oral sub-mucous fibrosis : a precancerous lesion
TRANSCRIPT
1
Oral Submucous Fibrosis: A Precancerous Lesion
Sabrina_Abbas_49DDCH_2017
Sabrina_Abbas_49DDCH_2017 2
Presenters:Dr.Sabrina Farida Chowdhury
Dr.Shanjida Wasima Raka
Sabrina_Abbas_49DDCH_2017 3
Precancerous Lesion:A generalized state associated with a significantly increased risk of cancer
Sabrina_Abbas_49DDCH_2017 4
Premalignant Lesions:• Leukoplakia(Dysplastic or Speckled)• Erythroplasia• Tertiary syphillis• Oral submucous fibrosis• Chronic candidosis• Lichen planus• Pipe smoker keratosis
Sabrina_Abbas_49DDCH_2017 5
Erythroplasia Oral submucous fibrosis
Dysplastic Leukoplakia Tertiary syphillis
High Risk for Malignant Change
Sabrina_Abbas_49DDCH_2017 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 7
Aetiological factors :• Chewing betel nut, betel leaf
Sabrina_Abbas_49DDCH_2017 8
-Panmasala
- Vitamin D deficiency -Protein Deficiency - Alcohol
Sabrina_Abbas_49DDCH_2017 9
Site:OSMF affects most part of oral cavity,pharynx and upper third of the esophagus
Sabrina_Abbas_49DDCH_2017 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 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 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-intolerance to spicy food-Hearing loss due to stenosis of Eustachian tube
Sabrina_Abbas_49DDCH_2017 13
StagingOral 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 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 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 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 17
2.Hyaluronidase injection3.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 Extracts5.Chymotrypsin6.Interferon Gamma7.Immune Milk
Sabrina_Abbas_49DDCH_2017 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 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 20
A Case Report on- Oral Submucous Fibrosis (Group 2)
Sabrina_Abbas_49DDCH_2017 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 22
Patient’s Profile:Name:Monju DasAge:48yearsSex:FemaleOccupation:Home makerReligion:Hinduism
Sabrina_Abbas_49DDCH_2017 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 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 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 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 27
General examination:Appearance:Ill lookingBody Built:AverageCo-operation:Co-operativeDecubitus :On choiceAnaemia:AbsentJaundice:AbsentPulse:76 beats/minBlood Pressure:12o/85mm hgrespiratory rate:18 breaths/min
Sabrina_Abbas_49DDCH_2017 28
Local ExaminationExtraoral Examination:• Appearance:Anxious• Lip:Competent• Limited mouth opening -28mm
Sabrina_Abbas_49DDCH_2017 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 30
Palpation:Fibrous band were palpable on the both side
Measuring the mouth opening:28mm
Sabrina_Abbas_49DDCH_2017 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 32
Diagnosis:upon clinical finding and history,the case was diagnosed as Oral submucous fibrosis group 2.
Sabrina_Abbas_49DDCH_2017 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 34
First Day15/02/2017
Sabrina_Abbas_49DDCH_2017 35
Sabrina_Abbas_49DDCH_2017 36
Sabrina_Abbas_49DDCH_2017 37
Mouth opening-28mm
Sabrina_Abbas_49DDCH_2017 38
Sabrina_Abbas_49DDCH_2017 39
Second Day22-02-2017
Sabrina_Abbas_49DDCH_2017 40
Mouth Opening-29mm
Sabrina_Abbas_49DDCH_2017 41
Third visit01-03-2017
Mouth opening:29.5 mmFourth visit09-03-2017
Mouth opening:31mm
Sabrina_Abbas_49DDCH_2017 42
Fifth Visit16-03-2017
Sabrina_Abbas_49DDCH_2017 43
Sabrina_Abbas_49DDCH_2017 44
Sabrina_Abbas_49DDCH_2017 45
Mouth opening:34mm
Sabrina_Abbas_49DDCH_2017 46
Sabrina_Abbas_49DDCH_2017 47
Sabrina_Abbas_49DDCH_2017 48