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Limited mouth opening in oral submucous fibrosis: reasons, ramifications, and remedies
Author(s) -
Sharma Mohit,
Radhakrishnan Raghu
Publication year - 2017
Publication title -
journal of oral pathology and medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.887
H-Index - 83
eISSN - 1600-0714
pISSN - 0904-2512
DOI - 10.1111/jop.12513
Subject(s) - oral submucous fibrosis , medicine , fibrosis , hypoxia (environmental) , pathology , radiation therapy , lactate dehydrogenase , downregulation and upregulation , gastroenterology , biology , chemistry , oxygen , biochemistry , organic chemistry , enzyme , gene
Limited mouth opening ( LMO ) in oral submucous fibrosis ( OSF ) has been attributed to both the submucosal and muscle fibrosis ( MF ). While reflectory trismus was proposed before as an auxiliary mechanism by another group, the stretch‐mediated muscle damage ( MSD ), histopathological changes in blood vessels (such as endothelial dysfunction, endothelial hypertrophy, and endarteritis obliterans), and upregulated anaerobic isoforms of lactate dehydrogenase ( LDH ) have been proposed by us as complementary events leading to MF . Additionally, the amount of hypoxia‐mediated upregulation of anaerobic isoforms of LDH determines the extent of MF . Radiotherapy ( RT )‐mediated release of reactive oxygen species causes vascular damage thereby worsening hypoxia. While the alteration in LDH levels secondary to hypoxia enhances fibrosis, RT worsens it. Oral squamous cell carcinoma occurring in the background of OSF is an absolute contraindication for RT as it augurs unfavorable prognosis. An algorithm to demonstrate this with evidence is clearly depicted. The role of HIF ‐1α in the progression of OSF and its malignant transformation, and the consideration of hyperbaric oxygen therapy as a therapeutic remedy in OSF are underscored.