Oral submucous fibrosis
Overview
A rare disorder involving inflammation and progressive fibrosis of tissues inside the mouth. The condition starts with redness, blistering and ulceration inside the mouth that is eventually replaced with stiff fibrous tissue as it heals. The inside of the mouth can become stiff and hinder oral functions such as eating, speaking and even opening the mouth. Even the pharynx may occasionally be involved. The condition can become cancerous. The disorder is often associated with chewing betel nuts in Asian and Indian areas.
Symptoms
* Progressive inability to open mouth * Eating problems * Mouth pain * Increased salivation * Dry mouth
Diagnosis
The early cases of oral submucous fibrosis present as chronic inflammatory cell infiltration of subepithelial connective tissues. This otherwise nonspecific infiltrate usually contains a number of eosinophils, cells seldom found in oral inflammation. Older lesions demonstrate a reduced vascularity, reduced numbers of inflammatory cells, and dense bundles and sheets of collagen immediately beneath the epithelium. The eventual thick band of hyalinized subepithelial collagen shows varying extension into submucosal tissues, typically replacing the fatty or fibrovascular tissues normal to the site. Minor salivary glands in the area of habitual quid placement often demonstrate a chronic inflammatory infiltrate and replacement of acinar structures by the hyalinized fibrosis. The hyalinized stroma can be distinguished from the amyloid infiltration of amyloidosis through the use of Congo red staining and thioflavin-T staining under polarized and immunofluorescent light. The epithelium is atrophic, with or without excess surface keratin, and demonstrates intercellular edema. A fourth of the biopsied cases will demonstrate epithelial dysplasia at the time of biopsy. When squamous cell carcinoma is seen, it has the same features of carcinoma as those seen in persons without the betel quid chewing habit.
Treatment
There is no effective treatment for oral submucous fibrosis and the condition is irreversible once formed. Plastic surgery may be required to allow for improved opening of the mouth. Surface leukoplakias are handled by close follow-up and repeated biopsies of areas of severe involvement. All dysplasias and carcinomas are treated in the routine manner for those entities.