Oral Submucous Fibrosis Clinical Presentation

Updated: Jun 18, 2018
  • Author: Nektarios I Lountzis, MD; Chief Editor: William D James, MD  more...
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Presentation

History

Symptoms of oral submucous fibrosis include the following [3] :

  • Progressive inability to open the mouth (trismus) due to oral fibrosis and scarring

  • Oral pain and a burning sensation upon consumption of spicy foodstuffs

  • Increased salivation

  • Change of gustatory sensation

  • Hearing loss due to stenosis of the eustachian tubes

  • Dryness of the mouth

  • Nasal tonality to the voice

  • Dysphagia to solids (if the esophagus is involved)

  • Impaired mouth movements (eg, eating, whistling, blowing, sucking)

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Physical Examination

Oral submucous fibrosis is clinically divided into three stages, [50] and the physical findings vary accordingly. [3, 4, 50]

Stage 1

Stomatitis includes erythematous mucosa, vesicles, mucosal ulcers, melanotic mucosal pigmentation, and mucosal petechia.

Stage 2

Fibrosis occurs in ruptured vesicles and ulcers when they heal, which is the hallmark of this stage. Early lesions demonstrate blanching of the oral mucosa.

Older lesions include vertical and circular palpable fibrous bands in the buccal mucosa and around the mouth opening or lips, resulting in a mottled, marblelike appearance of the mucosa because of the vertical, thick, fibrous bands running in a blanching mucosa. Specific findings include the following:

  • Reduction of the mouth opening (trismus)

  • Stiff and small tongue

  • Blanched and leathery floor of the mouth

  • Fibrotic and depigmented gingiva

  • Rubbery soft palate with decreased mobility

  • Blanched and atrophic tonsils

  • Shrunken budlike uvula

  • Sinking of the cheeks, not commensurate with age or nutritional status

Stage 3

Leukoplakia is precancerous and is found in more than 25% of individuals with oral submucous fibrosis.

Speech and hearing deficits may occur because of involvement of the tongue and the eustachian tubes.

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Complications

Oral dysplasias and squamous cell carcinomas are complications of oral submucous fibrosis. In patients with oral submucous fibrosis, the risk of developing oral carcinoma is 7.6% over a 10-year period. [3]

If the palatal and paratubal muscles are involved in patients with oral submucous fibrosis, conductive hearing loss may occur because of functional stenosis of the eustachian tube. [51]

Patients with oral submucous fibrosis who require anesthesia for trismus correction, resection, and reconstructive (oncoplastic) surgery may have difficulty during laryngoscopy and intubation of the trachea. [52]

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