oral submucous fibrosis

口腔粘膜下線維症

WordNet

1. of or relating to or affecting or for use in the mouth; "oral hygiene"; "an oral thermometer"; "an oral vaccine"
2. an examination conducted by spoken communication (同)oral exam, oral_examination, viva voce, viva
3. using speech rather than writing; "an oral tradition"; "an oral agreement" (同)unwritten
4. a stage in psychosexual development when the childs interest is concentrated in the mouth; fixation at this stage is said to result in dependence, selfishness, and aggression
5. of or involving the mouth or mouth region or the surface on which the mouth is located; "the oral cavity"; "the oral mucous membrane"; "the oral surface of a starfish"
6. development of excess fibrous connective tissue in an organ

PrepTutorEJDIC

1. 『口頭の』,口述の(spoken) / 口の,口部の / 経口の
2. 《選択を表し,語句・節を結んで》《肯定文・疑問文で》・・・『または』・・・,・・・か・・・ / 《否定文で》・・・も・・・もない / 《命令的表現の後で》『さもないと』 / 《前出の語を言い換えたり説明したりして》『すなわち』,言い換えれば
3. 線維症(線維性結合線維が増殖し過ぎる症状)

Wikipedia preview

出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/11/02 21:18:21」(JST)

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Oral submucous fibrosis
Classification and external resources
Specialty	gastroenterology
ICD-10	K13.5
DiseasesDB	33590

Oral submucous fibrosis (OSMF or OSF) is a chronic, complex, premalignant ( 1% transformation risk ) lesion of the oral cavity, characterized by juxta-epithelial inflammatory reaction and progressive fibrosis of the submucosal tissues (the lamina propria and deeper connective tissues). As the disease progresses, the jaws become rigid to the point that the person is unable to open the mouth. The condition is remotely linked to oral cancers and is associated with areca nut or betel quid chewing, a habit similar to tobacco chewing, is practiced predominantly in Southeast Asia and India, dating back thousands of years.

History

In 1952, T.Sheikh coined the term distrophica idiopathica mucosa oris to describe an oral fibrosing disease he discovered in five Indian women from Kenya. S.G. Joshi subsequently coined the termed oral submucous fibrosis (OSF) for the condition in 1953.

Classification

Oral 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

Khanna and Andrade in 1995 developed a group classification system for the surgical management of trismus:

• Group I: Earliest stage without mouth opening limitations with an interincisal distance of greater than 35 mm.
• Group II: Patients with an interincisal distance of 26–35 mm.
• Group III: Moderately advanced cases with an interincisal distance of 15–26 mm. Fibrotic bands are visible at the soft palate, and pterygomandibular raphe and anterior pillars of fauces are present.
• Group IVA: Trismus is severe, with an interincisal distance of less than 15 mm and extensive fibrosis of all the oral mucosa.
• Group IVB: Disease is most advanced, with premalignant and malignant changes throughout the mucosa.

Pathogenesis

"Exposure to arecanut (Arecacatechu) containing products with or without tobacco (ANCP/T) is currently believed to lead to OSF in individuals with genetic immunologic or nutritional predisposition to the disease. "

This hypersensitivity reaction results in a juxta-epithelial inflammation that leads to increased fibroblastic activity and decreased breakdown of fibers. The fibroblasts are phenotypically modified, and the fibers they form are more stable, produce thicker bundles that progressively become less elastic. once the original loosely arranged fibrous tissue is replaced by the ongoing fibrosis, the movability of the oral tissues is reduced, there is loss of flexibility and reduced opening of the mouth.

These collagen fibers are non degradable and the phagocytic activity is minimized.

According to a recent cross sectional study the time taken for return of salivary pH to baseline levels after chewing arecanut containing mixtures is significantly longer in habitual users with OSF when compared to unaffected users.

Symptoms

In the initial phase of the disease, the mucosa feels leathery with palpable fibrotic bands. In the advanced stage the oral mucosa loses its resiliency and becomes blanched and stiff. The disease is believed to begin in the posterior part of the oral cavity and gradually spread outward.

Other features of the disease include:

• Xerostomia
• Recurrent ulceration
• Pain in the ear or deafness
• Nasal intonation of voice
• Restriction of the movement of the soft palate
• A budlike shrunken uvula
• Thinning and stiffening of the lips
• Pigmentation of the oral mucosa
• Dryness of the mouth and burning sensation
• Decreased mouth opening and tongue protrusion

Causes

Dried products such as paan masala and gutkha have higher concentrations of areca nut and appear to cause the disease. Other causes include:

• Immunological diseases
• Extreme climatic conditions
• Prolonged deficiency to iron and vitamins in the diet

Common sufferers

The incidence of the disease is higher in people from certain parts of the world including South-East Asia, South Africa and the Middle East.

Treatment

Biopsy screening although necessary is not mandatory most dentist can visually examine the area and proceed with the proper course of treatment.

Treatment includes:

• Abstention from chewing areca nut (also known as betel nut) and tobacco
• Minimizing consumption of spicy foods, including chiles
• Maintaining proper oral hygiene
• Supplementing the diet with foods rich in vitamins A, B complex, and C and iron
• Forgoing hot fluids like tea, coffee
• Forgoing alcohol
• Employing a dental surgeon to round off sharp teeth and extract third molars

Treatment also includes following:

• The prescription of chewable pellets of hydrocortisone (Efcorlin); one pellet to be chewed every three to four hours for three to four weeks
• 0.5 ml intralesional injection Hyaluronidase 1500 IU mixed in 1 ml of Lignocaine into each buccal mucosa once a week for 4 weeks or more as per condition
• 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
• Submucosal injections of hydrocortisone 100 mg once or twice daily depending upon the severity of the disease for two to three weeks
• Submucosal injections of human chorionic gonadotrophins (Placentrax) 2-3 ml per sitting twice or thrice in a week for three to four weeks
• Surgical treatment is recommended in cases of progressive fibrosis when interincisor distance becomes less than 2 centimetres (0.79 in). (Multiple release incisions deep to mucosa, submucosa and fibrotic tissue and suturing the gap or dehiscence so created by mucosal graft obtained from tongue and Z-plasty. In this procedure multiple deep z-shaped incisions are made into fibrotic tissue and then sutured in a straighter fashion.)
• Pentoxifylline (Trental), a methylxanthine derivative that has vasodilating properties and increases mucosal vascularity, is also recommended as an adjunct therapy in the routine management of oral submucous fibrosis.
• IFN-gamma is antifibrotic cytokine which alters collagen synthesis and helps in OSF.
• Colchicine tablets 0.5 mg twice a day
• Lycopene, 16 mg a day helps in improvement of OSF

The treatment of patients with oral submucous fibrosis depends on the degree of clinical involvement. If the disease is detected at a very early stage, cessation of the habit is sufficient. Most patients with oral submucous fibrosis present with moderate-to-severe disease. Severe oral submucous fibrosis is irreversible. Moderate oral submucous fibrosis is reversible with cessation of habit and mouth opening exercise. Current modern day medical treatments can make the mouth opening to normal minimum levels of 30 mm mouth opening with proper treatment.

Stem cell therapy for oral submucosal fibrosis

Recently scientists have proven that intralesional injection of autologous bone marrow stem cells is a safe and effective treatment modality in oral sub mucosal fibrosis. It has been shown autologous bone marrow stem cell injections induces angiogenesis in the area of lesion which in turn decreases the extent of fibrosis thereby leading to significant increase in mouth opening.

See also

• Cutaneous condition

References

External links

• Stem Cell Therapy for Oral Submucosal Fibrosis in India
• Oral submucous fibrosis info
• Maxillofacialcenter.com
• Waent.org
• Wrongdiagnosis.com

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English Journal

• The Efficacy of ErCr:YSGG Laser Fibrotomy in Management of Moderate Oral Submucous Fibrosis: A Preliminary Study.

• Chaudhry Z1, Gupta SR2, Oberoi SS3.
• Journal of maxillofacial and oral surgery.J Maxillofac Oral Surg.2014 Sep;13(3):286-94. doi: 10.1007/s12663-013-0511-x. Epub 2013 Apr 18.
• INTRODUCTION: Oral submucous fibrosis (OSMF) is a chronic insidious disease mainly associated with fibroelastic change of the oral mucous membrane, leading to progressive trismus and oral burning sensation. The management of OSMF is empirical, depends on staging of the condition and is combination o
• PMID 25018602

• Malignant transformation in 5071 southern Taiwanese patients with potentially malignant oral mucosal disorders.

• Wang YY, Tail YH, Wang WC, Chen CY, Kao YH, Chen YK, Chen CH.
• BMC oral health.BMC Oral Health.2014 Aug 5;14(1):99. [Epub ahead of print]
• BACKGROUND: Oral cancers can be preceded by clinically evident oral potentially malignant disorders (OPMDs). The current study evaluated the rate and the time of malignant transformation in the various OPMDs in a cohort of patients from southern Taiwan. Parameters possibly indicative for malignant t
• PMID 25096230

• Necessitating a Quality of life instrument specific to Oral Precancers/Oral Potentially malignant disorders.

• Satheeshkumar PS1, Mohan MP2.
• Oral oncology.Oral Oncol.2014 Aug 2. pii: S1368-8375(14)00198-5. doi: 10.1016/j.oraloncology.2014.07.006. [Epub ahead of print]
• PMID 25096825

Japanese Journal

• Non-Invasive Techniques for Detection and Diagnosis of Oral Potentially Malignant Disorders

• The Tohoku Journal of Experimental Medicine 238(2), 165-177, 2016
• NAID 130005126459

• Translational approach utilizing COX-2, p53, and MDM2 expressions in malignant transformation of oral submucous fibrosis

• Journal of Oral
• NAID 130005099738

• Evaluation of hearing deficit in patients with oral submucous fibrosis

• Journal of Oral
• NAID 130005076032

Related Links

• Oral Submucous Fibrosis - Diseases & Conditions ...

In 1952, Schwartz coined the term atrophica idiopathica mucosa oris to describe an oral fibrosing disease he discovered in 5 Indian women from Kenya. Joshi subsequently coined the termed oral submucous fibrosis ...

• Oral submucous fibrosisとは - goo Wikipedia (ウィキペディア)

Oral submucous fibrosis (OSMF) is a chronic, complex potential potent pre-cancerous ( appox 20% may have chances ) condition characterized by juxta-epithelial inflammatory reaction and progressive fibrosis of the submucosal ...

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★リンクテーブル★

リンク元	「口腔粘膜下線維症」
関連記事	「oral」「submucous」

「口腔粘膜下線維症」

　　[★]

英

oral submucous fibrosis

「oral」

　　[★]

• adj,

• 経口の、経口用の

⇔parenteral

関

orally、p.o.、per os、peroral、perorally

　 　 　 　 　 　

「submucous」

　　[★]

• 粘膜下の

関

submucosa、submucosal