口腔粘膜下纤维性变中成纤维细胞形态学初步研究

为探讨口腔粘膜下纤维性变（ＯＳＦ）中胶原堆积的原因，电镜下对（ＯＳＦ）患者病变部位中的成纤维细胞（Ｆｂ）的形态学进行研究，并对各阶段的Ｐｂ进行计数。结果显示：幼稚的Ｆｂ（少分化Ｆｂ和幼Ｆｂ）在正常及病变各均无差别，肌成纤维细胞在ＯＳＦ中期增多，纤维细胞在ＯＳＦ早期减少，中期增加至正常水平，晚期则较其余各期增多，研究结果提示：ＯＳＦ中的Ｆｂ形态发生了改变。     

口腔粘膜下纤维性变中成纤维细胞的超微结构观察

为探讨口腔粘膜下纤维性变（ＯＳＦ）中胶原增生的机制,透射电镜下对成纤维细胞分类计数结果表明合成胶原功能最旺盛的成胶原细胞在病变早期,中期增多,降解胶原能力最强的破纤维细胞在病变中期,晚期减少,其差异均有显著性。提示ＯＳＦ中胶原纤维的堆积在早期主要为合成的增多,中期既有合成的增多,也有降解的减少,而晚期则主要为胶原降解不足所致。     

口腔粘膜下纤维性变中胶原纤维的超微结构研究

为探讨口腔粘膜下纤维性变（ＯＳＦ）中胶原堆积的原因，电镜下对ＯＳＦ患者病变部位中的胶原纤维形态进行研究，结果显示：（１）胶的原纤维横断面：ＯＳＦ早期“负染”胶原和管状胶原较正常增多，中期主要为“负染”胶原和管状胶原，晚期则绝大多数“负胶原”（２）胶原原纤维纵切面；ＯＳＦ早期以黑色纤维为主，中期黑白纤维混杂，晚期以白色纤维为主。研究结果提示：ＯＳＦ的胶的纤维发生了变性，其程度随病变发展而加 。     

口腔粘膜下纤维性变临床分析

目的：总结口腔粘膜下纤维性变(OSF)临床特征,提高OSF临床检出率和诊断率。方法：对382例OSF患者临床资料进行总结,对其发病因素,临床特征进行分析。结果：1)382例OSF患者中男性370例(96．8％),20～40岁以上的OSF患者328例(85％);2)382例OSF患者均有咀嚼槟榔史,其发病与咀嚼槟榔的时间呈正相关关系,但与咀嚼槟榔的量无正相关关系;3)因热、辣食物有烧灼感、张口困难而就诊者分别为99．2％和50．2％,糜烂或起疱、张口受限者分别为85．8％和50．3％,颊、翼颌韧带受累者分别为96．3％和99．2％,患者常有多个部位受累。结论：1)OSF好发于青年男性;2)槟榔是OSF发病的关键因素;3)OSF临床症状和体征多样。     

口腔粘膜下纤维性变临床分型探讨

目的：为提高口腔粘膜下纤维性变（ＯＳＦ）的临床检出率和诊断率。方法：对湖南省湘潭市１１０４６人进行口腔普查将检出的３３５名ＯＳＦ患者按不同临床表现分为弥漫型和局限型,其中具有ＯＳＦ典型临床表现者为弥漫型,其它为局限型,并于１０年后复查了其中７２名患者。结果：３３５名患者中弥漫型仅１３例,占３．９％,局限型３２２例,占９６．１％。复查显示：在无适当治疗下,两型之间无相互转化。结论：局限型ＯＳＦ是湘潭     

Surgical Interventions in Oral Submucous Fibrosis: A Systematic Analysis of the Literature

Background

Oral submucous fibrosis (OSMF) is a potentially malignant disorder of the oral cavity. The surgical management of this condition involves excision of the fibrotic bands and interpositional grafts to retain the increased oral opening. Various procedures and graft material have been utilised with differing success rates.

Objectives

The present review aims to collate and analyze from world literature the different modalities utilized in the surgical management of OSMF. The reasons for the choice of a particular surgical procedure, the study protocol, the average follow-up period and the results were scrutinized.

Materials and Methods

The PRISMA protocol was followed for the systematic review. Search engines and medical databases like Ovid, Medline, Pubgate, Researchgate, PubMed, Google etc. were tapped for information related to the subject. The search words “OSMF”, “surgical interventions in OSMF”, “flaps and grafts in treatment of OSMF” were employed for retrieval of data. An analysis of the treatment modalities, the reason for the selection of a particular modality, the organization of the sample selection and the follow-up periods including the proclaimed success rates was done.

Results

The review resulted in a total of 56 articles on the subject from the sources mentioned above. A total of 995 surgically treated cases were included in the analysis. Interestingly the review revealed very few controlled clinical trials, most being random trials on surgical procedures in small groups of patients with very short follow up periods. The choice of procedure seems to be determined entirely by the preference of the operator/s.

Conclusions

There exist no definite protocols for the adoption of a particular treatment mode in OSMF. Adequate documentation and follow up need to be established to statistically analyse the results and proclaimed successes of various treatment modalities.     

茶色素治疗口腔粘膜下纤维性变的临床观察

39名口腔粘膜下纤维性变（OSF）患分别采取常规治疗与加茶色素治疗进行临床观察,对照组（22人）采用常规治疗（口服VitAD、VitBco、VitE等）,研究组（17人）采用常规治疗加服茶色素,并治疗前作血液流变学检查,结果显示,对照组刺激痛等症状有一定改善,但张口度无改善,有效率13.6%。研究组中12名有血液流变改变的患7人张口度增加3-15mm(58.3%),平均改善7.9mm,且血液流变改变愈明显的,其张口度的改善情况愈好,5名血液流变无改变的患仅1人张口度提高2mm(20%),研究组总有效率58.8%,两组差别有显性（P<0.005),提示,茶色素对治疗血液流谱的OSF患有较好疗效。     

Dentoalveolar Surgery in Oral Submucous Fibrosis: Need for Caution

Performing exodontia in patients with the precancerous condition of oral submucous fibrosis is difficult but frequently necessary. There is mucositis and trismus, faulty wound healing and predisposition to infection. Exodontia and dentoalveolar surgery in these patients may result in distressing sequelae and diagnosis of any subsequent complications like space infection is difficult. Hence, these patients must be treated as a special care group and measures adopted to ease distress. Literature has been reviewed with an eye to understand the underlying nature of the disease and factors that contribute to these problems.     

Concomitant Association of Oral Submucous Fibrosis and Oral Squamous Cell Carcinoma and Incidence of Malignant Transformation of Oral Submucous Fibrosis in a Population of Central India: A Retrospective Study

Aim

To evaluate the incidence of oral squamous cell carcinoma concomitant with oral sub mucous fibrosis in central India and to correlate precipitating factors associated with oral submucous fibrosis and oral squamous cell carcinoma. This paper also aims to study the incidence of oral squamous cell carcinoma arising secondary to untreated oral submucous fibrosis.

Materials and Methods

Two hundred and twenty five cases of oral squamous cell carcinoma and one hundred and nineteen cases of oral submucous fibrosis of various regions in oral cavity were included in the study. All the included cases were clinically and histopathologically diagnosed and retrospective data was retrieved.

Result

In the present study of 119 patients of oral submucous fibrosis, 97.4 % were found to have betel nut chewing habit. Incidence of malignant transformation to oral squamous cell carcinoma in patients of untreated oral submucous fibrosis was found to be 4.2 % in the present study. The incidence of oral cancer concomitant with oral submucous fibrosis was found to be 25.77 %, which is statistically significant.

Conclusion

From the present study, it is evident that the malignant potential of OSF is underestimated. However, considering the small sample size and the fact that the study was carried out in a small geographical area, further study with a larger sample size and longer duration of follow up on a multicentric basis may be required to reveal the actual malignant potential of the disease.     

RUNX3和RASSF1A在口腔黏膜下纤维性变及其癌变组织中的表达

目的：研究Runt相关转录因子3（RUNX3）、RAS相关区域家族1A（RASSF1）在口腔黏膜下纤维性变（OSF）及其癌变组织中的表达与分布,初步探讨二者在OSF癌变过程中的作用。方法：采用免疫组织化学SP法检测10例正常口腔黏膜组织、35例OSF组织、10例OSF癌变组织中RUNX3、RASSF1A蛋白的表达及分布。结果：RUNX3在正常口腔黏膜组阳性表达率为90.00%（9/10）,OSF组为85.71%（30/35）,OSF癌变组为30.00%（3/10）,正常对照组与OSF组无统计学差异,OSF癌变组显著低于正常对照组（P〈0.05）及OSF组（P〈0.05）。RASSF1A在正常口腔黏膜组阳性表达率为80.00%（8/10）,OSF组为62.86%（22/35）,OSF癌变组为20.00%（2/10）,正常对照组与OSF组无统计学差异,OSF癌变组织组显著低于正常对照组（P〈0.05）及OSF组（P〈0.05）。结论：RUNX3和RASSF1A表达下调或缺失与OSF癌变有关。     

Coming to America: Betel Nut and Oral Submucous Fibrosis

BackgroundOral submucous fibrosis (OSF) is an insidious precancerous disease affecting the oral cavity, pharynx and upper digestive tract. Its etiology is linked directly to betel nut use, which is common to the Indian subcontinent. With the increase in immigration of people from the Indian subcontinent to the United States, many American dental professionals will encounter this disease in the near future. The author provides a general overview of OSF.MethodsThe author provides a literature review of OSF, including its epidemiology, etiology, clinical presentation, histopathology and treatment modalities.ResultsOSF is a precancerous oral disease linked definitively to the use of betel nut. It is endemic to people in the Indian subcontinent. Patients' primary complaint is progressive trismus. Treatment is based on disease severity.Clinical ImplicationsOSF is a debilitating but preventable oral disease. Its incidence in the United States will increase as the South Asian immigrant population expands. Consequently, American dental professionals may encounter patients with this disease, and it is important that they are aware of it. In addition, for dental care professionals practicing in a South Asian American community, public health education is important to inform the population about the deleterious oral health effects of betel nut consumption.     

上皮间质转化相关蛋白在口腔黏膜下纤维化及其癌变组织中的表达

目的：探讨上皮间质转化相关标记蛋白E－cadherin和β－catenin在口腔黏膜下纤维化组织（oral submu－cous fibrosis,OSF）及其癌变组织中的表达特点及作用。方法：应用免疫组化SP法检测60例OSF患者,15例OSF癌变患者以及5例正常对照者的口腔黏膜组织中E－cadherin和β－catenin的表达并用IPP图像处理软件分析其平均光密度值。结果：①E－cadherin免疫组化阳性反应基本位于细胞膜,在正常黏膜和OSF早、中、晚期以及OSF癌变组织中其异常表达率分别为0、5％、20％、35％和53．3％;其平均光密度值分别为0．125±0．004,0．116±0．0006,0．109±0．008,0．103±0．009与0．095±0．008,各组之间表达均有显著性差异（P＜0．05）。②β－catenin免疫组化阳性反应在正常细胞基本位于细胞膜,而在OSF各组病变组织细胞中出现膜表达减少而质核表达增加的现象。在正常黏膜和OSF早、中、晚期以及OSF癌变组织中其异常表达率分别为0、60％、80％、90％和93．3％;其平均光密度值分别为0．105±0．007,0．098±0．009,0．106±0．012,0．114±0．007与0．119±0．003,β－catenin蛋白含量在早期组略有下降,但与正常组相比,表达无显著性差异（P＞0．05）;而OSF病变组间比较,表达均有显著性差异（P＜0．05）。结论：OSF及其癌变组织中E－cadherin的表达降低,β－catenin胞质核表达明显升高,EMT可能参与OSF及其癌变过程。     

Custom Made Protective Appliance for Oral Submucous Fibrosis

Oral submucous fibrosis is a chronic, debilitating disease characterized by gradually increasing fibrosis of oral cavity and pharynx, mainly the buccal mucosa, resulting in trismus. Various flaps have been used to reconstruct the surgical defects following excision of fibrous bands. It is inevitable to prevent these flaps from trauma by occlusion. The main objective of the authors is to introduce a technical innovation used to protect the flaps in the post-operative period. Here, we propose an easy and economical method to protect the flaps.     

Extended Nasolabial Flaps in the Management of Oral Submucous Fibrosis

Purpose  

We evaluated the use of extended nasolabial flaps in the management of oral submucous fibrosis.     

槟榔碱诱导口腔角质形成细胞凋亡研究

目的:了解槟榔碱(arecoline)对体外培养的人口腔黏膜角质形成细胞(keratinocyte,KC)凋亡的影响。方法:不同浓度的槟榔碱以及在不同时间处理体外培养的KC,在荧光显微镜下观察KC凋亡形态学改变并计算凋亡百分率,用比色法检测Caspase-3活性的改变。结果:1)槟榔碱能以一定时间和浓度依赖方式诱导培养的KC发生凋亡,其细胞凋亡率较正常对照组明显增高(P<0.05)。2)槟榔碱作用KC,其Caspase-3活性较正常对照组明显增高(P<0.05)。结论:槟榔碱可诱导KC凋亡,Caspase-3可能参与了这一细胞凋亡过程的调控。KC凋亡异常可能是口腔黏膜下纤维性变的重要发病机理之一。     

Treatment of Oral Submucous Fibrosis Using Split Skin Graft and a Polyethylene Stent: A Prospective Study

Aim

Aim of this study was to evaluate the split skin graft held in place with a polyethylene stent for the treatment of oral submucous fibrosis.

Methods

Fifteen prospective patients diagnosed clinically with oral submucous fibrosis, from June 2011 to 12 December 2012, were recruited for this study. All patients were treated surgically using the same surgical technique of fibrotomy followed by split skin graft along with a polyethylene stent. Preoperative and postoperative mouth opening measurements at 1 week and after a minimum of 6 months were evaluated by measuring the inter incisal distance.

Results

Mean follow up was 9.8 months with a minimum of 6 months. Mean preoperative mouth opening was 12.9 mm (6–20 mm). Intraoperatively mean mouth opening was 37.9 mm (36–41 mm). After 1 week mean mouth opening was 35.8 mm (31–40 mm). At 6 months follow up, mean mouth opening was 33 mm (20–40 mm).

Conclusion

Fibrotomy followed by split skin graft along with a polyethylene sheet stent and sufficient postoperative physiotherapy is a simple, cost effective and viable treatment modality for oral submucous fibrosis.     

口腔粘膜下纤维化中ET-1mRNA表达的研究

目的:通过研究内皮素-1(endothelin-1,ET-1)在口腔粘膜下纤维化中mRNA的表达,探讨ET-1与OSF(oral submucous fibrosis)病变发生发展的关系。方法:选取30例OSF患者,其中早、中、晚期组各10例,5例健康志愿者作为对照组,每例研究对象取其口腔颊粘膜,运用逆转录聚合酶链反应(RT-PCR)研究ET-1在OSF中mRNA的表达水平。结果:ET-1的mRNA在OSF各期中的表达均较正常口腔粘膜高(P<0.05);ET-1mRNA在OSF早期的表达均明显低于中、晚期(P<0.05),其中期的表达与晚期相比差异无显著性(P>0.05)。结论:各种调节因素在基因转录水平对ET-1表达的上调以及由此造成的ET-1基因的异常表达可能与OSF病变的发生发展密切相关。     

bFGF在口腔黏膜下纤维性变组织中的表达研究

目的:检测碱性成纤维细胞生长因子(basic fibroblast growth factor,bFGF)在正常颊黏膜(normal buccalmucosa,NBM)、口腔黏膜下纤维性变(oral submucous fibrosis,OSF)上皮组织中的表达,探讨bFGF在OSF发生发展中可能发生的作用。方法:收集10例NBM、30例颊部OSF上皮组织,利用免疫组化(immunohistochemistry,IHC)、聚合酶链式反应(PCR)和Western Blotting(WB)的方法研究bFGF在其中的分布和表达情况。结果:IHC提示:bFGF在NBM和OSF上皮组织中均有表达。在正常黏膜中,bFGF主要表达在黏膜下层的成纤维细胞胞浆中。在OSF早期,bFGF主要表达在上皮细胞间隙,基底膜和细胞浆中,发展到中晚期后则逐渐扩大表达,广范分布在细胞核中。bFGF的阳性表达率与其病理级别呈正相关。PCR提示正常黏膜组织中有bFGF mRNA的表达。在OSF组织中,bFGF mRNA随病变的加重而表达增加。WB提示:NBM上皮组织中未探及bFGF蛋白的表达,在OSF标本中bFGF随病变的加重而表达增强。结论:bFGF在OSF的发生发展中起着一定的作用。     

口腔粘膜下纤维性变组织中内皮素1的免疫组织化学和定量研究

目的：探讨ＥＴ－１在口腔粘膜下纤维性变（ＯＳＦ）发病机制中的作用。方法：采用免疫组化染色ＳＡＢＣ法和图像分析技术,对ＯＳＦ早、中、晚期各１０例、口腔扁平苔藓（ＯＬＰ）１０例以及正常人１０例的颊粘膜组织中ＥＴ－１表达进行定量分析。结果：①ＯＳＦ组织中ＥＴ－１免疫阳性物质超量表达,正常及ＯＬＰ组织中ＥＴ－１表达微弱;②ＯＳＦ早、中、晚期组织中ＥＴ－１含量显著高于正常（Ｐ〈０．０１）,且早、中期显著高于晚期（Ｐ〈０．０１）;③ＯＳＦ早、中期组织ＥＴ－１含量显著高于ＯＬＰ（Ｐ〈０．０１）,晚期间质ＥＴ－１含量显著高于ＯＬＰ（Ｐ〈０．０５）,上皮ＥＴ－１含量两者差异不显著（Ｐ〉０．０５）;④口腔粘膜中上皮和间质的ＥＴ－１含量呈显著正相关（Ｐ〈０．０５）。结论：ＥＴ－１在ＯＳＦ的表达具有特异性,且可能影响ＯＳＦ病变的发生发     

内皮素-1(ET-1)在口腔粘膜下纤维性变中的表达水平

为探讨ＥＴ－１与口腔粘膜下纤维性变（ＯＳＦ）的关系,应用免疫组化染色和图像分析技术,检测了ＯＳＦ３０例、正常口腔粘膜（ＮＯＲ）１０例组织中ＥＴ－１的定位分布和含量。结果显示：①ＯＳＦ组织中ＥＴ－１有异常表达,其免疫阳性物质主要分布于上皮棘细胞、基底细胞,间质成纤维细胞、血管内皮细胞及平滑肌细胞的胞浆胞膜上;②ＥＴ－１在ＯＳＦ组织表达的阳性率及相对含量均显著高于ＮＯＲ（Ｐ＜０．０１）;③ＯＳＦ各期ＥＴ－１相对含量存在差别,其中早、中期上皮细胞ＥＴ－１相对含量显著高于晚期（Ｐ＜０．０５）。由此提示,ＥＴ－１可能参与了ＯＳＦ的纤维化过程