Oral Submucous Fibrosis (OSF)

• 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 (OSF) for the condition in 1953.

• Oral submucous fibrosis is a chronic debilitating disease of the oral cavity characterized by inflammation and progressive fibrosis of the submucosal tissues (lamina propria and deeper connective tissues):

  • Oral submucous fibrosis results in marked rigidity and an eventual inability to open the mouth.

  • The buccal mucosa is the most commonly involved site, but any part of the oral cavity can be involved, even the pharynx

• Oral submucous fibrosis (OSF) is a premalignant condition caused by betel chewing:

  • It is very common in Southeast Asia but has started to spread to Europe and North America.

  • The condition is well recognized for its malignant potential and is particularly associated with areca nut chewing, the main component of betel quid.

  • Betel quid chewing is a habit practiced predominately in Southeast Asia and India that dates back for thousands of years.

    • It is similar to tobacco chewing in westernized societies.

  • The mixture of this quid, or chew, is a combination of the areca nut (fruit of the Areca catechu palm tree, erroneously termed betel nut) and betel leaf (from the Piper betel, a pepper shrub), tobacco, slaked lime (calcium hydroxide), and catechu (extract of the Acacia catechu tree).

    • Lime acts to keep the active ingredient in its freebase or alkaline form, enabling it to enter the bloodstream via sublingual absorption.

    • Arecoline, an alkaloid found in the areca nut, promotes salivation, stains saliva red, and is a stimulant:

      • Major constituents of betel quid are arecoline from betel nuts and copper, which are responsible for fibroblast dysfunction and fibrosis.

•  OSF can lead to squamous cell carcinoma, a risk that is further increased by concomitant tobacco consumption.

• OSF is a diagnosis based on clinical symptoms and confirmation by histopathology.

  • Hypovascularity leading to blanching of the oral mucosa, staining of teeth and gingiva, and trismus are major symptoms:

    • Symptoms of oral submucous fibrosis (OSF) include the following:

      • Progressive inability to open the mouth (trismus) due to oral fibrosis and scarring

        • Oral pain and a burning sensation upon consumption of spicy foodstuffs

          • Increased salivation

          • Change of gustatory sensation

          • Hearing loss due to stenosis of the eustachian tubes

          • Dryness of the mouth

          • Nasal tonality to the voice

          • Dysphagia to solids (if the esophagus is involved)

          • Impaired mouth movements (eg, eating, whistling, blowing, sucking)

             

       

       

• Oral submucous fibrosis is clinically divided into three stages, and the physical findings vary according:
  • Stage 1:
    • Stomatitis includes erythematous mucosa, vesicles, mucosal ulcers, melanotic mucosal pigmentation, and mucosal petechia.

 

• Stage 2:
  • Fibrosis occurs in ruptured vesicles and ulcers when they heal, which is the hallmark of this stage.
    • Early lesions demonstrate blanching of the oral mucosa.
    • Older lesions include vertical and circular palpable fibrous bands in the buccal mucosa and around the mouth opening or lips, resulting in a mottled, marblelike appearance of the mucosa because of the vertical, thick, fibrous bands running in a blanching mucosa.
    • Specific findings include the following:
      • Reduction of the mouth opening (trismus)
      • Stiff and small tongue
      • Blanched and leathery floor of the mouth 
      • Fibrotic and depigmented gingiva
      • Rubbery soft palate with decreased mobility
      • Blanched and atrophic tonsils
      • Shrunken budlike uvula
      • Sinking of the cheeks, not commensurate with age or nutritional status

 

• Stage 3:
  • Leukoplakia is precancerous and is found in more than 25% of individuals with oral submucous fibrosis.
  • Speech and hearing deficits may occur because of involvement of the tongue and the eustachian tubes.

Rodrigo Arrangoiz MS, MD, FACS a head and neck surgeon and is amember of Sociedad Quirúrgica S.C at the America British Cowdray Medical Center.He is first author on some publications on oral cavity cancer:

• Oral Tongue Cancer: Literature Review and Current Management 

  • https://www.oatext.com/pdf/CRR-2-153.pdf

• Understand Cancer: Research and Treatment Oral Cavity Cancer: Literature Review and Current Management. 

  • https://www.researchgate.net/publication/303366031_Understand_Cancer_Research_and_Treatment_Oral_Cavity_Cancer_Literature_Review_and_Current_Management

Training:

• General surgery:

• Michigan State University:

• 2004 al 2010• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• Fox Chase Cancer Center (Filadelfia):

• 2010 al 2012• Masters in Science (Clinical research for health professionals):

• Drexel University (Filadelfia):

• 2010 al 2012
• Surgical Oncology / Head and Neck Surgery / Endocrine Surgery:

• IFHNOS / Memorial Sloan Kettering Cancer Center:

• 2014 al 2016