CLINICAL FINDINGS AND HISTOPATHOLOGICAL CORRELATION OF ORAL SUBMUCOUS FIBROSIS- A COMPARISION OF PROGNOSTIC SIGNIFICANCE

Abstract

Rapidly growing world in terms of mechanization, industrialization and technology has subjected mankind to emotional, mental, and physical tension. In reaction to such factors, human beings fall prey to stress relieving habits because of their euphoric effect along with hallucinogenic, psychotropic and mind relaxing properties to relieve stress and anxiousness. However, they have deleterious effects on the body apart from only being addictive. The most initial portal of entry of such habits is oral cavity and hence it is the first and most at danger. In the subcontinent specifically Pakistan, such common ill habits of areca nut products consumption include betel quid (Gutka), betel nut (Chalia), betel leaf (pan) and other associated factors which eventually leads to develop oral submucous fibrosis (OSMF). The aim of this research was to evaluate and compare symptomatic and asymptomatic subjects for alterations in normal anatomy of oral mucosa through tissue biopsy for OSMF symptomatic cases and brush cytology (using soft bristle toothbrush) for all groups involved in the study i.e., cases, asymptomatic chewers (control group 1) and healthy controls (control group 2) The study included 50 OSMF symptomatic cases along with control group 1 and control group 2 of both sexes. H & E stained microscopic slides were prepared from oral mucosa. Under a light microscope, clearly defined slides were evaluated to record histological and cytological features and assessed for their morphology. Collected data was manually entered into the Statistical Package for the Social Sciences version 23.0 and analyzed using Binary logistic regression analysis, Chi Square test and Fisher’s Exact test at 95% confidence interval with p value ≤ 0.05 as statistically significant and 0.01 as highly significant. Burning sensation (0.741), white fibrotic lines (0.351), ulcerations (0.357), hyalinization of lamina propria (0.180), collagen presence around blood vessels (0.328) and muscles (0.877), residual edema (0.747), Histo grade II (0.515), Histo grade III (0.537), Ulceration XI (0.357), epithelial type (0.193), gender (0.301), ethnicity (0.48), bacterial colonies with gender (0.127), fungal colonies with type of habit (0.111) did not show statistically significant association in cases of OSMF while Age (0.000), dysplasia (0.001), squamous cell carcinoma (0.004), Histo grade I (0.011), Histo grade IV (0.000), nuclei (0.005), bacterial colonies (0.046), dysplasia and inflammatory cells (0.029), histology of dysplasia and appearance of nuclei (0.016), association of nuclei and nucleoli with OSMF (0.000), bacterial colonies and inflammatory cells (0.000), fungal colonies and inflammatory cells (0.000), epithelium with OSMF (0.004), dysplastic cells and hyalinization in lamina propria (0.023) showed a reasonably higher value of significance. The results demonstrate that oral brush cytology can be used as a potentially practical noninvasive screening tool for predicting oral mucosal disease in a resource challenged setting and non-compliant patients. However clinical judgement followed by tissue biopsy is of prime importance and gold standard. Immediate biopsy is mandatory for assessment of exact clinical and histological stage. Presence of hyperchromasia, dysplasia, inflammatory cells, hyalinization, bacterial and fungal colonies are high risk features for OSMF predictability. All ill habit chewers should be followed on a priority basis for early detection and management of OSMF. Since diagnosis is mostly clinical and treatment of oral submucous fibrosis is incredibly challenging, it was important to conduct a study to bring awareness to the replete literature in terms of clinico-histological and cytological presentation of OSMF