Research Article
An Evaluation of Clinical and Histopathological Aspects of
Patients with Oral Submucous Fibrosis in the Background of
Oral Squamous Cell Carcinoma
B. S. M. S. Siriwardena ,
1
K. L. T. D. Jayawardena,
2
N. H. Senarath,
1
and W. M. Tilakaratne
1
1
Faculty of Dental Sciences, University of Peradeniya, Sri Lanka
2
Faculty of Allied Health Sciences, University of Peradeniya, Sri Lanka
Correspondence should be addressed to B. S. M. S. Siriwardena; samadarani@yahoo.com
Received 28 May 2018; Revised 6 August 2018; Accepted 24 September 2018; Published 9 October 2018
Academic Editor: Satoshi Maruyama
Copyright © 2018 B. S. M. S. Siriwardena et al. Tis is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Background. Te behavior and prognosis of oral squamous cell carcinoma (OSCC) is presumably diferent in patients with oral
submucous fbrosis (OSF). Te objective of this study was to assess the efects of demographic features, habits, and histopathological
features in the transformation of OSF to OSCC. Methods. Data were extracted from the archives and histopathological evaluation
and presence of nodal metastasis were recorded. Results. OSF was detected in 130 (48%) out of 273 OSCC patients. Te mean age
of presentation among OSF-positive patients was 57.7 years, while patients diagnosed only with OSCC had a comparatively higher
age, 59.5 years. In the below 50 years of age group, presence of OSF with OSCC was less (40%). In the OSF-positive group, male to
female ratio was 3.2:1. Te common primary sites were buccal mucosa and tongue in both groups. Betel quid chewing was present in
more than 95% of the sample. Betel chewing, smoking, and alcohol consumption were present in 26.15% of OSF-positive patients.
Degree of fbrosis was neither associated with the level of histological diferentiation of the tumor (p= 0.195) nor associated with the
malignant transformation (p =0.373). Lymph node metastasis was not seen in 76.63% and 68.54% of the patients with and without
OSF, respectively. Conclusions. High degree of prevalence of OSF was observed among the OSCC patients. Tere were also a male
predilection and younger age at presentation in these patients. However, a signifcant association was not observed in the degree of
fbrosis with malignant transformation or the level of histopathological diferentiation of the tumor. Lymph node metastasis also
failed to express a signifcant relationship with the presence of OSF.
1. Introduction
Oral squamous cell carcinoma (OSCC) is a critical health
problem afecting millions of people worldwide. Even though
the causes may vary regionally, the course of the disease
and sufering prevails undeterred. Te potentially malignant
period of OSCC is an aspect that provides a benefcial
approach to prevention. Tis period may be manifested as
localized or generalized alterations of the epithelium, leading
towards carcinogenesis.
Oral submucous fbrosis (OSF) is one such potentially
malignant condition that subjects the oral cavity to a wide-
spread alteration in morphology and physiology. Te clinical
manifestation comprises the classic triad: blanching of the
mucosa, burning sensation on irritation with spicy food,
and depapillation of the tongue. Tese will be followed by
depigmentation of the lips and loss of elasticity of the mucosa
with development of palpable fbrous bands in the oral cavity,
progressing from the anterior region to the posterior region
of the mouth. Tere are also apparent woody changes of sof
palate and tongue, ultimately resulting in loss of mobility of
the tongue along with restricted mouth opening [1–3].
Tis disease takes course due to the chronic exposure
of the oral mucosa to carcinogens already identifed in a
constituent of the betel quid. In Sri Lanka, the betel quid
is composed of betel leaf, areca nut, slaked lime, and
fermented/dried tobacco leaf. Te main etiological factor
for OSF is identifed as areca nut. Arecoline in areca nut is
Hindawi
BioMed Research International
Volume 2018, Article ID 4154165, 7 pages
https://doi.org/10.1155/2018/4154165