation