Evaluation of the extent of interstitial fibrosis in oral squamous cell carcinoma compared with normal oral mucosa and oral epithelial dysplasia

Objective: to evaluate the extent of interstitial fibrosis in samples of normal oral mucosa (NOM), oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC). Materials and method: descriptive study. eighteen samples of NOM, 15 samples of OED, and 13 samples of OSCC were analyzed; all stained with Masson's trichrome stain. the areas of greatest fibrosis underlying the normal, dysplastic, and malignant neoplastic oral epithelium were identified in order to determine the extent of interstitial fibrosis. interstitial fibrosis was classified according to its proportion in the total image, being 0 (without fibrosis), +1 (1-25 percent), 2+ (26-50 percent), 3+ (51-75 percent) and +4 (76-100 percent). variables were analyzed using the Kruskal-Wallis test and Dunn's Pairwise post-hoc test. Results: the samples of NOM and OED did not present interstitial fibrosis (type 0) in the majority of the cases respectively. OSCC samples were characterized by an extension of type 2+ interstitial fibrosis in 45 percent of all cases of OSCC. the extent of interstitial fibrosis was different between NOM and OSCC (p<0.001), and between OED and OSCC (p<0.001). Conclusion: the extent of interstitial fibrosis is directly proportional to the malignization of the analyzed samples, being an adequate marker for OSCC.

Comparative Study of the Efficacy of Newer Antioxitands Lycopene and Oxitard in the Treatment of Oral Submucous Fibrosis

Objective: To compare the efficacy of oxitard and lycopene in the management of Oral Submucous Fibrosis (OSMF). Material and Methods: 120 subjects with clinicpathologically diagnosed OSMF were included in the study and divided equally in 2 groups, Group A (oxitard) and Group B (lycopene). Group A was administered 2 oxitard capsules twice daily and Group B was given 8 mg lycopene in 2 divided doses of 4 mg for 3 months. Gingival index and plaque index were documented for all patients and compared. Evaluation for different clinical parameters was done at regular intervals and data was analyzed using the Student's paired t test and Chi-square test. P-value <0.001 was considered to be statistically significant. Results: Clinical improvements in mouth opening and tongue protrusion was significant in Group A (p<0.001). Subjective symptoms of pain associated with the lesion (p=0.0001), difficulty in swallowing (p=0.0004) and speech (p=0.0002) significantly improved in the Group A. However, there was no significant improvement in burning sensation (p>0.001) among the 2 groups. Although the mean gingival index and plaque index in group A was reduced but it was found to be not statistically significant. Conclusion: Oxitard capsules can bring about significant clinical improvements in the symptoms like mouth opening, tongue protrusion, difficulty in swallowing and speech and pain associated with the lesion when compared to lycopene, thereby improving the quality of life of the affected individuals.

Oral Squamous Cell Carcinoma in Background of Oral Submucous Fibrosis: A Case Report.

Oral submucous fibrosis (OSMF) is a well-recognized, potentially malignant disorder of the oral cavity that can affect any part of the oral mucosa, characterized by mucosal rigidity of varying intensity caused by fibro elastic transformation of the juxta epithelial layer of connective tissue. OSMF occurs in Indians and other population of the Indian subcontinent with certain oral habits. Betel quid chewing is a popular oral habit with potential links to the occurrence of oral cancer. In patients with submucous fibrosis, the oral epithelium becomes atrophic and thereby becomes more vulnerable to carcinogens. Since the ingredients of betel quid, tobacco are crucial for tumor initiation, promotion and progression, exposure to these toxicants simultaneously has been shown to markedly potentiate the oral cancer incidence in OSMF patients. The rate of malignant transformation of OSMF has been estimated to be 2-10%. Most cases with malignant transformation in OSMF have occurred gradually over a long period of time. This paper presents a case of oral submucous fibrosis turning into malignancy in a 34-year-old male patient.

Cryosurgery in the Management of Potentially Malignant Lesions: A Report of Two Cases.

Cryosurgery is a therapeutical approach that uses freezing to obtain a tissue inflammatory or destructive response. It has been successfully used for both cutaneous and oral conditions. The characteristics of oral mucosa like humidity and smoothness makes it an ideal site for this approach. Oral submucous fibrosis is a potentially malignant disorder of the oral mucosa, with areca nut chewing being the primary causative agent. Leukoplakia is a potentially malignant lesion associated with excessive consumption of alcohol and tobacco. Although there are no specific treatment modalities to prevent recurrence, abandoning habits can decrease the chance of recurrence, as well as the transfiguration into malignant tumors of these disorders. However, with the advent of cryosurgery, oral surgeons are provided with a new modality for treating oral potentially malignant disorders. This case report highlights the pioneering effect of nitrous oxide cryosurgery in treating two cases of oral submucous fibrosis with leukoplakia and oral leukoplakia respectively showing promising results during follow-up.

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.

Neutral zone and oral submucous fibrosis.

Oral submucous fibrosis is a premalignant condition in which rigidity of the lip, tongue, and palate results in reduced mouth opening and tongue movement. Limited mouth opening, mucosal rigidity, and reduced salivary flow makes prosthodontic procedures difficult in these patients and affects the stability, retention, and the support of removable prostheses. The burning sensation in the mouth that these patients experience reduces the tolerance to prostheses. We report a case of oral submucous fibrosis where the conventional neutral zone technique with certain modifications was utilized to rehabilitate a completely edentulous patient with this condition.