Oral Maxillofac Surg DOI 10.

1007/s10006-010-0209-x

REVIEW ARTICLE

Management of oral submucous fibrosis: an overview

Punnya V. Angadi & Sanjay Rao

# Springer-Verlag 2010

Abstract Oral submucous fibrosis is a disease due to a chronic, insidious change in fibroelasticity, characterized by burning sensation in the oral cavity, blanching, and stiffening of the oral mucosa and oro-pharynx leading to trismus and inability to open the mouth. The symptoms and signs depend on the progression of the lesions and number of affected sites. It is predominantly seen in Indians and other Asians. Once, the disease has developed, there is neither regression nor any effective treatment. It is considered as a pre-malignant stage of oral cancer and reported risk of malignant transformation varies from 2.37.6%.The common etiological factor considered for this unremitting disease is use of areca nut; however, the precise pathogenesis still remains elusive and controversial. A wide range of treatment consisting of drug management, surgical therapy, and physiotherapy have been attempted till date; with varying degrees of benefit, but none of them have proved to be a cure for this disease. This field remains open for clinical trials and research. This paper aims to provide an overview on various management modalities available for oral submucous fibrosis. Keywords Oral submucous fibrosis . Areca nut . Conservative management . Surgical management

Introduction Oral submucous fibrosis (OSMF) is a chronic, insidious oral mucosal condition that affects predominantly Indians and other Asians [1, 2]. The hallmark of the disease is submucosal fibrosis that affects the oral cavity, pharynx, and esophagus. It is characterized by juxta-epithelial inflammation followed by chronic change in the fibroelasticity of lamina propria and epithelial atrophy. This results in burning sensation, blanching, and stiffening of oral mucosa and oropharynx leading to restricted mouth opening [39]. What makes it more sinister is the malignant transformation rate, which is reported to be 7.6% over a 17year period [1019]. The pathogenesis of the disease is thought to be multifactorial; with chewing of betel quid/areca nut being recognized as one of the most important risk factors for OSMF [5, 8, 17, 2022].

History It was first described by Schwartz in 1952 as atrophica idiopathica tropica [23]. Subsequently, Joshi (1953) is credited to have coined the term oral submucous fibrosis [6]. Paymaster in 1956 was the first to describe it as a precancerous condition [24] and studies by Pindborg substantiated this report. [25, 26]

P. V. Angadi (*) : S. Rao KLE VK institute of Dental Sciences and Hospital, J.N.M.C. Campus, Nehrunagar, Belgaum 590010 Karnataka State, India e-mail: punnya_angadi@rediffmail.com

Clinical presentation It has a specific geographic distribution and predominantly affects the Asians especially Indians (Southern States) and Taiwanese. It is predominantly seen in the second or third