DEPARTMENT OF ORAL MEDICINE

AND RADIOLOGY

A Case Report on

ORAL SUBMUCOUS
FIBROSIS

Submitted by
SAYED NABI AHAMED
 ORAL SUBMUCOUS FIBROSIS

INTRODUCTION:

It is a chronic and high-risk

precancerous condition. The condition was
prevalent in the days of Sushruta (600 BC), a
great practitioner of ancient medicine
labeled this condition as ‘Vidhari’. After the
lapse of many years, Schwatz (1952) was the
first person to bring this condition to
limelight. He described this condition as
‘Atrophia idiopathic mucosa oris’
DEFINITION:

An insidious chronic disease affecting

any part of the oral cavity and sometimes
pharynx and is associated with juxtaepithelial
inflammatory reaction followed by fibroelastic
changes in lamina propria, with the epithelial
atrophy leading to stiffness of oral mucosa
and causing trismus and inability to eat.
ETIOLOGY:
 Betel-nut chewing
 Excessive use of chillies
 Lime used in betel nut chewing
 Tobacco usage
 Nutritional deficiency
 Defective iron metabolism
 Bacterial or viral infections
 Psychological stress
 Immunological factors
 Genetic factors

STAGES OF ORAL SUBMUCOUS FIBROSIS:

 Stage of stomatitis and vesiculation
 Stage of fibrosis
 Stage of sequelae and complication.
HISTOPATHOLOGY:
 Variable degree of cellular atypia.
 Hyperkeratinized, atropic epithelium.
 Marked irregular epithelial stratification, nuclear
pleomorphism and intercellular edema.
 Underlying connective tissue shows
hyalinization.
 The stromal blood vessels are dilated and
congested.

LABORATORY INVESTIGATIONS:
 Routine blood examination.
 Scanning and transmission electron microscopy.
 Biopsy.
MANAGEMENT:
Restriction of habit / behavioural therapy.

Medicinal therapy.
 B complex preparation
 Corticosteroids
 Placental extract
 Hyaluronidase
 Vitamin E

Surgical treatment.
 Excision of fibrous bands followed by use of
tongue flap
 CO2 laser surgery
 Cryosurgery
 Oral physiotherapy
 Diathermy
 CASE REPORT

Name : Vajravel
Age : 40 years
Sex : Male
Occupation : Farmer
O.P. No. : 21470
Address : Erugaloor, Kattur, Sangakiri,
Salem.

CHIEF COMPLAINT
Patient complains of loosening of tooth in
right upper and lower back region for the past
HISTORY OF PRESENT ILLNESS
Patient was apparently normal before 1 year
and then he developed pain and loosening of
tooth in right upper and lower back region and
restricted mouth opening on both sides of the
cheek region.

PAST MEDICAL HISTORY

Diabetes
Hypertension
Cardiovascular problems
Drug allergy No relevant
history
Bleeding disorder
PAST DENTAL HISTORY
Undergone extraction due to pain two
months before.

HISTORY OF DRUG ALLERGY

No relevant history

FAMILY HISTORY
No relevant history

PERSONAL HISTORY
Marital status : Married
Brushing habit : Brushes with brush and paste
Deleterious habits:
Smoking / alcohol : Nil
Tobacco chewing : Had the habit before one
year

CLINICAL EXAMINATION
GENERAL EXAMINATION
Built : Moderately built
Temperature : Afebrile
Pulse : 75/min
GAIT : Normal
Posture : Normal
Clubbing : Absent
EXTRA-ORAL EXAMINATION
Growth
Swelling
Sinus
Fistula No abnormalities detected
TMJ
Facial pain

LYMPH NODE EXAMINATION:

Right submandibular lymphnode is palpable
of size 1x1 cm which is single in number, tender,
mobile in nature and soft in consistency.
INTRA-ORAL EXAMINATION
Mouth opening : Restricted
Restriction of tongue movement
Restricted jaw movement

HARD TISSUE EXAMINATION

No. of teeth : 14
Dental caries : 48
Missing teeth : 11, 12, 13, 14, 15, 16, 24,
25, 26, 27, 28, 43, 35,
37, 38, 43, 46, 47
Root stump : Nil
Mobility : Grade I in 42, 31, 32
Grade II in 18, 41, 23
Stains : Generalised
Attrition : Generalised
Erosion : Absent
Abrasion : Absent
Generalized hard and soft deposits present

SOFT TISSUE EXAMINATION

Gingiva:
Colour : Reddish pink
Contour : Bulbous marginal gingiva
and blunt
interdental papilla
Texture : Stippling absent
Position : Generalised recession
Labial mucosa : No abnormalities detected
Buccal mucosa : It is blanched, fibrotic bands
present during palpation.
Aggravating burning
sensation upon consumption of
spicy foods.
Tongue : Depapillated tongue
Floor of the mouth : No abnormalities
detected
Soft palate : Uvula appears to
shrunken
SUMMARY
Patient named Vajravel of age 40 years
came to the dental OP with a complaint of
loosening of tooth in right upper and lower back
region and restricted mouth opening on both
sides of the cheek region. He had undergone
treatment for oral submucous fibrosis one month
before.
On extra oral examination right
submandibular lymphnode is palpable of 1x1 cm,
which is single in number, tender, mobile in
nature and soft in consistency.
On intra oral examination buccal mucosa is
blanched, fibrotic bands present during palpation
and aggravating burning sensation upon
PROVISIONAL DIAGNOSIS
ORAL SUBMUCOUS FIBROSIS

INVESTIGATION
Biopsy

FINAL DIAGNOSIS
ORAL SUB MUCOUS FIBROSIS

TREATMENT PLAN
Stop habit of tobacco chewing.
Medically:
Cap. Antoxid 0-0-1 7 days
Multivitamin supplement
Intralesional injection of corticosteroids.
Surgically:
Excision of fibrous bands.
FRONTAL VIEW
BUCCAL MUCOSA – LEFT
BUCCAL MUCOSA - RIGHT
DEPAPILATED TONGUE
SHRUNKEN UVULA