Oral submucous fibrosis in paediatric age group

Comparative Evaluation of Eustachian Tube Changes in Oral Submucous Fibrosis Patients

Aim and Objective: Oral submucous fibrosis (OSMF) is a potentially premalignant disorder affecting the oral cavity and its adjacent structures. The present study was aimed at a comparative evaluation of eustachian tube (ET) changes in OSMF patients using audiometry and cone-beam computed tomography (CBCT). Materials and Methods: A total of 40 patients who were clinically diagnosed with OSMF were taken for the study and were graded into clinical and functional staging. After grading, the patients were subjected to audiometry to evaluate their hearing deficit. Subsequently, the patients were subjected to CBCT analysis for the evaluation of the length and volume of the ET. The length of ET was measured in the axial sections of the full-face CBCT images taken at the level of the root tip of the upper first molar. The radiolucency from the nasopharyngeal opening to the maximum distance was considered. The volume of ET was measured using third-party software (ITK-SNAP) in the radiolucent area. Result: The age group in which a higher number of OSMF cases were seen was between 41 and 50 years. There was mild to moderate hearing loss observed in the right and/or left ear, with little variation between right and left ear changes in audiometry. The CBCT analysis did not show a significant difference in the mean length of the eustachian tube when comparing OSMF cases with normal. However, as the disease worsened, the length on the right and left sides significantly decreased. Additionally, there was no statistically significant difference in the mean eustachian tube volume between disease cases and controls. According to the clinical subgrades, the overall volume decreased from lower grade to higher grade, but there was no discernible difference between the left and right ear. The volume on function sub-grading between the right and left ear, however, was significantly reduced. Thus, the length and volume of ET decreased as the disease severity increased, but the mild to moderate hearing loss found in different clinical and functional grades of OSMF cases was not statistically significant. Conclusion: Therefore, from the present study, it can be concluded that all OSMF cases should be evaluated for hearing deficit, and imaging of the eustachian tube should be part of the OSMF assessment for morphological changes of the ET that may cause hearing deficit.

Novel Treatment Approach of Oral Submucous Fibrosis in a 6-year-old Girl: A Case Report

Background

Oral submucous fibrosis is characterized by stiffness of oral mucosa, blanching and functional limitation, and areca nut predisposition is considered to be one of the main etiological factors. In recent years, there is an increasing prevalence of OSMF in the Indian subcontinent owing to increased consumption of smokeless tobacco products. Very few cases of pediatric OSMF are reported in PubMed literature. Oral submucous fibrosis has a malignant transformation rate of 7–13% and hence, it is important to intervene at an appropriate stage and manage it well in time.

Aim and objective

To report a case of oral submucous fibrosis (OSMF) in a 6-year-old Indian girl along with its management and follow-up.

Case description

A 6-year-old girl of Indian origin was diagnosed with OSMF and we have used sesame oil pulling as a novel treatment approach and observed good results with long-term follow-up. We have also reviewed PubMed literature for cases of pediatric OSMF reported till date.

Conclusion

A timely diagnosis and intervention becomes necessary in pediatric OSMF to improve oral function and prevent malignant transformation.

Clinical significance

It is important to report oral potentially malignant disorder (OPMD) cases in pediatric patients and create awareness through health education programs so that parents and children know about the ill effects of consuming tobacco products.

How to cite this article

Gupta S, Gupta S, Chaudhary C, et al. Novel Treatment Approach of Oral Submucous Fibrosis in a 6-year-old Girl: A Case Report. Int J Clin Pediatr Dent 2021;14(4):575–579.

No age predilection for a disease like OSMF. A case report of 5-year-old child

Background

Oral Sub Mucous Fibrosis (OSMF) is a clinical entity, well known since the time of Sushruta as 'Vidari'. OSMF is a chronic subtle disease that is associated with significant functional morbidity and an increased risk for malignancy. Generally, OSMF is considered as an adult disease, but recently Indian suburb area has reported incidence of 0.2-1.2 percent in pediatric age group as well. The pathogenesis of the disease is not well established, but is believed to be multifactorial. Areca nut chewing is considered as the major etiology amongst all. Children indulge in habit of chewing areca nuts due to its easy availability of different forms of multicolored attractive areca nut pouches in markets. Other factors involved in the consumption of Areca nut are levels of awareness, household environment, peer pressure, low cost, etc.

Case presentation

A 5-year-old boy reported with the complaint of restricted mouth opening since 3-4 months. He had habit of chewing betel nut, a minimum of 2-3 sachets daily since one and a half years. He also complained of intolerance to spicy food. The oral mucosa was pale, opaque, blanched with a reduced mouth opening of interincisal width being 06 mm.Palate was fibrotic with shrunken uvula.

Conclusion

This Case of OSMF in a 5-year-old boy is reported to be the first incidence of OSMF in a child with least interincisal opening of 06 mm.

Oral Submucous Fibrosis in Pediatric Patients: A Systematic Review and Protocol for Management

Aim

To conduct a systematic review evaluating the cases of oral submucous fibrosis in pediatric patients.

Material and Method

Systematic review was conducted using PRISMA guidelines. The article focused on oral submucous fibrosis in pediatric patients were included. A total of five manuscripts were included in our systematic review. The prevalence of OSMF in pediatric patients, gender distribution, causes, and clinical presentation were reviewed.

Results

On systematically reviewing, a total of 10 cases of OSMF in pediatric patients were found. The youngest patient reported to be diagnosed with OSMF was of 2.5 years of age. Female preponderance was noticed. All the patients had the habit of areca nut chewing which subsequently led to fibrosis.

Conclusion

Such a rapid increase in the rate of OSMF among pediatric population is a potential danger to the society. The habit of areca nut chewing is the major cause for this dreadful condition. Lack of health consciousness and low level of education are the major factors for initiation of this habit among children. Therefore it is imperative for the parents and school as well as government authorities to take serious actions.

Oral submucous fibrosis in a school-going Indian adolescent boy

A 14-year-old boy presented to our hospital with a chief complaint of difficulty in opening his mouth and a burning sensation on eating spicy food. The oral mucosa showed generalized diffused blanching and he was unable to protrude his tongue. For 6 years he had habitually chewed gutkha - a mixture of betel nut and tobacco for several minutes a day. This oral submucous fibrosis condition is very rare in young patients. The case highlights the link between oral submucous fibrosis and the regular use of areca nut (gutkha) products in a young boy.

Trismus in the paediatric population

Trismus is a rare presentation affecting neonates, children, and adults. In newborns there are serious implications, with potential to affect feeding, cause airway problems, and make intubation difficult. Causes of trismus seen in the paediatric patient are discussed in this review article; they are divided into intra- and extra-articular types. The extra-articular group consists of congenital and acquired disorders. The acquired group includes infective causes such as tetanus, iatrogenic causes related to drugs, cancer or dental treatment, and trauma causing articulation difficulty or triggering a rare type of bone growth in myositis ossificans. Changes in the mouth resulting from oral submucous fibrosis can undergo malignant transformation. This review aims to raise awareness of potential causes of trismus in paediatric populations, helping clinicians identify the underlying pathology so appropriate strategies for treatment be applied, with the ultimate aim of improving long-term outlook and quality of life for affected children.

Precancerous lesions of oral mucosa

Precancerous lesions of oral mucosa, known as potentially malignant disorders in recent years, are consists of a group of diseases, which should be diagnosed in the early stage. Oral leukoplakia, oral submucous fibrosis, and oral erythroplakia are the most common oral mucosal diseases that have a very high malignant transformation rate. Oral lichen planus is one of the potentially malignant disorders that may be seen in six different subtypes including papular, reticular, plaque-like, atrophic, erosive, and bullous type, clinically. Atrophic and erosive subtypes have the greater increased malignant transformation risk compared to another subtypes. Although there are various etiological studies, the etiology of almost all these diseases is not fully understood. Geographically, etiologic factors may vary. The most frequently reported possible factors are tobacco use, alcohol drinking, chewing of betel quid containing areca nut, and solar rays. Early diagnosis is very important and can be lifesaving, because in late stages, they may be progressed to severe dysplasia and even carcinoma in situ and/or squamous cell carcinoma. For most diseases, treatment results are not satisfactory in spite of miscellaneous therapies. While at the forefront of surgical intervention, topical and systemic treatment alternatives such as corticosteroids, calcineurin inhibitors, and retinoids are widely used.