"Oral Submucous Fibrosis Scoring Index" to Predict the Treatment Algorithm in Oral Submucous Fibrosis

New Insights for Consummate Diagnosis and Management of Oral Submucous Fibrosis Using Reactive and Reparative Fibrotic Parameter Derived Algorithm

Objective

Reproducibility of qualitative changes in histopathological diagnosis involving narrow variation is often challenging. This study aims to characterize the histological fibrotic events in detail so as to derive an in-depth multiparametric algorithm with individually quantified histological parameters for effective monitoring of the. disease process in oral submucous fibrosis and for potential therapeutic targets for early intervention.

Methods

Formalin fixed paraffin embedded (FFPE) blocks of oral submucous fibrosis (OSMF), were taken and sections were stained with Hematoxylin & Eosin stain and Masson Trichrome stain. Photomicrographs were assessed for various morphometric parameters with Image J software version 1.8. Linear Regression was used to model the relationship using Inflammatory Cell Count, Extent of Inflammation collagen stained area, Epithelial thickness integrated density of collagen, MVPA, Area, Perimeter, were taken as variables.

Result

Inflammatory cell count and the extent of inflammation also decreased with increasing grades of OSMF. Collagen proportionate area, integrated collagen density and epithelial thickness were compared among different grades of OSMF. Grade IV OSMF had greatest mean collagen proportionate area , highest integrated collagen density and lowest epithelial thickness when compared to other grades of OSMF. Linear regression model revealed smaller variation between Grade I to Grade II. Whereas Grade II to Grade IV exhibited larger variation suggestive of increased growth rate and all the coefficients were found to lie within 95% confidence limits.

Conclusion

Diagnostic algorithm with multiparametric regression model were derived and combinatorial therapeutic approaches have been suggested for more effective management of oral submucous fibrosis.

Characterization of anti-nuclear antibodies in patients with oral submucous fibrosis and its clinicopathologic implications - An immunofluorescence study

Background:

Oral submucous fibrosis (OSF), widespread in the Indian subcontinent, is a chronic debilitating disease of the oral cavity having a high potential for malignancy. The etiology of OSF is debatable. However, recently, autoimmunity had been suggested to play a significant role in its etiology, yet unproven. Hence, this study was conducted to explore the presence of antinuclear antibodies (ANAs) in the serum of OSF patients which is one of the serum markers of autoimmune diseases and its possible clinicopathologic associations.

Materials and Methods:

A total of 105 blood samples were collected from patients with OSF (n = 45), age- and sex-matched healthy controls with (n = 30) and without (n = 30) areca nut chewing habit. Serum positivity of ANA was determined by immunofluorescence and correlated with the oral habits and severity of the disease measured by maximum mouth opening (MMO) and site of involvement.

Results:

Significantly higher incidence of ANA (35.6%) was found in 45 OSF patients than in the healthy group (P = 0.001). Prevalence of ANA positivity was found higher in females (n = 11; 68%) than males (P < 0.001). A significantly lower MMO (P = 0.00) was found in ANA positive patients (17 ± 6.21 mm) in contrast to MMO in ANA-negative patients (28.74 ± 6.58 mm). The mean duration of habit and frequency of habit between ANA positive and negative patients was not significant. A significantly more number of sites of involvement was seen in ANA positive cases (P = 0.004). Out of 16 ANA positive OSF cases, 10 cases showed + 2 and 6 cases showed + 3 fluorescence intensity. Speckled (n = 8), homogeneous (n = 5) and nucleolar pattern (n = 3) were the fluorescence patterns observed.

Conclusion:

The presence of autoantibodies such as ANA, female predilection, alteration of humoral and cellular immunity justifies OSF as an autoimmune disease. This study provides broader prospective to adopt therapies that selectively target autoimmune pathways.

The effectiveness of therapeutic ultrasound in patients with oral submucosal fibrosis

CONTEXT

Oral submucosal fibrosis (OSMF) is a chronic disease occurring due to a reduction in fibroelasticity of the oral mucosa leading to trismus and inability to open the mouth that mostly affects habitual betel quid chewers.

AIMS

The present study aims to find the effectiveness of therapeutic ultrasound (US) in addition to conventional exercises in patients with OSMF.

SETTINGS AND DESIGN

It was a randomized controlled trial, carried out at KM Patel Institute of Physiotherapy, Shree Krishna Hospital, Karamsad, Anand, India. Both males and females with the confirmed diagnosis of OSMF and who were referred for physiotherapy treatment were included.

MATERIALS AND METHODS

A total of 20 patients were randomized by using shuffling cards into two groups (10 in each): experimental (ultrasound and jaw opening exercises) and control (jaw opening exercises). The maximal mouth opening was measured before and after intervention in both the groups.

STATISTICS

The maximal mouth opening was compared within the group before and after the treatment using paired t-test and the improvement in mouth opening between the groups was measured using unpaired t-test (P < 0.05).

RESULTS

The results showed significant improvement in mouth opening in both groups that is increased mouth opening by 0.47 ± 0.09 cm (P = 0.002)* in the experimental group and 0.25 ± 0.05 cm (P = 0.003)* in the control group. However, patients in the experimental group had more improvement by about 0.22 cm (P = 0.006)* compared to the control group (*P < 0.05).

CONCLUSION

Therapeutic US and conventional jaw opening exercises prove more beneficial compared to only jaw opening exercises in OSMF.