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OSMF

The authors propose a new clinical classification system for oral submucous fibrosis (OSMF) based on their extensive study of over 4,000 OSMF patients. The classification system has two parts: (1) a clinical staging from Stage 1 to 4 based on symptoms and extent of fibrosis, and (2) a functional staging from M1 to M4 based on inter-incisal mouth opening. This classification aims to accurately categorize OSMF to help determine appropriate treatment and prognosis. The authors believe this new system addresses limitations of previous classifications and will assist clinicians in managing OSMF cases.

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153 views20 pages

OSMF

The authors propose a new clinical classification system for oral submucous fibrosis (OSMF) based on their extensive study of over 4,000 OSMF patients. The classification system has two parts: (1) a clinical staging from Stage 1 to 4 based on symptoms and extent of fibrosis, and (2) a functional staging from M1 to M4 based on inter-incisal mouth opening. This classification aims to accurately categorize OSMF to help determine appropriate treatment and prognosis. The authors believe this new system addresses limitations of previous classifications and will assist clinicians in managing OSMF cases.

Uploaded by

Al Rawdha
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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PROPOSED CLINICAL CLASSIFICATION FOR ORAL

SUBMUCOUS FIBROSIS
• AUTHORS: Chandramani B. More , Sunanda Das, Hetul Patel,
Chhaya Adalja, Vaishnavee Kamatchi, Rashmi Venkatesh.

• PLACE: Dept of Oral Medicine & Radiology, K.M. Shah Dental


College & Hospital, Sumandeep Vidyapeeth University,
Vadodara.

• JOURNAL: Oral Oncology 48 (2012) 200–202

• SOURCE: Internet.
DEFINITION

OSMF is insidious chronic disease of oral cavity and


sometimes pharynx. Although occasionally preceded by
and/or associated with vesicle formation, it is always
associated with juxtaepithelial inflammatory reaction
followed by fibroelastic change in the lamina propria, with
epithelial atrophy leading to stiffness of oral mucosa causing
trismus and inability to eat.
(Pindborg 1966)
Oral Submucous Fibrosis (OSMF) is a chronic, progressive,
scarring disease, that predominantly affects people of
South Asia and South-East Asia, where chewing of
arecanut and its commercial preparation is high.
INTRODUCTION

• 2500- 3000 BC: Shusruta- Vidari


• 1952 : Schwartz
• 1953 : Joshi
• 1956 : Paymaster

The prevalence rate in India is about 0.2–0.5% which


accounts to about 5 million indians.

Hence it is considered a public health issue.


• The aetiology of OSMF is multifactorial but arecanut
chewing is the main causative agent.

• Once initiated, OSMF is not amenable to reverse at any


stage of the disease process even after cessation of the
putative causative factor of arecanut chewing.
INTRODUCTION

• The condition may remain either stationary or become


severe, leaving an individual handicapped, both
physically and psychologically

• The literature is replete with the clinico-pathologic


presentation of OSMF.

• Diagnosis and staging becomes very important as it


affects the treatment of the disease.
Classification systems bases on clinical features:
Pindborg JJ (1989)
Lal DR (1995)
Ranganathan K et al (2001)
Rajendran R(2003)

Classification system based on histopathological features:


Pindborg JJ et al (1966)
Utsunomiya H et al (2005)

Classification systems based in clinical features and


histopathological features
Khanna JN et al (1995)

Ranganathan K, Mishra G. An overview of classification schemes for oral


submucous fibrosis. JOMFP ;10(2):55-58
PINDBORG 1989

STAGE II STAGE III


STAGE I
Early lesion: Sequele of
Blanching
Stomatitis OSMF:
Vesicles Older lesion: Leukoplakia in
Ulcers Fibrous bands more than 25%
Pigmentation Reduction of mouth opening of individuals
petechie Stiff tongue with OSMF
Blanched and leathery floor Speech and
of mouth hearing deficits.
Bud like uvula
LAL DR ( 1995)

Divided the OSMF population into following groups


depending on interincisal opening:

GROUP A: Mouth opening greater than 35 mm


GROUP B: Mouth opening between 30-35 mm
GROUP C: Mouth opening between 20-30 mm
GROUP D: Mouth opening less than 20 mm.
RANGANATHAN et al ( 2001)

• Group I: Only symptoms on restriction in mouth.


• Group II: Limited mouth opening 20 mm and above
• Group III: Mouth opening less than 20mm .
• Group IV: OSMF advanced with limited mouth
opening. Precancerous or cancerous changes
observed
RAJENDRAN et al ( 2001)

• EARLY OSMF: Burning sensation, blisters especially in


palate, excessive salivation, defective gustatory
sensation

• ADVANCED OSMF: Blanched mucosa, fibrous bands.


Impaired tongue movements
• Numerous classifications are recommended till date.

• But the advantages and drawbacks of these classification


supersedes the other leading to perplexity.

• An accurate classification is seen to be lacking where every


patient can be categorized.

• The initial diagnosis of the disease is of utmost importance, as


the treatment and prognosis greatly depends on its staging.

• So, the clinical appearance holds the most important value in


staging OSMF.
• Hence extensive OSMF research in both, community and
clinical based studies was undertaken for the present study.

• After examining and studying more then 4000 patients


affected with OSMF, the authors have tried to formulate a
simple classification based on the common site of occurrence,
symptoms, other affected sites and associated lesions.
• This classification was implemented on trial basis in their
department for more than three years and after extensively
analyzing it on numerous patients reporting for treatment, it
has proved to be simple, easy and uncomplicated.

• Hence the authors have put forward a new system of


classification that will assist the clinician in the categorization
of OSMF according to its biological behaviour and for its
subsequent medical and surgical management.
• The clinical presentation of OSMF varies in terms of site as
well as severity.

• Extent of fibrosis and mouth opening are two very important


manifestations of OSMF that cannot be overlooked.

• Loss of pigmentation of oral mucosa and Stomatitis is the


most commonest initial feature in OSMF.

• The involvement of multiple oral sites is directly related to the


severity of the condition.
I. Clinical staging
• Stage 1. (S1) – Stomatitis and/or blanching of oral mucosa.
• Stage 2. (S2) – Presence of palpable fibrous bands in buccal mucosa
and/or oropharynx, with/without stomatitis.
• Stage 3. (S3) – Presence of palpable fibrous bands in buccal mucosa
and/or oropharynx, and in any other parts of oral cavity,
with/without stomatitis.
• Stage 4. (S4)
– A. Any one of the above stage along with other potentially
malignant disorders e.g. oral leukoplakia, oral erythroplakia, etc.
– B. Any one of the above stage along with oral carcinoma.
II. Functional staging
• M1. Inter-incisal mouth opening up to or >35 mm.
• M2. Inter-incisal mouth opening between 25 mm and 35 mm.
• M3. Inter-incisal mouth opening between 15 mm and 25 mm.
• M4. Inter-incisal mouth opening <15 mm.

Example – S1M1, S2M3, S2M4, S3M4, S4AM2, S4BM3.


DISCUSSION
• The distinct features of OSMF are taken into consideration
while preparing this proposed classification; stomatitis,
presence of palpable fibrous bands, inter-incisal mouth
opening and presence of potentially oral malignant disorders
or oral malignancy.

• Stomatitis is the very first symptom and significant feature in


the initial stage of OSMF.

• Because of the epithelial atrophy of oral mucosa is more


vulnerable for irritation and the patient invariably complains
of burning sensation on eating hot and spicy food.
DISCUSSION
• Burning sensation is the most initial symptom, followed by
either hyper salivation or dryness of mouth.

• The inter-incisal mouth opening is one of the important


criteria in the progression and advancement of the disease. In
severe labial involvement, the opening of the mouth is altered
to an elliptical shape and difficulty to evert.

• The dense fibrosis involving the tissues around the pterygo-


mandibular raphe causes varying degrees of trismus.

• The gradual reduction in the opening of mouth makes the


patient concerned about the condition and necessitates the
urge for treatment of OSMF.
CONCLUSION
• The proposed classification is based on the authors’ clinical
observations and extensive studies on numerous patients
suffering from OSMF with varying degrees of severity.

• The distinct features along with the association of PMD and


oral malignancy are taken into consideration while preparing
this classification.

• Authors believe that clinicians will be able to relate this new


system of classification that will assist them in the
categorization of Oral submucous fibrosis and for its
subsequent medical and surgical management.
THANK YOU

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