Oral Submucous Fibrosis

Potentially Malignant Disorder, Habit Cessation, Areca nut chewing

1. Oral submucous fibrosis

2. •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 opening
•Malignant transformation rate 8%

3. Etiology
•Precise etiology not known
•Suspected multifactorial
•Various factors considered are:
Arecanut (Pan masala)
Nutritional deficiency
Auto immune
Genetic (HLA DR3)

9. Clinical features
Symptoms
•Progressive inability to open mouth
•Burning sensation to spicy food
consumption
•Relative loss of auditory acuity (due to
stenosis of the opening of eustachian
tube)

16. Signs
•Early signs: Vesicles , petechiae, melanosis,
xerostomia
•Blanching of mucosa (pale marble like
appearance)
•Loss of elasticity and suppleness of oral
mucosa
•Restriction 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 mucosa
•Shortening of uvula

18. Staging
•Clinical staging
1: Faucial bands only
2: Faucial and buccal bands
3: Faucial, buccal and labial bands

19. •Functional staging
A: Mouth opening > = 20 mm
B: Mouth opening 11 to 19 mm
C: Mouth opening <= 10 mm

20. Differential diagnosis
Easy clinical diagnosis
• Scleroderma
•Anemia-pale mucosa with pigmentation
•Leukoplakia
•Scarring due to thermal or chemical burn

21. Management
•Stop habit
•Mild cases: Intralesional injection of cortico
steroids (Betamethasone 4mg/ml)
•Surgical splitting or excision of bands
•Intra lesional injection of interferon gamma
•Miscellaneous medication that have been
tried
–Multivitamin supplements
–Placental extract (intra lesional injection)
–Hyaluronidase ,1500 iu (intra lesional injection)

22. Prognosis
•Does not regress completely even with
habit cessation
•Mild cases show improvement with steroid
injections
•Requires continuous monitoring for
malignant transformation