Oral Submucous Fibrosis Part 2

Buccal mucosa, faucial pillars ,soft palate, lips and hard palate.
The fibrous bands in the buccal mucosa run in a vertical direction ,sometimes so marked that the cheeks are almost immovable.
In the soft palate the fibrous bands radiate from the pterygomandibular raphe or the faucial pillars and have a sear like appearance

 The uvula is markedly involved , shrinks and appears as a small fibrous bud.
The faucial pillars become thick , short, and extremely hard.
The tonsils may be pressed between the fibrosed pillars
The lips are often affected and upon palpation , a circular band can be felt around the entire rima oris
When gingiva is affected , it is fibrotic, blanched and devoid of its normal stippled appearance.

Stage of stomatitis & vesiculation
It is earliest stage and characterized by recurrent stomatitis and vesiculation. Patient complaints of burning sensation in the mouth & inability to eat spicy food.
On examination vesicles on palate are seen.
They rupture and form superficial ulcers.
Some amount of fibrosis is also present.

Stage ll: Stage of fibrosis
There is inability to open mouth completely and stiffness in mastication. As disease advances there is difficulty in blowing out cheek & protruding tongue. Sometimes pain in ear and speech is muffled.On examination there in increasing amount of fibrosis in the submucosa. This causes blanching of mucosa.
Lips & checks become stiff & loose their normal resistance. Shortening & disappearance of uvula in advanced cases.
Dorsum of tongue shows atrophy of papillae.
Mucosa of floor of mouth show blanching & stiffness

Stage of sequelae & Complication
presents with all the complaints as in stage II. Also there may be evidence of leukoplakia.
Changes in mucosa are whitish or brownish black-
Pindborg et al (1967) found the OSMF was found in 40%cases of oral cancer than in general population 1.2%.

Stage 1: Early OSMF
Mild blanching.
No restriction in mouth opening .Central incisor tip Males… 35-45mm to tip of same side. Females 30-42mm.
No restriction in tongue protrusion .Mesio incisal angle of upper central incisor to the tip of the tongue when maximally extended with mouth wide open-Males 5-6 cms and Females 4.5-5.5 cms.

Stage 2 : Moderate OSMF
Moderate to severe blanching .
Mouth opening reduced by 33%.Flexibility also demonstrably decreased.
Burning sensation even in absence of stimuli.
Palpable bands felt.
Lymphadenopathy either unilateral or bilateral.
Demonstrable anemia on hematological examination.

Stage 3: Severe OSMF
Burning sensation very severe. patient unable to do day to day work.
More than 66% reduction in the mouth opening cheek flexibility and tongue protrusion, the tongue may appear fixed.
Ulcerative lesions may appear on the cheek.
Thick palpable bands.
Lymphadenopathy bilaterally evident..

Lab Findings
Lab findings reflect the nature of tissue changes in this condition rather than any diagnostic importance.
Increased ESR
High eosinophil count
Hyper gammaglobulinaemia
Lower serum vitamin A levels

Intralesional injections of hyaluronidase.
Use of Placentrix 2ml solution at interval of 3 days in five divided region
Topical application of 4% Acetic acid (variable) 3 times daily.

Topical application of immunomodulators:
5 Fluorouracil
Systemic administration of immunomodulators
Levamisole 150mg for 3 weeks
Dapsone 75 mg O.D for 90 days

Laser treatment