Histological changes to palatal and paratubal muscles in oral submucous fibrosis

Force, alternate movements, snap, suction and vibration functions of tongue are altered in oral submucous fibrosis patients

Background

One of the most common clinical manifestations of oral submucous fibrosis (OSMF) is restricted tongue movements. However, the characterization of involvement is needed to better understand the impairment of its functioning. In the present study, force, alternate movements, snap, suction, and vibration functions of the tongue were investigated in OSMF patients.

Methods

A total of 53 OSMF and 40 healthy individuals were recruited in the present study. Clinical parameters were used for the diagnosis and grading of OSMF. Alternate movements, snap, suction, vibration of the tongue and tongue force were assessed using standard methodology.

Results

Out of 53 OSMF subjects, 22 (42%) were in early stages and 31 (58%) in late stages. There were statistically significant differences between the OSMF and healthy individuals for tongue functions such as protrusion, retraction, lateral movements, altered snap, suction, and tongue vibration (p < 0.00001). All of the aforementioned tongue functions were more affected in advanced stage OSMF than in early stage OSMF (p < 0.00001).

Conclusion

Force, alternate movements, snap, suction and vibration functions of tongue are significantly altered in OSMF patients. The performance of the tongue movements by the OSMF subjects worsened with the disease progression.

Oral Submucous Fibrosis: Association of Clinical and Histological Severity with Hearing Loss and Middle Ear Function

OSMF is a precancerous condition of the oral cavity. Cons umption of Areca nut in quid has been proved to be the most consistent factor. To assess middle ear function in OSMF patients by audiometry and tympanometry. Two Hundred patients of < 40 years of age with OSMF were examined and followed by PTA and impedance audiometry. Impaired mobility was seen in 20(10%) ears, and retraction of tympanic membrane was found in 36(18%) ears. Clinical staging was done in four stages. Majority of the patients were males (58%) in the age group of 21-30 years belonging to stage III (38%) and IV (26%) respectively. PTA showed varying degrees of hearing loss in 73 (36.5%) ears. In Grade I, mild hearing loss was seen in 10 (35.71%) ears and moderately severe hearing loss was in 5 (11.36%) ears whereas in Grade II mild hearing loss in 11(25%) ears. Grade III and IV showed mild hearing loss in 11(14.47%) and 12 (23.07%) respectively. Tympanometry revealed type A curve in 126 (63%) ears followed by C curve in 50 (25%) and B curve in 24 (12%) ears. In patients of OSMF, there is involvement of palatal/paratubal muscles in the fibrosis process, which causes eustachian tube malfunction leading to disturbed middle ear functions and negative middle ear pressure. Most patients of oral submucous fibrosis showed direct association with grade of hearing impairment and eustachian tube dysfunction. Higher clinical grades, both clinically and histologically showed similar findings thereby we concluded that if the disease is treated early, preventing patients from having higher grades of disease, involvement of ear can be avoided, and patients can be saved from hearing impairment.

Role of coronoidectomy and temporalis myotomy in surgical management of oral submucous fibrosis

PURPOSE

The involvement of temporalis muscle fibers by oral submucous fibrosis (OSMF) and the procedure of coronoidectomy and temporalis myotomy in the surgical treatment protocol for the disease is a controversy. The primary objective of this study is to evaluate the histopathological changes in temporalis muscle fibers in patients undergoing surgical treatment for OSMF and to authenticate the importance of temporalis myotomy and coronoidectomy in surgical treatment protocol.

METHOD

A 3-year prospective study was conducted to assess the histopathological changes in temporalis muscle in surgically treated OSMF cases. The predictor variables were drawn from demographic characteristics (age and gender) etiology, and mouth opening. The outcome variables were histopathological assessment of temporalis muscle fibers for parameters suggestive of degenerative changes and fibrosis changes at cellular level.

RESULTS

Out of 56 patients, 30 patients were had surgical intervention. Twenty-eight (93.3%) were male and 2 (6.6%) were female with a ratio of 14:1. Histopathological examination of temporalis muscle fibers revealed hyalinization of muscle fibers in 80% of the patients followed by loss of striation (73.33%), fragmentation (60%), nucleus internalization (33.33%), infiltration of macrophages and other inflammatory cells (20.67%), multiple nuclei (20%), and swollen muscle fibers (6.67%). Mean preoperative mouth opening was 12.4 and post-operatively 41.3 mm on 1-year follow-up and this was stable on further follow-up.

CONCLUSION

The results of this study suggest involvement of temporalis muscle with disease itself and the justification for coronoidectomy and temporalis myotomy in the surgical protocol was established.

Assessment of Eustachian tube functioning following surgical intervention of Oral Submucus Fibrosis by using tympanometry & audiometry

Oral Submucus fibrosis has been reported to cause variation in hearing sensitivity & changes in middle ear function. This study was conducted to validate the influence of OSMF and its surgical correction on middle ear function and hearing sensitivity. In this study, 20 patients (40 ears) suffering from biopsy proven OSMF (Group 2 & 3) were tested for Middle ear dysfunction and hearing sensitivity using Tympanometry & Audiometry. On Tympanometry, Type A curve was obtained in 29 ears, Type B curve in 11 ears preoperatively. Immediate postoperatively TYPE A curve was obtained in 27 ears, TYPE B curve in 13 ears. After 1 month and 3 month Type B curve was not obtained in any ear. On Audiometry,28 ears showed normal hearing and 12 ears showed minimal conductive hearing loss preoperatively and Immediate postoperatively. Tests after 1 month and 3 months showed all 40 ears having normal hearing. Results were found statistically significant with p value 0.000 and F value of 11.331 in Tympanometry and 11.143 in Audiometry. Pearson correlation test revealed that results from both the test are highly co related (0.902). OSMF causes fibrotic changes in paratubal muscles which in addition with restricted mouth opening hampers proper Eustachian tube functioning in turn causing changes in Middle ear function. This feature is seldom/infrequently found in Group 2 and 3 and if encountered can be dealt effectively with surgical intervention.

Total Serum Protein Estimation and Its Correlation with Clinical and Histopathological Grading using Masson's Trichrome Stain in Patients of Oral Submucous Fibrosis

Objectives:

Oral submucous fibrosis (OSMF) caused by dense deposition of collagen fibers which is a protein. There is a plethora of research to evaluate degree of collagen deposition using various simple histochemical techniques, but its correlation with total serum protein (TSP) level has not been explored so far.

Materials and Methods:

This case–control study comprised total forty samples with thirty cases of OSMF and ten cases were selected as control group, divided into four groups as per Lai et al. classification. Histological grading was also done according to the Rooban et al.'s classification. Blood sample was collected to evaluate TSP estimation. Findings were tabulated, and comparisons were made between clinical, histological, and TSP estimation. Discrete statistical data were analyzed by Chi-square test, ANOVA, and t-test with a statistical analysis package (SPSS version software 6.0).

Results:

No significant correlation was obtained between clinical staging and histopathological grading. Definite correlation was obtained in TSP and globulin levels of OSMF patients and their grades of fibrosis histopathologically.

Conclusion:

In the present study, it was observed that biochemical investigations involving assessment of TSP can be used as a diagnostic tool in OSMF, along with histopathological examination.

Characterization of muscle alteration in oral submucous fibrosis-seeking new evidence

Background

The aim of the study was to assess the progression of Oral Submucous Fibrosis (OSF) by investigating the correlation between clinical mouth opening and muscle-epithelial distance in tissue sections. Characterization of changes involving muscle was ascertained.

Material and Methods

50 cases and 10 controls were included in this case-control study. Inter-incisal mouth opening was measured and classified according to Lai et al. as Group A (more than 35mm), Group B (30 to 35mm), Group C (20 to 30mm), Group D (less than 20mm). Histopathological sections were graded as very early, early, moderately advanced, advanced OSF. Muscle-epithelial distance was calculated using image analysis software. The four most common degenerative changes observed in muscles, namely fragmentation, highly eosinophilic areas with loss of striations, nucleus internalization and multiple pyknotic nuclei were also assessed.

Results

Comparisons of muscle-epithelial distance were made between the clinical and histopathological groups to those of controls. The mean muscle-epithelial distance was: Group A-626.8±309.36 µm, B-827.5±549.72 µm, C-673.2±321.93 µm, D-439.9±173.84µm, Controls-1222.19 ±441.7µm. Post-hoc Bonferroni Test revealed a statistically significant reduction in the muscle-epithelial distance in Group C (p-value = 0.001) and D (p-value = 0.001) as compared to controls. The mean muscle-epithelial distance in very early, early, moderately advanced and advanced OSF was 732.73±232.81µm, 726.54±361.63 µm, 548.36±273.13 and 172.40±58.41 µm respectively. Highly significant difference in muscle-epithelial distance was seen between controls as compared to early (p-value =0.002), moderately advanced (p-value = 0.001) and advanced OSF (p-value = 0.001. Fragmentation and highly eosinophilic areas were invariably noticed in advanced OSF. Multiple pyknotic nuclei were variable with no specificity.

Conclusions

Reduction in muscle-epithelial distance may prove to be a significant predictor of OSF progression. Degenerative changes must be noted while observing OSF cases, irrespective of the histopathological grade.

Key words:Oral submucous fibrosis, muscle changes, muscle-epithelial distance.

Eustachian tube dysfunction in OSMF- often present seldom discovered

OBJECTIVES

To evaluate the effect of OSMF on the eustachian tube function and to correlate it with various grades of the disease.

STUDY DESIGN

Twenty OSMF patients (40 ears) and 20 healthy controls (40 ears) were evaluated for eustachian tube function by eustachian tube function test, tympanometry and audiometry.

RESULTS

The audiometric and tympanometric analysis showed no significant differences in hearing abilities of OSMF patients and controls and between various grades of OSMF, indicating no hearing impairment. However, eustachian tube function test revealed a statistically significant difference in eustachian tube function in OSMF patients and controls. Further, there was a significant increase in severity of dysfunction with increase in severity of disease.

CONCLUSIONS

From the present study it is evident that the subjective function of Eustachian tube may be affected by disease process. But, probably the amount of deviation found in function of the eustachian tube is non contributing to cause a conductive hearing loss. Key words:Oral submucous fibrosis, eustachian tube function, tympanometry.

Reconstructive management of the rare bilateral oral submucos fibrosis using nasolabial flap in comparison with free radial forearm flap--a randomised prospective trial

BACKGROUND

Oral sub mucous fibrosis is a rare chronic, progressive, pre malignant collagen disorder of oral mucosa in people of Asian descent characterized by trismus, blanching and stiffness of mucosa, burning sensation in mouth and hypomobility of soft palate and tongue with loss of gustatory sensation. Betel nut chewing is the most common etiological agent. Surgery remains the main stay in severe cases and aims at release of fibrotic bands and resurfacing the raw areas with different options. Reconstruction can be done by using nasolabial flap or radial free forearm flap. The purpose of this study was to compare the mouth opening after the reconstruction with either nasolabial flap or radial free forearm flap.METHODS This study was carried out on fifty (50) patients with oral sub mucous fibrosis. Twenty five (25) of these were reconstructed by nasolabial flap and twenty five (25) were reconstructed by radial free forearm flap. At different intervals of their post-operative visits, they were evaluated for the interincisal distance and the difference between the two groups was assessed.RESULTS Average increase in interincisal distance was greater in patients reconstructed with radial free forearm flap compared with patient reconstructed by nasolabial flap i.e. 18.96 mm and 15.16 mm respectively with 'P' value > 0.05.CONCLUSIONS Based on the results of this study, there was no significant difference in mouth opening after reconstruction with radial forearm free flap compared to nasolabial flap [corrected].

Morphometric evaluation of soft palate in oral submucous fibrosis--a digital cephalometric study

The Present study was carried out to evaluate the morphology of soft palate in Oral Submucous Fibrosis (OSF) patients using digital lateral cephalogram. A total number of 70 patients were included in the study (Control group had 35 patients and Study group had 35 OSF patients) were evaluated for soft palate by digital lateral cephalogram. The anterio-posterior length and superior-inferior length of soft palate were measured. The morphology of soft palate was categorized as type 1, to type 6. Different types of soft palate were compared with stages of OSF. Among the Study group (35 patients) 62.9% had Stage 2 OSF. Leaf shaped (Type 1) soft palate was seen commonly in stage 2 OSF whereas butt shaped (Type 3) in stage 3 OSF. In the present study there was statistically significant difference in length (anterio-posterior) of Type 1 soft palate of OSF patients. In the present study as the OSF progressed to advanced stage there was gradual change from Type 1 and Type 2 variety of Soft palate to Type 3 and Type 6 variety of soft palate. The study observed that there was gradual reduction in the length of soft palate in anterior-posterior direction in OSF patients.

Oral submucous fibrosis with its possible effect on eustachian tube functions: A tympanometric study

Oral submucous fibrosis (OSMF) is a chronic inflammatory condition of oral cavity The common sites of involvement are cheek, tongue and soft palate The pathological changes not only involve the mucosa and submucosa but also extend deeper to involve the underlying muscles Atrophic and degenerative changes in the tubal and paratubal muscles have already been reported and involvement of these muscles may lead to eustachian tube dysfunction The present study was therefore, planned to assess the eustachian tube functions by tympanometry in cases of OSMF Out of 106 ears in 53 cases, 80 ears (75 5%) showed normal type-A curve Abnormal tympanograms included type-B curve in 17 (16 0%) and type-C curve in 9 (8 5%) ears On testing the compliance of middle ear there was shift in the compliance peaks in 78 (73 6%) ears with +200 daPa pressure change indicating normal eustachian tube functions In 28 (26 4%) ears, eustachian tube functions were found to be affected as there was no shift in the compliance peaks Similarly on-200 daPA pressure change in 24 (22 7%) ears there was no shift in compliance peaks An identical study was also carried out in 40 ears of 20 normal individuals The data derived were statistically much higher in the disease group Therefore, it was concluded that eustachian tube functions may be affected in OSMF.

Benefit of using muscle relaxants in the routine treatment protocol of oral submucosal fibrosis: a pilot study

The aim of this present work is to describe the nature and extent of fibrosis within muscle and to correlate this with the mouth opening (MO) in OSE patients and to prove our results in improvement of mouth opening in patients with OSMF with use of "muscle relaxants" along with other modalities of treatment . The study was conducted on 40 patients who visited our outpatient department with grade 3 (<19 mm) mouth opening. 20 of these patients underwent the routine treatment protocol of weekly injection of hyaluronidase with hydrocortisone and antioxidant capsules with added lycopene for 1 month. The remaining test subjects in addition to the routine injections and antioxidants were given skeletal muscle relaxants like thiocolchicoside or chlorzoxazone. The mouth opening (interincisal distance of maxillary and mandibular incisors at maximum possible mouth opening) was measured and graded as follows: grade 1 (>40 mm), grade 2 (20-39 mm) and grade 3 (<19 mm) with the help of vernier callipers after the study period of 1 month. 17 out of the 20 test patients who received muscle relaxants in addition to the routine protocol showed marked improvement with shift from grade 3 (<19 mm) to grade 1 (>40 mm) i.e. a greater than 20 mm improvement in mouth opening. Using muscle relaxants as a adjuvant therapy in the routine protocol of treatment of oral submucosal fibrosis will not only cater and halt the problem of fibrosis but also will take care of the muscle spasm and inflammation which also inadvertently contribute to the restricted mouth opening. We found excellent improvement on adding muscle relaxants to the routine protocol which was not just an objective but also a subjective success.