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OSMF

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Nibras Moh
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8 views20 pages

OSMF

Uploaded by

Nibras Moh
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Oral

Submucous
Fibrosis
Dr. Eman Alsheikh
MSc Oral Medicine – Cairo University
OSMF
• Oral submucous fibrosis (OSMF) is a precancerous
disorder of the submucosa that causes inflammation
& progressive fibrosis, leading to pronounced
stiffness and trismus.

• Chronic disease affecting oral mucosa as well as


pharynx and upper 2/3 of esophagus.
The clinical manifestation of this chronic, progressive disorder
depends on the disease's stage at the time of discovery.

Most patients initially display a sensitivity to spicy foods as well as


lip, tongue, and palate rigidity that, to varying degrees, limits
mouth opening & tongue mobility.

The hallmark of the illness is submucosal fibrosis, which mostly


affects the pharynx, upper third of the esophagus, and oral cavity.
Clinical features
• Oral submucous fibrosis (OSF) is a chronic, progressive, and irreversible disease that affects
the oral cavity. Some of its clinical features include:

• Trismus or incapability of opening the mouth because of oral fibrosis

• Change of taste

• Dryness of mouth

• Earache

• Loss of hearing, due to stenosis of eustachian tubes


Causes
• It can be caused by various factors, as explained below:
1. Excessive consumption of red chilies.
2. Too much chewing of areca nuts.
3. Deficiency of certain nutrients, like vitamin A.
4. Immunological factors: poor immune response of the body.
5. Genetically transmitted.
6. Extensive tobacco usage.
7. Patients with a deficiency of certain micronutrients.
The countries with the highest prevalence of the illness are
India, Bangladesh, Sri Lanka, Pakistan, Taiwan, Southern
China, Polynesia and Micronesia.

Asian immigrants to South and East Africa and the UK have


been the subject of several case-series reports.

There has been information on a large variance in OSF


prevalence among nations.

According to recent epidemiological data, the number of


patients increased from an estimated 250,000 in 1980 to 2
million in 1993, and OSF cases have increased dramatically in
India.
• The rapid spread of the disease is reportedly due to the increasing popularity of
commercially available areca nut preparations (pan masala) in India as well as an increase
in young people acquiring this habit because of easy availability, successful pricing
modifications, & marketing initiatives. Areca nut is the primary etiological factor.
• Areca nuts, capsaicin in peppers, a lack of micronutrients like iron & zinc, and a lack of vital
vitamins have all been mentioned as potential etiological factors. It has also been suggested that the
illness may have an autoimmune etiology due to the presence of certain autoantibodies and a
relationship with HLA antigens.

• This suggests that certain people may have a genetic susceptibility to develop OSF. However, it is
evident from the current scientific literature that regular use of areca nuts is the primary etiological
component
Pathogenesis

Areca nuts contain alkaloids → arecoline (1ry etiological factor)

Arecoline → has the capacity to modulate matrix metalloproteinase, lysyl oxidases, collagenases

All → affecting metabolism of collagen, & in addition to Prolonged alkaline pH induces death of
the fetal fibroblast type and replacement by a profibrotic fibroblast. lead to → increase fibrosis

Result in → decrease water-retaining proteoglycans & increase collagen type I production


• TNF has been reported to promote development of OSMF in which it stimulates
fibroblasts thereby it participating in development of fibrosis.

• Other cytokinesB rotcafssorg gnimrofsnart eta and INF gama lead to → increase
production and decrease degradation of collagen.
• First clinical sign → erythematous lesion; in conjunction
with
▪ Petechiae
▪ Pigmentations
▪ Vesicles
• The initial lesions followed by a paller mucosa may comprise –
lookslike- white marbling (marble-like appearance).
• Later → prominent clinical characteristics include Fibrotic
bands located beneath an atropic epithelium
Classification
Classification by Warnakulasurya 2010

• Grade I: burning sensation , blanching ,lethery mucosa , IC > 35 mm

• Grade II: moderate limitations of opening, IC: 35-20 mm

• Grade III: severe limitations , IC: < 20 Mm

• Grade IV: OSMF with PMD (leukoplakia, erythroplakia)

• Grade IV B: OSMF with oral epithelial dysplasia

• Grade V: OSMF coexist with SCC


Management
• The chronic & resistant nature of OSMF is widely established. As OSMF is a
premalignant condition & has the potential to change into malignancy, the prime
objective of treatment is to arrest the progression of the disease into malignancy.

• Then symptomatic relief should be given to the patient so that he can improve his
dietary status.
Management
• Several different treatment options are available to treat this illness, including medical
approaches, surgical management, and physiotherapy.

• The first step in proper treatment is educating the patient about the negative consequences of
areca nut & related chewing products so that the patient will discontinue the habit.

• Then 2nd step the management approaches consist of conservative, medical & surgical
management. Along with medical & surgical management, physiotherapy should be prescribed
• Treatment modalities of oral submucous fibrosis are
Nutritional or Supportive Therapy
• Micronutrients and minerals including iron, copper, calcium, zinc, magnesium, & selenium,
as well as vitamins A, B, C, D, and E, can significantly lower the levels of free radicals.

• Low fruit and vegetable consumption is associated with a higher risk of developing pre-
malignancies and cancers.

• . A good source of vitamins A, B1, B2, B6, B12, C, pantothenic acid, nicotinic acid, folic acid,
iron, copper, and zinc is immune milk, which also has a potent anti-inflammatory impact.
Conclusions
• There are numerous management strategies for OSMF.

• Corticosteroids, hyaluronidase, placentrex, IFN, &


microwave diathermy, among other therapy modalities,
have all been linked to the ability to treat the illness.

• A surgical procedure that involves cutting away fibrotic


tissues & filling the defect with grafts is also being studied.

• Recent research has shown that the pharmacological combination


generates beneficial effects in the management of this condition

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