yasser al kadri and zaid al azem

8/13/2019 Yasser Al Kadri and Zaid Al Azem

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42 years old Asian man c/o progressiveof his mouth opening over the last few

history reveals various chewing hexamination: band like contracturcheeks and pale stretched or


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Deferential Diagnosis:

Amyloidosis

Lichen Planus

Scleroderm

Actinomycosis (chronic infection)

Temporomandibular joint bony ankylosis & fibrous ankylosis

Juvenile rheumatoid arthritis

progressive myositis ossificans

Radiation fibrosis

Squamous Cell Carcinoma

Oral submucous fibrosis
http://www.pathologyoutlines.com/topic/oralcavityamyloidosis.htmlhttp://www.pathologyoutlines.com/topic/oralcavityamyloidosis.html


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Final diagnosis

oral submucous fibrosis

This is a highly potent,irriversible and chronic pre-cancerous coaffects various portions of the oral cavity as well as the pharynx

It causes progressive fibrosis of submucosal tissues and juxta-einflammatory reactions.

This disease also leads to fibro-elastic changes in the lamina prwith epithelial atrophy, which results in stiffness of the oral muaffects soft palate, buccal mucosa and tongue.

It may become impossible to open to the mouth due to the extstiffness of the jaw.


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Etiology :Exact etiology is unknown. The suggested factors are,

1. Chronic Irritation

Chilies

Areca nut

Tobacco Chewing

2. Deficiency disease.

3. Defective iron metabolism4. Bacterial Infection

5. Immunological disorders

6. Genetic disorder.


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staging

Group I: This is the earliest stage and is not associated with moulimitations. It refers to patients with an interincisal distance of g35 mm.

Group II: This refers to patients with an interincisal distance of 2

Group III: These are moderately advanced cases. This stage refepatients with an interincisal distance of 15-26 mm. Fibrotic banat the soft palate, buccal mucosa and pterygomandibular raphe

Group IVA: Trismus is severe, with an interincisal distance of lesand extensive fibrosis of all the oral mucosa.

Group IVB: Disease is most advanced, with premalignant and mchanges throughout the mucosa.


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Sign and symptoms:

Progressive inability to open the mouth

Oral pain and a burning sensation

Increased salivation

Pain in the ear or loss of hearing

Nasal intonation of voice

Thinning and stiffening of the lips. Pigmentation of the oral mucosa.

Impaired mouth movements - eating, whistling, blowing,

Dysphagia to solids


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Treatment:

1. Stop the habit of chewing betel nut and tobacco

2. Minimiz e the consumption of spicy foods and chilies

3. Maintain a good oral hygiene.

4. Get the third molars extracted.

5. Round off the sharp edges of teeth.

6. Take Vitamin B Complex, Vitamin A and Vitamin C

7. Take iron supplements.

8. Practice muscle stretching exercise for the mouth


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Medical treatment:

Steroids :weekly submucosal intralesional injections or topical application odexamethasone, Triamcinolone

Injection or topical hyaluronidase with or without steroids.

Intra-lesional interferon gamma.

Sub mucosal injection of healthy human placental extracts.


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Surgical Treatment

Simple excision of the fibrous bands:

Split-thickness skin grafting following bilateral temporalis myocoronoidectomy:

Nasolabial flaps and lingual pedicle flaps

Use of a KTP-532 laser release


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Done By

Zaid AL-Azem ID# 200810052

Yasser AL-Kadri ID# 200911229

yasser al kadri and zaid al azem

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