This document summarizes common lesions of the oral cavity, including ulcers caused by infections (viral like herpes, bacterial like Vincent's infection, fungal like candidiasis), immune disorders (aphthous ulcers, Behcet's syndrome), trauma, skin disorders (lichen planus, pemphigus vulgaris), and submucous fibrosis caused by chewing areca nut. It describes the etiology, clinical features, and management of each condition. Major types of oral ulcers and lesions are infections, immune disorders, trauma, neoplasms, and skin disorders that may manifest in the oral cavity.
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostotic ii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformans c. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitis b. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibroma b. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular type ii. Psammomatoid type
d. Gigantiform cementomas
Includes most common tumors of oral cavity including scc,bcc, melanoma, ameloblastoma, odontoma, fibromas, pindborg tumors etc.
Presented by Dr. Binaya Subedi
Fibro-osseous lesions of the jaws
Fibrous dysplasia
Cemento-osseous dysplasia
Focal cemento-osseous dysplasia
Periapical cemento-osseous dysplasia
Florid cemento-osseous dysplasia
Ossifying fibroma
Juvenile aggressive ossifying fibroma
Cherubism
Fibro-osseous lesions (FOL) are characterized by replacement of normal bone architecture by collagen fibers and fibroblasts containing calcified tissue.
They include a wide variety of lesions of developmental, dysplastic and neoplastic origins with clinical and radiographic presentation and behavior.
Because of the histological similarities between diverse diseases, proper diagnosis requires correlation of history, clinical and radiographic findings.Fibrous Dysplasia
2. Reactive (dysplastic lesions arising in the tooth-bearing area (presumably of periodontal origin).
a. Periapical cemento-osseous dysplasia
b. Focal cemento-osseous dysplasia
c. Florid cemento-osseous dysplasia
3. Fibro-osseous neoplasms (widely designated as cementifying fibroma, ossifying fibroma or cemento-ossifying fibroma.Bone dysplasias
a. Fibrous dyspla i. Monostotic ii. Polyostotic
iii. Polyostotic with endocrinopathy (McCune-Albright)
iv Osteofibrous dysplasia
b. Osteitis deformans c. Pagetoid heritable bone dysplasias of childhood
d. Segmental odontomaxillary dysplasia
2. Cemento-osseous dysplasias
a. Focal cemento-osseous dysplasia b. Florid cemento-osseous dysplasia
3.Inflammatory/reactive processes
a. Focal sclerosing osteomyelitis b. Diffuse sclerosing osteomyelitis
c. Proliferative periostitis
4. Metabolic Disease: hyperparathyroidism
5. Neoplastic lesions (Ossifying fibromas)
a. Ossifying fibroma b. Hyperparathyroidism jaw lesion syndrome
c. Juvenile ossifying fibroma i. Trabecular type ii. Psammomatoid type
d. Gigantiform cementomas
Includes most common tumors of oral cavity including scc,bcc, melanoma, ameloblastoma, odontoma, fibromas, pindborg tumors etc.
Presented by Dr. Binaya Subedi
A cyst is an epithelium-lined sac containing fluid or semisolid material. In the formation of a cyst, the epithelial cells first proliferate and later undergo degeneration and liquefaction. The liquefied material exerts equal pressure on the walls of the cyst from within. Cysts grow by expansion and thus displace the adjacent teeth by pressure. May can produce expansion of the cortical bone. On a radiograph, the radiolucency of a cyst is usually bordered by a radiopaque periphery of dense sclerotic bone. The radiolucency may be unilocular or multilocular. Odontogenic cysts are those which arise from the epithelium associated with the development of teeth. The source of epithelium is from the enamel organ, the reduced enamel epithelium, the cell rests of Malassez or the remnants of the dental lamina.
Oral submucous fibrosis (OSMF or OSF) is a chronic, complex, premalignant (1% transformation risk) condition 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.
A cyst is an epithelium-lined sac containing fluid or semisolid material. In the formation of a cyst, the epithelial cells first proliferate and later undergo degeneration and liquefaction. The liquefied material exerts equal pressure on the walls of the cyst from within. Cysts grow by expansion and thus displace the adjacent teeth by pressure. May can produce expansion of the cortical bone. On a radiograph, the radiolucency of a cyst is usually bordered by a radiopaque periphery of dense sclerotic bone. The radiolucency may be unilocular or multilocular. Odontogenic cysts are those which arise from the epithelium associated with the development of teeth. The source of epithelium is from the enamel organ, the reduced enamel epithelium, the cell rests of Malassez or the remnants of the dental lamina.
Oral submucous fibrosis (OSMF or OSF) is a chronic, complex, premalignant (1% transformation risk) condition 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.
Dentists play an important role in the diagnosis and management of desquamative gingivitis. The importance of being able to recognise and properly diagnose this condition is accentuated by the fact that a serious and life threatening disease may initially manifest as desquamative gingivitis.
This PowerPoint presentation demonstrate a useful review of Oral candidiosis, including its different types, clinical presentations, differential diagnosis, and treatment options.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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5. HERPANGINA
SYN: Vesicular stomatitis , Acute
lymphonodular pharyngitis
Cause: Enteroviruses-Coxsackie A, EV 71
Characteristic vesicular rash on tonsillar pillars,
soft palate, uvula, tonsils, posterior pharyngeal
wall
Discrete 1- to 2-mm vesicles and ulcers
Enlarge over 2-3 days to 3-4 mm and are
surrounded by erythematous rings up to 10 mm
1-15 lesions are present, usually around 5
Usually resolve without complications
Rarely, meningitis
6. Herpetic gingivostomatitis
Syn: orolabial herpes
Cause: HSV
Primary
Children
Clusters of multiple vesicles -> ulcers
Fever, malaise and headache , sore throat and
lymphadenopathy.
Secondary
Adults, mild
Vermilion border of the lip > hard palate and gingiva
Reactivation of dormant virus in trigeminal ganglion
Acyclovir, 200 mg, five times a day for 5 days to reduce
viral load
7. Hand, foot and mouth disease
Cause: Coxsackievirus A16 and enterovirus 71 (EV71)
spread via the fecal-oral and perhaps respiratory
routes
primarily in children
vesicular palmoplantar eruption and erosive
stomatitis.
Cloudy vesicles with a red halo are highly
characteristic of this disease.
8. Vincent’s infection
Syn: acute necrotising ulcerative gingivitis, trench
mouth
Causative organisms include a fusiform bacillus and a
spirochaete –borrelia vincentii
Affects young adults and middle-aged persons
Starts at the interdental papillae -> free margins of the
gingivae
Lesions covered with necrotic slough.
Gingivae become red and oedematous.
Similar ulcer and necrotic membrane may also form
over the tonsil (vincent’s angina).
Diagnosis: smear from the affected area.
Treatment is
Systemic antibiotics (penicillin or erythromycin and
metronidazole),
Frequent mouth washes (with sodium bicarbonate
solution) and attention to dental hygiene.
9. Moniliasis (candidiasis)
caused by Candida albicans
Thrush
white grey patches on the oral mucosa and
tongue.
infants and children
systemic malignancy and diabetes or taking
broad spectrum antibiotics, cytotoxic drugs,
steroids or radiation.
Thrush can be treated by topical application of
nystatin or clotrimazole.
10. Chronic hypertrophic candidiasis. Also called candidal leukoplakia.
White patch which cannot be wiped off.
Mostly affects anterior buccal mucosa just behind the angle of mouth.
Hypertrophic form usually requires excisional surgery.
12. Aphthous ulcers
Recurrent and superficial
Aetiology: Unknown. Autoimmune, Nutritional
(Folate, B12, Iron), Viral, Bacterial, Food
allergies, Hormonal, Stress
usually involving movable mucosa, i.e. inner
surfaces of lips, buccal mucosa, tongue, floor
of mouth and soft palate, sparing mucosa of
the hard palate and gingivae.
Minor form
more common,
ulcers are 2–10 mm in size and multiple with a
central necrotic area and a red
They heal in about 2 weeks without leaving a
scar.
Major form, ulcer is very big, 2–4 cm in size,
and heals with a scar but is soon followed by
another ulcer.
13. Topical application of steroids
Cauterisation with 10% silver nitrate.
In severe cases, 250 mg of tetracycline dissolved in 50 ml of water is
given as mouth rinse and then to be swallowed, four times a day.
Local pain can be relieved with lignocaine viscous.
14. Behcet’s syndrome (Oculo-oro-
genital syndrome)
Behçet's disease is a complex multisystem disease characterized by
oral and genital ulcers and other systemic features.
Diagnosis is based on the International Criteria for Behçet's Disease
including:
oral aphthae,
genital aphthae,
ocular lesions,
cutaneous lesions,
and a positive pathergy test.
Cutaneous lesions should display a neutrophilic vascular reaction on
histopathologic examination.
15. Seen worldwide, with the highest prevalence reported in Turkey and
Japan
prevalence and often the severity is increased in the Middle East
and the Mediterranean
predominantly affect males
Cause and Pathogenesis
Heredity, immunologic factors, infectious agents, inflammatory
mediators, and clotting factors likely contribute.
16. Oral aphthae, or Canker sores are often the initial
feature of Behçet's disease and constitute a requisite
diagnostic feature
usually occur in crops of more than 3 to 10s
painful and shallow, and they heal without scarring
over 1 to 3 weeks
Genital ulcers typically occur on the scrotum and penis
in males and on the vulva or vaginal mucosa in
females.
These aphthae are similar in appearance to oral
lesions, but they have a greater tendency to scar and
may recur less frequently.[
17. Cutaneous-
erythema nodosum–like lesions,
pyoderma gangrenosum–like lesions,
Sweet's syndrome–like lesions,
cutaneous small vessel vasculitis, and pustular vasculitic
lesions including lesions induced by trauma—the so-called
pathergy lesion.
Pathergy signifies the development of erythematous
pustules or papules 24 to 48 hours following puncture of
the skin with a 20- to 21-gauge sterile needle.
Specimens from all these lesions demonstrate a
neutrophilic vascular reaction on histopathologic
analysis.
Ophthalmic (83% to 95% of men and 67% to 73% of
women)
anterior and posterior uveitis,
retinal vasculitis, and hypopyon, with secondary
glaucoma,
cataract formation, decreased visual acuity, and
synechiae formation
18. Arthritis of Behçet's disease is typically a nonerosive, inflammatory,
symmetric, or asymmetric oligoarthritis
Central nervous system (CNS) involvement is most commonly
characterized by
brain stem or corticospinal tract syndromes (neuro-Behçet's syndrome),
venous sinus thrombosis,
increased intracranial pressure
isolated headache.
Cardiac complications include
myocardial infarction,
pericarditis,
arterial and venous thromboses, and
aneurysm formation.
19. Miscellaneous lesions of oral cavity
and tongue
Median rhomboid glossitis
red rhomboid area, devoid of papillae, seen
on the dorsum of tongue in front of foramen
caecum.
Due to chronic oral candidiasis
20. TRAUMATIC ULCER
lateral border of tongue -jagged tooth or ill-fitting
denture;
buccal mucosa -cheek bite;
palate - injury with a foreign object such as pencil
or tooth brush
acute ulcerative lesions of oral and
oropharyngeal mucosa - ingestion of acids or
alkalies or hot fluids.
Aspirin burn - buccal sulcus
22. Erythema multiforme
Acute, self-limited, polymorphous eruption
Symmetrically distributed macules, papules, and bullae, with
an edematous, petechial, vesicular, or bullous dusky violet
center.
It is probably due to cell-mediated hypersensitivity reaction
to certain drugs or infections, particularly in genetically
predisposed individuals, those immunocompromised or with
autoimmune disease.
Mucosal lesions are ocular (conjunctivitis, keratitis), oral
(stomatitis, cheilitis), nasal, pharyngeal, tracheal, and genital
(balanitis and valvulitis).
Dull red, flat or slightly raised maculopapules, which may
remain small or may increase in size to reach a diameter of 1-
3 cm in 48 h. Typical cases show at least some target (or iris)
lesions.
The disease is self-limiting and management is mainly
supportive. Steroids are used to treat the severe form.
23. Pemphigus vulgaris
autoimmune disorder affecting older age group (50–70) [AMBD]
Oral ulcerations are superficial and involve palate, buccal mucosa and
tongue.
Jagged intraoral erosions->Blisters
Treatment consists of systemic steroids and cytotoxic drugs.
24. Benign mucous membrane
pemphigoid (BMMP)
Most common AMBD
autoimmune disorder.
Mucosal lesions involve cheek,
gingivae and palate > Conjunctiva
Bulla filled with clear or haemorrhagic
fluid -> ruptures to form superficial
ulceration covered with shaggy
collapsed mucosa.
Skin lesions may be absent.
Treatment consists of steroids.
25. Lichen planus
Oral lichen planus (OLP) can occur without
cutaneous disease.
Onset before middle age is rare; the mean age of
onset is in the sixth decade.
Women outnumber men by more than 2:1.
Mucous membrane involvement is observed in
more than 50% of patients with cutaneous lichen
planus
The most common location of OLP is the buccal
mucosa (80% to 90%) followed by the tongue (30%
to 50%)
Lavy white lesions on buccal mucosa
26. Geographic tongue
Also called benign migratory glossitis,
Well-defined areas of atrophied filiform
papillae bordered by arcs of normal or
hyperplastic filiform papillae and by
gradual changes in the location of these
lesions over time
27. Submucous Fibrosis
Definition:
Submucous fibrosis represents a multifactorial disorder;
with the considered chief etiologic factor being the consistent and habitual use
of areca (betel) nut, either in the form of chewing or simply placing a quid of
material (paan masala) in the buccal or labial sulcus several time per day, or in
a packaged powdered form with other components (guthka), over many years.
premalignant condition with transformation rates as high as 7.6%
Etiology and pathogenesis:
failure of collagen remodeling
altered epithelial-mesenchymal interactions ->formation of collagenous bands
and aggregates within the submucosa and lamina propria.
diminished level of functional collagenase levels
28. Clinical Features
Changes of submucous fibrosis are most marked
over soft palate, faucial pillars and buccal mucosa
Initial mucosal alterations: erythema with or without
vesiculation.
Later: slow diminishment of erythema and a
progressive decrease in the degree of oral opening
and tongue mobility
Pallor of the normally pink mucosa becomes
evident as the underlying chronic inflammation
recedes and fibrosis and hyalinization progress.
Scar bands may become evident deep within the
buccal soft tissues, further limiting jaw opening and
function.
Development of squamous cell carcinoma is
characterized by a gradual thickening of the
epithelial surface with hyperplastic to verrucous
surface qualities becoming evident.
29. Histology:
juxtaposition of atrophic epithelium
surfacing a subjacent fibrosis.
Early connective tissue alterations
are characterized by delicate and
loosely arranged collagen fibers with
progressive degrees of hyalinization
In the late stages:
complete hyalinization of the
supportive connective tissue.
Variable degrees of chronic
inflammation occur in the form
of lymphocytes and plasma
cells.
Variable levels of dysplasia have
been noted.
30. Management of oral submucous fibrosis is problematic, particularly in advanced
cases and when the use of areca-containing products remains in place.
Medical:
Avoid irritant factors
Topical injection of steroids-Dexamethasone
Treat existent anaemia or vitamin deficiencies
Encourage jaw opening exercises.
Surgical
Surgical release procedures of scar bands have been only modestly successful.
More recently collagenase and pentoxifylline administration in separate studies
has been proposed
