introduction definition case report onosf its etiology and prevelance pathogenesis and histo pathological findings diagnosis and differential diagnosis classification investigations and treatment counselling and prevention

1. ORAL SUB-MUCOUS
FIBROSIS.....
TAKEN FROM ARTICLE PUBLISHED ON 13 APRIL 2015
JOURNAL : CLINICAL COSMETIC & INVESTIGATIONAL DERMATOLOGY..
MADE BY: AMMARA IFTHIKAR
MARIYAM TAUQEER...

2. INTRODUCTION....
Oral Submucous Fibrosis is a Pre-malignant disorder associated with
chewing of Areca nut ( Betel nut ).
• It is very common in Southeast Asia but has started to spread to
Europe and North America.
• Can lead to squamous cell carcinoma, a risk that is further increased
by concomitant tobacco consumption.

3. DEFINATION...
• Oral Submucous Fibrosis (OSMF) is a chronic disease of insidious onset and a
prevailing
potentially malignant disorder characterized by epithelial inflammatory reaction
along
with mucosal fibrosis.
• First described by Schwartz as“Atrophica Idiopathic Mucosae Oris” In 1952.

4. CASE REPORT....
A 35-year-old Indian women presented with difficulty in mouth
opening and burning sensation while eating. On examination,
blanching of the oral mucosa with diffuse white pigmented lesion of
size 3.5 to 2 cm along with melanotic pigmentation was seen on the
left buccal mucosa posteriorly. The patient was diagnosed with oral
submucous fibrosis.

5. ETIOLOGY...
• Multi-Factorial.
• Local Factors.
Chillies.
Areca Nut ( major factor).
• Systemic Factors.
Nutritional deficiency.
Genetic Factors.
Auto immunity.

6. PREVELANCE...
• The disease is predominantly seen in India , Bangladesh , Sri-lanka , Pakistan ,
Taiwan ,
Southern China , Polynesia and Micronesia.
• More prevalent in younger Individual (15 -35 yrs age).
• 2.3: 1 Male: Female.

7. PATHOGENESIS...

8. HISTO PATHOLOGICAL FEATURES...
• Collagen Hyalinization as Smooth Sheet.
• Extensive Fibrosis Obliterating the mucosal Blood Vessels and eliminating the
melanocytes.
• Fibroblast markedly absent in hyalinized zone.
• Total loss of epithelial rete-pegs.
• Mild to moderate Atypia present.
• Extensive degeneration of Muscle fibres evident.

9. DIAGNOSIS...

10. INVESTIGATION

11. • CLASSIFICATION OF OSF.....

12. Very early (stage I) Early (stage II) Moderately advanced
(stage III)
Advanced (stage IV)
A finely fibrillar collagen,
dispersed with marked
edema
The juxta-epithelial area
shows early hyalinization
The collagen is moderately
hyalinized
The collagen is completely
hyalinized
The fibroblastic response
is strong
Plump young fibroblasts
are present in moderate
numbers
The fibroblastic response is
less marked, the cells
present being mostly adult
fibrocytes
The hyalinized areas are
devoid of fibroblasts
Histopathological classifications of oral submucous fibrosis
The blood vessels are
sometimes normal, but
more often they are
dilated and congested
The blood vessels are
dilated and congested
Blood vessels are normal or
constricted
Blood vessels are
completely obliterated or
narrowed
Inflammatory cells, mainly
PMNs leukocytes with an
occasional eosinophil, are
present
Inflammatory cells are
mostly mononuclear
lymphocytes, eosinophils,
and an occasional plasma
cell
Inflammatory exudates
consist of lymphocytes and
plasma cells, although an
occasional eosinophil is
seen
Inflammatory cells are
lymphocytes and plasma
cells

22. C0UNSELING AND PREVENTION
• Encourage through education for discontinuation of habit.
• Patient should be explained about the disease and its possible malignant
potential.
• Counseling for deaddiction.
• Vitamin, iron and mineral rich diet should be advised.
• Intake of fresh fruits and leafy vegetables should be included in regular diet.

23. THANK YOU....