Idiopathic Oral Submucous Fibrosis in an 8-Year-Old Pakistani Female: A Case Report
Keywords:
Idiopathic oral submucous fibrosis, pediatric OSF, Karachi, areca nut-free OSF, multi-disciplinary management, rare oral disease.Abstract
Idiopathic oral submucous fibrosis (OSF) in children is an infrequent entity, in particular in regions like India and Pakistan, where the use of areca nut is culturally widespread. Unlike the usual OSF cases due to areca nut or tobacco consumption, idiopathic OSF occurs without any identifiable etiological factors, and poses differential diagnostic and therapeutic challenges. It is a case report of an 8-year-old female child presenting in KKF Dental OPD, a Project by Liaquat College of Medicine and Dentistry from Karachi, Pakistan, who had a minimal mouth opening of 11 mm with bilateral fibrous bands in the buccal mucosa and did not give a history of any areca nut or tobacco habit. Her condition deteriorated due to poor follow-up despite primary management by doing jaw exercises, dietary modification, and applying aloe vera gel. The clinical, psychological, and social implications of OSF in the pediatric age group are reported upon, with an emphasis on early diagnosis and management by a multi-disciplinary team to prevent impairment and malignant transformation. Various medical, surgical, and physiotherapeutic treatments such as corticosteroids, proteolytic enzymes, nutritional support, fibrous band excision, and reconstructive surgery are applied to the patients. This case calls for increased awareness about idiopathic OSF in children, particularly in regions with a higher prevalence level, and calls for the implementation of broad, culture-specific measures to reduce this problem. Etiology will need further clarification to optimize its management protocols for such rare cases of debilitating afflictions.
References
1. Zeng L, Peng H, Yu H, Wang W, Duan C, Fang C et al. Expression profiles of tRNA?derived small RNA and their potential roles in oral submucous f2qibrosis. J Oral Pathol Med. 2021; 50(10): 1057-66. doi: 10.1111/jop.13245.
2. Talla H, Reddy PVR, Mudavath M, Bathina T. Oral submucous fibrosis in a 5 year old child. Contemp Clin Dent. 2019; 10(4): 679-681. doi: 10.4103/ccd.ccd_898_18
3. Sitheeque M, Ariyawardana A, Jayasinghe RD, Tilakaratne WM. Depigmentation of oral mucosa as the earliest possible manifestation of oral submucous fibrosis in Sri Lankan preschool children. J Investig Clin Dent. 2010; 1(2): 156-9. doi: 10.1111/j.2041-1626.2010.00021.x.
4. Talla H, Reddy PR, Mudavath M, Bathina T. Oral submucous fibrosis in a 5 year old child. Contemp Clin Dent. 2019; 10(4): 679. doi: 10.4103/ccd.ccd_898_18.
5. Jain A, Taneja S. Oral submucous fibrosis in pediatric patients: A systematic review and protocol for management. Int J Surg Oncol. 2019; 2019: 1-6. doi: 10.1155/2019/3497136.
6. Agrawal A, Sarkar P, Shigli K. Oral submucous fibrosis in a 9-year-old Indian irl. BMJ Case Rep. 2011; 2011(sep28): bcr0820114588-bcr. doi: 10.1136/bcr.08.2011.4588.
7. Rashid S, Manzar S, Kazmi F, Shahzad HB, Jan ZA, Qureshi MM. Influence of risk habits on demographic factors and its impact on oral submucous fibrosis. Pak J Med Health Sci. 2021; 15(11): 3058-61.
8. Siddiq M, Shakeel J, Haider SM, Siddiq S. Mean lipid profile among patients uffering from oral sub-mucous fibrosis reporting in a tertiary care hospital of Karachi, Pakistan: A descriptive study. Ann Punjab Med Coll. 2021; 15(1): 12-6.
9. Tamang PS, Bajgai GP, Pokhrel HP. Distribution of oral submucous fibrosis cases and malignant transformation rate among Bhutanese patients reated at Jigme Dorji Wangchuck National Referral Hospital, Bhutan. Int Healthcare Res J. 2021; 4(12): OR7-OR10.
10. More CB, Das S, Patel H, Adalja C, Kamatchi V, Venkatesh R. Proposed clinical classification for oral submucous fibrosis. Oral Oncol. 2012; 48(3): 200-2. doi: 10.1016/j.oraloncology.2011.10.011.
11. Zain R, Gupta P, Warnakulasuriya S, Shrestha P, Ikeda N, Axell T. Oral lesions associated with betel quid and tobacco chewing habits. Oral Dis. 1997 Sep; 3(3): 204-5. doi: 10.1111/j.1601-0825.1997.tb00039.x.
12. Alshadwi A, Bhatia I. Excision of Oral Submucous Fibrosis and Reconstruction With Full Thickness Skin Graft: A Case Study and Review of the Literature. Case Rep Dent. 2012; 2012: 628301. doi: 10.1155/2012/628301.
13. Wollina U, Verma S, Ali FM, Patil K. Oral submucous fibrosis: An update. Clin Cosmet Investig Dermatol. 2015; 8: 193-204. doi: 10.2147/CCID.S80576.
14. Aggarwal A, Shetti A, Keluskar V, Bagewadi A. Estimation of serum beta carotene levels in patients with oral submucous fibrosis in India. J Oral Sci. 2011; 53(4): 427-31. doi: 10.2334/josnusd.53.427.
15. Dhariwal R, Mukherjee S, Pattanayak S, Chakraborty A, Ray J, Chaudhuri K. Zinc and vitamin A can minimize the severity of oral submucous fibrosis. BMJ Case Rep. 2010; 2010(May 11): bcr1020092348-bcr.
16. Anuradha A, Patil B, Asha V. Evaluation of efficacy of aloe vera in the treatment of oral submucous fibrosis – A clinical study. J Oral Pathol Med. 2017; 46(1): 50-5. doi: 10.1111/jop.12463.
17. Shanbhag VKL. Aloe Vera in the Management of oral submucous fibrosis. Oncobiology and Targets. 2017; 04: 1.
18. Rajan B, Ebenezer V, Kumar B, Muthumani. Surgical management of OSMF with coronoidectomy and buccal fat pad replacement - A case report. Biosciences Biotechnology Research Asia. 2014; 11(2): 883-6.
19. Nidhi N, Srikrishna K, Kumar V. Role of physiotherapy in the management of oral submucous fibrosis: A case control study. Int J Contemp Med Res. 2019; 6(1).
20. Chitlange NM. Physiotherapeutic approach in oral submucous fibrosis: A systematic review. Cureus. 2023 Nov 2; 15(11): e48155. doi: 10.7759/cureus.48155.
21. Nayak A, Fiaz S, Bhatnagar SS. Ayurvedic Management of Oral Submucous Fibrosis -a Conceptual Study. Int Res J Ayurveda Yoga. 2021; 04(03): 123-8.
22. Solanki V, Unadkat RS, Mehta CS, Baraiya HP, Bineesh EP. An Ayurvedic Approach on Oral Submucous Fibrosis and Its Management – A Review. Asian Pacif J Health Sci. 2022; 9(4): 117-22.
23. Rao NR, Villa A, More CB, Jayasinghe RD, Kerr AR, Johnson NW. Oral submucous fibrosis: A contemporary narrative review with a proposed inter-professional approach for an early diagnosis and clinical management. J Otolaryngol Head Neck Surg. 2020; 49(1): 3. doi: 10.1186/s40463-020-0399-7.
24. Khalam SA, Kumar L, Zacariah RK, Kurien NM, Raj P. Oral submucous fibrosis: A clinical review. Madridge J Dent Oral Surg. 2017; 2(1): 28-30.
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