Oral submucous fibrosis: a clinicopathologic review of 205 cases in Indians

Introduction

Oral submucous fibrosis is a disease due to a chronic, insidious change in fibro-elasticity, characterized by burning sensation in the oral cavity, blanching, and stiffening of the oral mucosa and oro-pharynx leading to trismus and inability to open the mouth. The symptoms and signs depend on the progression of the lesions and number of affected sites. It is predominantly seen in Indians and other Asians. Once the disease has developed, there is neither regression nor any effective treatment. There are only few studies on the frequency and clinicopathological feature of oral submucous fibrosis in the Indian population in recent years.

Material and methods

The present study evaluated 205 cases of oral submucous fibrosis for the age, sex, site of involvement, duration of disease at the time of diagnosis, associated habits and common presenting symptoms, presence of other mucosal lesions, malignant potential, and the histopathology.

Results and discussion

Oral submucous fibrosis was seen in younger age (20??0 years) than that reported in literature and showed a characteristic male preponderance. A strong association with smokeless tobacco use especially arecanut in the form of gutkha was established and was related to earlier development of oral submucous fibrosis (OSMF), i.e., within a year of the habit. A total of 11.6% of cases were associated with malignancy and occurred predominantly in males.

Conclusion

This article gives an insight into OSMF in this part of southern India and adds to its biologic profile.     

Oral submucous fibrosis. Case report and review of the literature

A case history and brief literature review of oral submucous fibrosis is presented. This condition is most frequently found in the Indian subcontinent and only rarely encountered elsewhere. The aetiology is considered to be related to dietary habits and customs found in the population. The condition has a known malignant potential. With increasing migration to Australia from the Indian subcontinent the condition should be known and recognized by clinicians.     

Oral submucous fibrosis. A review

A bstract — Oral submucous fibrosis (OSF) affects an estimated 2.5 million people, mostly in the Indian subcontinent. Limitation of oral opening resulting in difficulty in eating is the main presenting feature. Although nutritional deficiencies and immunological processes may play a part in the pathogenesis, the available epidemiological evidence indicates that chewing betel quid (containing areca nut, tobacco, slaked lime or other spices) is an important risk factor for OSF. Genetically determined susceptibility could explain why only a small fraction of those using betel quid develop the disease. In OSF there is an incidence of oral cancer of 7.6 per cent for a median 10 year follow-up period. Risk markers for malignant transformation in OSF include epithelial dysplasia, silver binding nucleolar organizer region counts, and sister-chromatid exchange frequencies; p53 tumour suppressor gene mutations may be involved in these potentially malignant changes.     

Oral submucous fibrosis in a 12-year-old Bangladeshi boy: a case report and review of literature

Oral submucous fibrosis is commonly seen in the adult population of the ethnic minorities in the UK, although its presentation in a child is rare. Whilst the condition is considered multifactorial and irreversible, we present a case of oral submucous fibrosis in a 12-year-old Bangladeshi boy whose cessation of habitual betel nut chewing and forcible mouth chewing exercises led to an improvement in his mouth opening, although his ability to protrude his tongue remained unaltered. The clinical features, pathogenesis and management of submucous fibrosis are described. The widespread use of betel quid among Asians in the UK is summarized and the importance of its recognition as a precancerous condition is emphasized.     

Oral submucous fibrosis, a clinically benign but potentially malignant disease: report of 3 cases and review of the literature

Oral submucous fibrosis (OSF) is a premalignant condition mainly associated with the practice of chewing betel quid containing areca nut, a habit common among South Asian people. It is characterized by inflammation, increased deposition of submucosal collagen and formation of fibrotic bands in the oral and paraoral tissues, which increasingly limit mouth opening. Recently, OSF has been reported among South Asian immigrants in Canada, the United Kingdom and Germany. Dentists in western countries should enhance their knowledge of this disease as it seems to be increasing with population migration. In this paper, we review the literature on OSF and present 3 cases representing different stages of the disease to help dentists make an early diagnosis and reduce the morbidity and mortality associated with this condition.     

Oral submucous fibrosis

2 cases of oral submucous fibrosis have been reported. In each case, the diagnosis was confirmed histologically, and the treatment instituted was identical. Excision of buccal fibrotic bands was carried out, with subsequent placement of skin grafts. The patients were followed postoperatively to monitor results and particularly, to screen for malignant changes. The literature concerning oral submucous fibrosis is reviewed.     

Oral submucous fibrosis

Oral submucous fibrosis is defined and its importance with respect to debilitation and precancerous potential evaluated. Current theories of aetiology are discussed and its pathogenesis and clinical presentation described. Management of the disease is discussed and the conclusion is drawn that modern surgical techniques, currently offer the best prognosis.     

Oral submucous fibrosis: study of 1000 cases from central India

BACKGROUND: Very few reports have been published on the gender specificity of oral submucous fibrosis (OSF) in relation to habit patterns and the severity of disease in the world literature. The purpose of the study was to ascertain the gender specificity for different habits and severity of OSF. METHODS: A hospital-based cross-sectional study on various habit patterns associated with OSF was performed in Nagpur over a 5-year period. A total of 1000 OSF cases from 266,418 out patients comprised the study sample. RESULTS: The male-to-female ratio of OSF was 4.9:1. Occurrence of OSF was at a significant younger age group (<30 years) among men when compared with women (OR = 4.62, 3.22-6.63, P = 0.0001). Reduced mouth opening, altered salivation and altered taste sensation were found to be significantly more prevalent in women when compared with men. Exclusive areca nut chewing habit was significantly more prevalent in women (OR = 44.5, 25.4-79.8, P = 0.0001). Whereas significant increase for Gutkha (Areca quid with tobacco) (OR = 2.33, 1.56-3.54, P = 0.0001) and kharra/Mawa (crude combination of areca nut and tobacco) (OR = 6.8, 4.36-11.06, P = 0.0001) chewing was found in men when compared with women. CONCLUSIONS: There is a marked difference in literacy, socioeconomic status, areca nut chewing habits, symptoms and disease severity in women when compared with men in the central Indian population.     

Oral submucous fibrosis as a precancerous condition

Abstract – An evaluation of the malignant potential of submucous fibrosis, based on observations of 89 patients with the disease in Ernakulam District, Kerala, India was done. Out of the 89 patients, 12 were referred patients and 77 were diagnosed in population based studies. At the time of first examination oral cancer was found to be coexistent in nine (10%) cases. For 66 patients follow-up observations ranging from 4 to 15 yr (median 8 yr) were available. During this period malignant transformation was observed in three patients (4.5%). Considering malignant transformation and coexistence together, oral cancer was observed in 13% of the present material. Leukoplakia was found in 26% of the patients with submucous fibrosis. Out of 42 submucous fibrosis patients biopsied, 12% showed squamous cell carcinoma, 26% epithelial dysplasia, and 76% atrophic epithelium. These findings reinforced the hypothesis that submucous fibrosis is a precancerous condition.     

Oral submucous fibrosis: a new concept in surgical management: Report of 100 cases

Oral submucous fibrosis (OSF) is a collagen disorder commonly seen in the Indian subcontinent. A series of 100 patients is presented. All lesions were biopsied. The condition was staged into four categories. Very early and early cases were treated by local injection of triamicinolone acetonide, while advanced cases were treated by surgical intervention. A new surgical technique of a palatal island flap based on the greater palatine artery in combination with temporalis myotomy and bilateral coronoidectomy was used in 35 cases. A follow-up ranging from 6 months to 3 1/2 years showed good results.     

Oral submucous fibrosis as a precancerous condition

An evaluation of the malignant potential of submucous fibrosis, based on observations of 89 patients with the disease in Ernakulam District, Kerala, India was done. Out of the 89 patients, 12 were referred patients and 77 were diagnosed in population based studies. At the time of first examination oral cancer was found to be coexistent in nine (10%) cases. For 66 patients follow-up observations ranging from 4 to 15 yr (median 8 yr) were available. During this period malignant transformation was observed in three patients (4.5%). Considering malignant transformation and coexistence together, oral cancer was observed in 13% of the present material. Leukoplakia was found in 26% of the patients with submucous fibrosis. Out of 42 submucous fibrosis patients biopsied, 12% showed squamous cell carcinoma, 26% epithelial dysplasia, and 76% atrophic epithelium. These findings reinforced the hypothesis that submucous fibrosis is a precancerous condition.     

Oral submucous fibrosis in a Greek female

Submucous fibrosis of the oral cavity is a disease affecting almost exclusively the Indian race, although sporadic cases have been described in non-Indians. Its aetiology is unknown and dietary factors have been incriminated in its pathogenesis, such as chilli ingestion. In this paper we present a case of oral submucous fibrosis in a 67-year-old Greek female, who two years after initial diagnosis developed squamous cell carcinoma of the tongue. The clinical course and histological findings are described and the potential of this disease as a predisposing factor for the development of malignancies of the oral mucosa is discussed.     

Pyknodysostosis--a report of two cases with a brief review of the literature

Pyknodysostosis is a rare sclerosing bone disorder that has an autosomal dominant trait. It is characterized by short stature, brachycephaly, short and stubby fingers, open cranial sutures and fontanelle, and diffuse osteosclerosis, where multiple fractures of long bones and osteomyelitis of the jaw are frequent complications. We present a report of two cases of pyknodysostosis with evidence of long bone fractures and chronic suppurative osteomyelitis of the jaws in one of the cases. Some of the specific oral and radiological findings that are consistent with pyknodysostosis are reported, along with a brief review of the literature.