Oral Sub-mucous Fibrosis : A Precancerous Lesion

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 Sabrina_Abbas_49DDCH_2017 1

2. Presenters: Dr.Sabrina Farida Chowdhury Dr.Shanjida Wasima Raka Sabrina_Abbas_49DDCH_2017 2

3. Precancerous Lesion: A generalized state associated with a significantly increased risk of cancer Sabrina_Abbas_49DDCH_2017 3

4. Premalignant Lesions: Leukoplakia (Dysplastic or Speckled) Erythroplasia Tertiary syphillis Oral submucous fibrosis Chronic candidosis Lichen planus Pipe smoker keratosis Sabrina_Abbas_49DDCH_2017 4

5. Erythroplasia Oral submucous fibrosis Dysplastic Leukoplakia Tertiary syphillis High Risk for Malignant Change Sabrina_Abbas_49DDCH_2017 5

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 Sabrina_Abbas_49DDCH_2017 6

7. Aetiological factors : Chewing betel nut, betel leaf Sabrina_Abbas_49DDCH_2017 7

8. - Panmasala - Vitamin D deficiency -Protein Deficiency - Alcohol Sabrina_Abbas_49DDCH_2017 8

9. Site: OSMF affects most part of oral cavity,pharynx and upper third of the esophagus Sabrina_Abbas_49DDCH_2017 9

10. Pathogenesis: Oral Mucosa Betel Quid Constant Irritation Chronic Inflammation Activated T cell and macrophages at the site Increase in cytokines IL6,TNF,increase in growth factor TGF beta Sabrina_Abbas_49DDCH_2017 10

11. Increase in Collagen production Decrease in collagen degradation Increased collagen(insoluble cross0linking of insoluble form of collagen) Fibrosis Oral Submucous Fibrosis Sabrina_Abbas_49DDCH_2017 11

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 - i ntolerance to spicy food -Hearing loss due to stenosis of Eustachian tube Sabrina_Abbas_49DDCH_2017 12

13. Staging O ral 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 Sabrina_Abbas_49DDCH_2017 13

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 Sabrina_Abbas_49DDCH_2017 14

15. Treatment Conservative Trearment : 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 Sabrina_Abbas_49DDCH_2017 15

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 Sabrina_Abbas_49DDCH_2017 16

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 Sabrina_Abbas_49DDCH_2017 17

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 Sabrina_Abbas_49DDCH_2017 18

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 / Sabrina_Abbas_49DDCH_2017 19

20. A Case Report on- Oral Submucous Fibrosis (Group 2) Sabrina_Abbas_49DDCH_2017 20

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. Sabrina_Abbas_49DDCH_2017 21

22. Patient’s Profile: Name: Monju Das Age:48years Sex:Female Occupation:Home maker Religion:Hinduism Sabrina_Abbas_49DDCH_2017 22

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 Sabrina_Abbas_49DDCH_2017 23

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. Sabrina_Abbas_49DDCH_2017 24

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 Sabrina_Abbas_49DDCH_2017 25

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 Sabrina_Abbas_49DDCH_2017 26

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 Sabrina_Abbas_49DDCH_2017 27

28. Local Examination Extraoral Examination: Appearance:Anxious Lip:Competent Limited mouth opening - 28mm Sabrina_Abbas_49DDCH_2017 28

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 Sabrina_Abbas_49DDCH_2017 29

30. Palpation: Fibrous band were palpable on the both side Measuring the mouth opening:28mm Sabrina_Abbas_49DDCH_2017 30

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 Sabrina_Abbas_49DDCH_2017 31

32. Diagnosis: upon clinical finding and history,the case was diagnosed as Oral submucous fibrosis group 2. Sabrina_Abbas_49DDCH_2017 32

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 Sabrina_Abbas_49DDCH_2017 33

34. First Day 15/02/2017 Sabrina_Abbas_49DDCH_2017 34

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37. Mouth opening-28mm Sabrina_Abbas_49DDCH_2017 37

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39. Second Day 22-02-2017 Sabrina_Abbas_49DDCH_2017 39

40. Mouth Opening-29mm Sabrina_Abbas_49DDCH_2017 40

41. Third visit 01-03-2017 Mouth opening:29.5 mm Fourth visit 09-03-2017 Mouth opening:31mm Sabrina_Abbas_49DDCH_2017 41

42. Fifth Visit 16-03-2017 Sabrina_Abbas_49DDCH_2017 42

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45. Mouth opening:34mm Sabrina_Abbas_49DDCH_2017 45

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