3. Definition:
Oral Submucous fibrosis is a chronic, progressive, scarring, high-risk
precancerous condition of the oral mucosa.
WHO Definition:
An insidious chronic disease affecting any part of the oral cavity and
sometimes the pharynx. Although occasionally preceded by or
associated with vesicle formation, it is always associated with juxta-
epithelial inflammatory reaction followed by fibro-elastic changes of
lamina propria, with epithelial atrophy leading to stiffness of the oral
mucosa and causing trismus and inability to eat
13. Pathogensis:
• It has been linked to the chronic placement in the mouth of betel quid or paan. The quid
consists typically of a nut from the areca palm tree and slaked lime, usually with tobacco
or sweetener and condiments, wrapped in a betel leaf. Slaked lime acts to release
alkaloids from the areca nut i.e.
• Arecoline
• Arecadine
• Guvacine
• Guvacoline
submucosal changes are due to areca nut and whereas epithelial alterations and
carcinogenesis may be due to tobacco
1. Areca nut disrupts the homeostatic equilibrium between synthesis and degradation of
the extracellular matrix.
2. Cytokines and growth factors produced by activated inflammatory cells may promote
fibrosis by
14. • Inducing proliferation of fibroblast
• Upregulating collagen synthesis
• Downregulating collagenase production
• Copper found in areca nuts also upregulate collagen production
15. Stages by Haider et al (2000)
Clinical Staging:
Stage 1: Faucial bands only
Stage 2:Faucial and buccal bands
Stage3: Faucial , Buccal and Labial bands
Functional Staging:
Satage1: Mouth opening >20mm
Stage2: Mouth opening 11-19mm
Stage3: Mouth opening <10mm
16. Management:
• Discontinuation of habit and counseling
• Supportive care
• Medical Management:
• Steroids
• Hyaluronidase
• Chymotrypsin
• Interferon gamma
• Immune Milk
• Turmeric
• Lycopene
• Pentoxyfilline
17.
18.
19. • Mouth opening exercises
By Hiester’s Jaw opener
Exercise by ice cream sticks
• Diathermy
• Ultrasounds
20.
21. Surgical Management:
• Simple excision of the fibrous bands
• Split-thickness skin grafting following bilateral temporalis myotomy or
coronidectomy
• Nasolabial flaps or Lingual pedicle flaps
• CO2 laser surgery
• Cryosurgery: Liquid Nitrogen or Argon gas used preferably through
cryoprobe guided by MRI/USG. The frozen tissue is either natuarrly
absorbed by the body or dissolved and form a scab.
