Surgical treatment of oral submucosal fibrosis

Oral submucosal fibrosis is a serious condition that might be associated with serious complications in the affected patient. The disease also represents a major challenge to the healthcare specialists and the patient before achieving proper management of the condition. Different pharmacological and surgical interventions have been validated. However, no single modality has been proved as an adequate management approach for the disease, which is probably due to the limited number of investigations in this concern and the limited knowledge about the pathogenesis of the condition. In the present literature review, we have discussed the different surgical approaches that have been reported in the literature for managing patients with oral submucosal fibrosis. These approaches mainly aimed to remove the fibrous bands in the oral cavity and maintain adequate mouth opening. It should be noted that it would be hard to write a solid conclusion in this concern because most of the current evidence was either lacking or obtained from a limited number of studies with no proper sample sizes or adequate follow up durations. Accordingly, the indication of the surgical intervention should be primarily done by the surgeon based on the degree of involvement of the oral cavity. Finally, we recommended that further comparative investigations be carried out to further demonstrate the most appropriate management modality and to rule out whether pharmacological or surgical modalities are more efficacious in these settings.

Prevalence of Oral Sub Mucosal Fibrosis in Pre- Anesthesia Clinic in India: A Cross Sectional Observational Study

Introduction: Oral submucous fibrosis (OSMF) is a premalignant lesion of the buccal mucosa usually caused by chewing of betel nut, areca nut and tobacco. OSMF causes difficulty in laryngoscopy and intubation of the trachea. Patient of submucosal fibrosis do come for emergency and elective surgeries requiring general anaesthesia. In such scenario maintaining airway is a big challenge for anaesthesiologist. Knowledge of Prevalence of submucosal fibrosis in local region and degree of OSMF with difficult intubation may help anaesthesiologist to prepare and plan airway management in such conditions. Aims and Objectives: To evaluate the prevalence of oral submucous fibrosis in patients coming in pre-anaesthesia clinic and assessment of airway and prevalence of degree of OSMF by measuring Interincisal mouth opening in patients of oral submucosal fibrosis. Methods: Cross-sectional observational study was conducted in the department of anaesthesiology on 500 patients coming in pre-anaesthesia clinic. Patients were identified and sent to dental department for confirmation of diagnosis OSMF if one or more clinical feature of OSMF were present. A detailed proforma was used to record demographic parameter, the type of tobacco, betelnut and areccanut chewing habits, difficulty in mouth opening, inter incisor distance. OSMF was divided in 4 stages on the basis of inter incisor distance. Results: Prevalence rate of submucosal fibrosis patients coming in our pre-anaesthesia clinic was 8%. Thirty patients were found to be in stage 1 (75%.), nine patients were found to be in stage 2 (22.5%) and only one patient was in stage 3. Conclusion: Being aware of the prevalence of OSMF in the region and stages of OSMF in regard to inter incisor distance in pre-operative clinic helps anaesthesiologists to prepare and plan airway management. And hence surgical exploration can be avoided.

MANAGEMENT OF ORAL SUBMUCOSAL FIBROSIS (OSMF) WITH PANCHGAVYA SHUKTA SHODHAN GANDUSHA AS A DINACHARYA PROCEDURE

The rate of tobacco in addition to above conditions consumption in various forms in recent years is viewed as an emerging epidemic. The symptoms of OSMF may include burning sensation in mouth, intolerance to spicy, pain in mouth, changes in color of oral mucosa, difficulty in opening of mouth. Mukha rogas have been mentioned in Ayurved, with various treatment modalities especially Gandusha and is one of the im-portant Upakrama in Dincharya. Panchagavya is prepared by mixing five products of cow and used in tra-ditional many applications. Shukta varga includes acidic and partially alcoholic preparations of self-generated nature. Application of Panchagavya externally can reduce the Kaathinyata (Hardness) under the Twacha (skin) of oral cavity.

Egr-1 mediates low-dose arecoline induced human oral mucosa fibroblast proliferation via transactivation of Wnt5a expression

Background Arecoline is an alkaloid natural product found in the areca nut that can induce oral submucous fibrosis and subsequent development of cancer. However, numerous studies have shown that arecoline may inhibit fibroblast proliferation and prevent collagen synthesis. Results High doses of arecoline (> 32 μg/ml) could inhibit human oral fibroblast proliferation, while low doses of arecoline (< 16 μg/ml) could promote the proliferation of human oral fibroblasts. Wnt5a was found to be both sufficient and necessary for the promotion of fibroblast proliferation. Egr-1 could mediate the expression of Wnt5a in fibroblasts, while NF-κB, FOXO1, Smad2, and Smad3 did not. Treatment with siRNAs specific to Egr-1, Egr inhibitors, or Wnt5a antibody treatment could all inhibit arecoline-induced Wnt5a upregulation and fibroblast proliferation. Conclusions Egr-1 mediates the effect of low dose arecoline treatment on human oral mucosa fibroblast proliferation by transactivating the expression of Wnt5a. Therefore, Egr inhibitors and Wnt5a antibodies are potential therapies for treatment of oral submucosal fibrosis and oral cancer.

Analysis of Oral Carcinogenesis Factors Based on Non Negative Matrix Evolutionary Spectrum Clustering Decomposition

To explore the risk factors of Oral Submucosal fibrous carcinogenesis and provide theoretical basis for selfprevention and clinical treatment. First of all, an evolutionary non negative matrix factorization framework based on clustering quality is proposed for dynamic oral carcinogenesis detection. Then, the equivalence among evolutionary spectral clustering, ENMF and density optimization of evolutionary modules is proved theoretically. At the same time, based on this equivalence, a new semi-supervised ENMF algorithm is proposed by adding a priori information to ENMF without increasing the time complexity. Using this algorithm, 42 patients with Oral Submucosal Fibrosis and 40 non-cancerous patients with oral submucosal fibrosis were analyzed by single factor and multi-factor analysis to study the quantitative relationship between Oral Submucosal Fibrosis and 14 related factors. The results suggested that age, betel nut chewing duration, smoking duration and leukoplakia or lichen planus were the four factors which were introduced into the cluster quality analysis. Age, betel nut chewing duration, smoking duration and complications of leukoplakia or lichen planus are risk factors for Oral Submucosal fibrous carcinogenesis.

Positive Feedback Loop of SNAIL-IL-6 Mediates Myofibroblastic Differentiation Activity in Precancerous Oral Submucous Fibrosis

Oral submucosal fibrosis (OSF) is a premalignant disorder of the oral cavity, and areca nut chewing is known to be a major etiological factor that could induce epithelial to mesenchymal transition (EMT) and activate buccal mucosal fibroblasts (BMFs). However, this detailed mechanism is not fully understood. In this study, we showed that the upregulation of Snail in OSF samples and fibrotic BMFs (fBMFs) may result from constant irritation by arecoline, a major alkaloid of the areca nut. The elevation of Snail triggered myofibroblast transdifferentiation and was crucial to the persistent activation of fBMFs. Meanwhile, Snail increased the expression of numerous fibrosis factors (e.g., α-SMA and collagen I) as well as IL-6. Results from bioinformatics software and a luciferase-based reporter assay revealed that IL-6 was a direct target of Snail. Moreover, IL-6 in BMFs was found to further increase the expression of Snail and mediate Snail-induced myofibroblast activation. These findings suggested that there was a positive loop between Snail and IL-6 to regulate the areca nut-associated myofibroblast transdifferentiation, which implied that the blockage of Snail may serve as a favorable therapeutic strategy for OSF treatment.

Egr-1 mediates low dose Arecoline induced human oral mucosa fibroblasts proliferation by transaction the expression of Wnt5a

Background Arecoline is the main carcinogens in Areca nut that induce oral submucous fibrosis to develop into cancer. However, many previous studies have showed that Arecoline may inhibit proliferation and prevent collagen synthesis of fibroblasts. Results High dose Arecoline (> 32 µg/ml) could inhibit but low dose Arecoline (< 16 µg/ml) could promote the proliferation of human oral fibroblasts. Wnt5a was both sufficient and necessary for the promotion of fibrobasts proliferation. Egr-1, but not NF-κB, FOXO1, Smad2 or Smad3, mediated the expression of Wnt5a in fibrobasts. The specific siRNAs of Egr-1, Egr inhibitors or Wnt5a antibodies treatment blocked Arecoline induced Wnt5a upregulation and fibroblasts proliferation. Conclusions Egr-1 mediates low dose Arecoline induced human oral mucosa fibroblasts proliferation by transaction the expression of Wnt5a, and Egr inhibitors or Wnt5a antibodies are potential therapeutic drugs of oral submucosal fibrosis and oral cancer.