Expression of Ki67 as Potential Biomarker in Oral Submucous Fibrosis: An Immunohistochemical Study

Background: Oral submucous fibrosis (OSMF) is a potentially malignant disorder (PMD) known to transform into oral cancer. One of the important hallmarks of malignant transformation is the uncontrolled growth rate, commonly reflected as increased cell proliferation which can be significantly detected by proliferative markers such as a high Ki?67 index. Aim: The aim of this study is to evaluate the degree and pattern of expression of Ki67 in OSMF, oral squamous cell carcinoma (OSCC) and in normal mucosal (NOM) patients and to correlate the Ki67 expression with clinical and histological grading of OSMF and OSCC patient. Materials and Methods: A prospective cross?sectional study was conducted over a duration of two years. An immunohistochemical study was performed for Ki76 expression on 35 cases of OSMF, 10 cases of OSCC and 10 normal mucosal patients. Statistical Analysis: Data were analysed using SPSS version 21. Chi?squared test was used to analyse the differences between the intensity levels in OSMF, OSCC and NOM. Results: Expression of Ki67 was significantly higher in OSMF than that of NOM samples but less than that of OSCC samples. Expression of Ki67 increased with increasing grade of clinical and histological stages. Conclusion: The study demonstrated a high incidence of Ki67 overexpression in OSMF and OSCC and showed a correlation between clinical and histological grading of OSMF and OSCC. Identification of high?risk oral PMDs and intervention at premalignant stages could constitute one of the key steps in reducing the mortality, morbidity and cost of treatment associated with malignant transformation of these diseases

A comparative physicochemical and pharmacological evaluation of dexamethasone sodium phosphate and betamethasone sodium phosphate mucoadhesive gels for the treatment of oral submucous fibrosis in rats

Abstract The present study is aimed to formulate steroidal oral mucoadhesive gels of dexamethasone sodium phosphate and betamethasone sodium phosphate. Six gel formulations each of dexamethasone sodium phosphate and betamethasone sodium phosphate prepared using two different polymers carboxymethyl cellulose sodium and hydroxypropyl methylcellulose, in variable proportions. All the formulations subjected for assessment of various physicochemical parameters and mechanical properties. The formulations BSP5 and DSP5, both containing 1.25 % carboxymethyl cellulose sodium, 1.25 % hydroxypropyl methylcellulose, exhibiting mucoadhesive strength of 12.300 ± 0.004 and 12.600 ± 0.01, adhesiveness of 28.04 ± 00 and 30.02 ± 00, cohesiveness of 28.04 ± 00 and 30.02 ± 00, drug release of 86.869 ± 0.380 % and 88.473 ± 0.457 % respectively were considered as promising ones and were further subjected for stability studies and in vivo study in male albino rats. Formulation DSP5 upon oral application for 4 months in arecoline induced oral submucous fibrosis rats, showed more than 80 % reduction in fibrosis as compared with BSP5 which showed nearly 50 % reduction. These results were concluded on the basis of histopathological profile and weight gain among the experimental animals during in vivo study. Hence, DSP5 by minimizing the painful injuries and morbidities justifies being suitable noninvasive model for OSMF treatment.

Pentoxifylline - A Boon In Medical Management Of Oral Submucous Fibrosis ??

AIM- OSMF is very prevalent and most premalignant condition in South East Asian population especially in India now days. There is numerous management modalities documented but still it is challenging to come up with definitive treatment of OSMF. In the wake of searching the effective medical management of OSMF here we have compare the two drugs Pentoxifylline and Antioxident over 50 affected individuals

Evaluation of Fibrotic Changes in OSMF:A Retrospective Study Using Special Stains and Polarizing Microscopy

Background: Oral submucous fibrosis (OSMF), a potentially malignant oral disorder has the highest rate of malignant transformation of about 7-13%. The connective tissue changes that occur in this disease are characteristic and are stained with special stains. Objective: The study was done to compare common and special stains under light microscopy and polarizing microscopy to evaluate the levels of fibrosis in oral submucous fibrosis and assess the type of collagen present in the stromal area. Materials and Methods: Fifty tissue blocks were selected from the archives and were prepared and stained with H&E, Masson's trichrome, Van Gieson and Picrosirius red and studied under light microscope and polarizing microscope respectively. Results: H and E stained slides were useful in diagnosing the lesion but was not able to highlight the level of fibrosis. Masson's trichrome and Van Gieson stained slides showed the depth of the lesion which extended even to the deeper muscle layer. The type of collagen present was definitively seen by the birefringence in polarizing microscopic study. Interobserver variation was less and all the values regarding the effectiveness of the special stains in detecting the level of fibrosis were statistically significant. Conclusion: Special stains can be used routinely in laboratories to demonstrate connective tissue lesions especially in cases of OSMF. Depth of the lesion and the area of involvement help in treatment planning to be delivered. Large scale studies with more categories and inclusion criteria are required along with the special stains to assess the other alterations in OSMF

Use of lycopene in the management of oral submucous fibrosis: a clinical study.

Background: Oral Submucous Fibrosis is a potentially malignant disorder well known for its chronic and resistant nature. The conservative drug treatment that is currently available for this disorder is clearly inadequate. Objective: The study was done to evaluate the efficacy of oral lycopene therapy when used in combination with conventional intralesional steroid therapy in the management of oral submucous fibrosis. Methods: Thirty patients with oral submucous fibrosis (grade III and IV) were included and randomly divided into 2 groups consisting of 15 each: Group A (oral lycopene with biweekly intralesional steroids and hyaluronidase), Group B (biweekly intralesional steroids and hyaluronidase alone). Mouth opening and burning sensation were recorded from baseline to 6 weeks. Cases were followed up to 3 and 6 months. Results: We observed a complete relief of burning sensation in all patients of both the groups, There was significant increase in mouth opening among both groups. The patients in the group B had increased moth opening than the group A patients.The results were statistically significant Conclusion: Lycopene in combination with intralesional steroids and Hyaluronidase, is highly efficacious in improving the mouth opening and reducing other symptoms in patients with Oral Submucous Fibrosis. No side effects were reported with its usage.

Oral Submucous Fibrosis-A Review on its Etiopathogenesis.

The chains of habit are generally too small to be felt until they are too strong to be broken”. HABIT’ is an automatic pattern of behavior in reaction to a specific situation, may be inherited or acquired through frequent repetition. Betel quid chewing is one such habit, and it is an ancient practice common in many countries of Asia and among migrated Asian communities in Africa, Europe and North America. Oral submucous fibrosis is a progressive disease of the oral and pharyngeal mucosa sometimes involving the esophagus. This manuscript attempts to review the etiopathologies and various treatment modalities available.

Oral sub-mucous fibrosis: realities of etiology / Fibrose de submucosa oral: a realidade da etiologia

Oral sub-mucous fibrosis (OSMF) is a well known potentially malignant condition resulting commonly due tothe use of areca nut. Areca nut chewing is a primordial tradition in Asian countries. It is also a psychoactiveessence. With the emergence of commercial pan masala and gutkha, witness of massive growth in the salesof these products, with huge worldwide export market developed. Various components in this quid have itsown mechanism of action resulting in OSMF. Other causes proposed were chillies, misi, nutritional deficiency,genetic predisposition, immunologic aspects, infection and saliva. This review attempts to give an overviewabout the postulated etiologies and its role in causation of OSMF.

Fibrose de submucosa oral (FSMO) é uma condição potencialmente maligna muito conhecida resultante geralmentedo uso da noz de areca ou betel. Mastigar a noz de betel é uma tradição primordial nos países asiáticos.É também uma essência psicoativa. O surgimento comercial da pan masala e da gutkha, aliado ao enorme crescimento nas vendas desses produtos, possibilitou um grande mercado de exportação em todo o mundodesenvolvido. Vários componentes neste material tem seu próprio mecanismo de ação, resultando em FSMO.Outras causas propostas foram pimentões, misi, deficiência nutricional, predisposição genética, aspectos imunológicos,infecção e saliva. Esta revisão procura dar uma visão geral sobre as etiologias postuladas e seu papelna causa da FSMO.

Evaluation of the effect of newer antioxidant lycopene in the treatment of oral submucous fibrosis.

Background and Objective: Oral submucous fibrosis (OSMF) is a well-known premalignant condition encountered in Indian population. Although the disease is advancing rapidly, its reliable treatment modality for its various stages has not yet evolved. The aim of the present study is to compare the effect of newer antioxidant lycopene with a placebo in conjunction with the cessation of causative habit in the treatment of OSMF. Materials and Methods: The study group included 92 patients with OSMF. The OSMF diagnosis was established through a composite of accepted clinical and histopathological characteristics. Out of 92, 46 patients were given lycopene and remaining 46 were on placebo drug. Lycopene group patients received 8 mg Lycored TM per day in two divided doses of 4 mg each, while placebo group patients received placebo tablet twice a day. Patients were examined for changes in mouth opening and other clinical symptoms of OSMF during three months and were followed up for next two months. Results: Lycopene was found to be significantly efficacious in the amelioration of signs and symptoms of OSMF. It was effective in reducing the objective signs of OSMF as demonstrated by the improved maximal mouth opening, percentage of which was 69.56%(P<0.05). Interpretation and Conclusion: Reactive oxygen compounds or free radicals have been implicated as one of the major harmful factors for premalignant and malignant conditions. Present study concludes that lycopene, a newer antioxidant, appears to be a very promising drug in the management of OSMF.

Use of Nasolabial Flap in the Management of Oral Submucous Fibrosis – A Clinical Study.

Oral submucous fibrosis is a chronic debilitating disease associated with restricted mouth opening and poor oral hygiene. The treatment aims at good release of fibrosis and to provide long term results in terms of mouth opening. Various local grafts have been used to cover the buccal mucosal defects after the fibrotic bands are released in oral submucous fibrosis. Successful use of inferiorly based nasolabial flaps in the management of oral submucous fibrosis is projected. A total of 10 histologically proven cases of oral submucous fibrosis having a mouth opening of less than 20 mm were surgically treated .The procedure involved (1) bilateral release of fibrotic bands (2) measurement of intra-operative interincisal distance (greater than 35 mm achieved in all patients after release of bands) (3) covering the defects with inferiorly based nasolabial flap. All patients had post-operative physiotherapy, and were followed up regularly for one year. All flaps healed without evidence of infection, dehiscence, or necrosis. Results were assessed by comparing the pre-operative & pos-toperative maximum mouth opening. The inferiorly based nasolabial “islanded” flaps provide reliable coverage of defects of the buccal mucosa and improves mouth opening.