ORAL SUBMUCOUS FIBROSIS & TUMOURS OF THE ORAL CAVITY

ORAL SUBMUCOUS FIBROSIS AND TUMOURS OF THE ORAL CAVITY 

ORAL SUBMUCOUS FIBROSIS (OSMF)

ETIOLOGY

• Chronic chewing of areca nut (supari), betel quid, tobacco.

• Nutritional deficiencies, especially iron and vitamin B complex.

• Autoimmune factors leading to chronic inflammation and fibrosis.

• Genetic predisposition.

• Capsaicin present in chillies causing mucosal irritation.

• Chronic irritation leads to increased fibroblast activity and collagen deposition.

SUSHRUTA REFERENCE
A condition similar to OSMF can be correlated with "Krukachchhu" under मुखरोग:

"वाक्स्वरघोषकण्ठोष्ठतालुजिह्वाप्रपाकिनः |
मुखरोगा महाघोरा जायन्ते दोषसंभवाः॥"
— Su. Su. 16/1

CLINICAL FEATURES

• Burning sensation in mouth, especially on eating spicy food.

• Progressive inability to open the mouth (trismus).

• Blanched, stiff oral mucosa with palpable fibrous bands.

• Loss of tongue mobility.

• Dryness of mouth.

• Difficulty in speech and swallowing.

• Hyperpigmented and atrophic oral mucosa.

TREATMENT
AYURVEDIC APPROACH:

• Snehana with medicated ghritas (e.g., Yashtimadhu ghrita).

• Kavala and Gandusha with til taila, yashtimadhu kwatha.

• Nasya with medicated oils like Anu taila.

• Lepa with soothing herbs like Yashtimadhu, Haridra, Daruharidra.

• Raktamokshana and Agnikarma in severe fibrotic bands.

• Rasayana therapy for tissue regeneration.

"यष्टिमधुकतैलैश्च गण्डूषं लवणाम्बुना |
गण्डोषं कृच्छ्रवक्त्रं च मुखपाकं च नाशयेत्॥"
— A.H. Su. 22/23

MODERN MANAGEMENT

• Cessation of areca nut and tobacco use.

• Intralesional steroid injections (e.g., hydrocortisone, triamcinolone).

• Hyaluronidase and interferon injections.

• Surgical release of fibrous bands in severe cases.

• Physiotherapy for improving mouth opening.

• Nutritional support with multivitamins and antioxidants.

TUMOURS OF THE ORAL CAVITY

PLEOMORPHIC ADENOMA

ETIOLOGY

• Arises from minor salivary glands (commonly palate).

• Unknown exact cause; possibly linked to radiation exposure or genetic mutations.

• More common in middle-aged adults.

CLINICAL FEATURES

• Painless, slow-growing firm mass, usually on the hard palate.

• Non-ulcerated, mobile, rubbery consistency.

• No associated lymphadenopathy in benign cases.

• Long-standing tumors can undergo malignant transformation.

TREATMENT
AYURVEDIC MANAGEMENT

• Local use of Lekhana Lepa with Daruharidra, Haridra, Kustha.

• Agnikarma in small accessible masses.

• Internal use of Kanchanar Guggulu, Triphala Guggulu.

MODERN MANAGEMENT

• Complete surgical excision with surrounding margin.

• Preservation of adjacent structures if possible.

• Histopathological evaluation to rule out carcinoma ex-pleomorphic adenoma.

MALIGNANCIES OF THE TONGUE

ETIOLOGY

• Smoking, tobacco chewing, alcohol consumption.

• HPV infection (especially HPV-16).

• Chronic irritation from sharp teeth or dentures.

• Iron deficiency (Plummer-Vinson syndrome).

CLINICAL FEATURES

• Non-healing ulcer or proliferative lesion on lateral border of tongue.

• Pain, especially radiating to ear.

• Difficulty in speech, mastication, swallowing.

• Enlargement of cervical lymph nodes.

• Indurated margins, bleeding on touch.

TREATMENT
AYURVEDIC VIEW

• Similar to Arbuda or Dushta Vrana.

• Use of Tikta-Kashaya dravyas, Lekhana karma, and Raktamokshana.

• Rasayana therapy post-shodhana.

"अर्बुदं तु महागौरवं मांसपेशिषु वर्तते |
स्थूलं चिरव्यापि च समुलं मांसनिचये॥"
— Su. Ni. 11/12

MODERN MANAGEMENT

• Wide local excision or partial glossectomy depending on tumor size.

• Neck dissection for nodal metastasis.

• Postoperative radiotherapy or chemoradiation in advanced stages.

• Regular follow-up and rehabilitation.

MALIGNANCIES OF THE PALATE

ETIOLOGY

• Arise from minor salivary glands or squamous epithelium.

• Common in smokers and alcoholics.

• HPV infection can also be associated.

CLINICAL FEATURES

• Ulcer or mass on hard or soft palate.

• Pain, especially during eating.

• Nasal regurgitation if soft palate involved.

• Ulceration and foul-smelling discharge.

TREATMENT
AYURVEDIC MANAGEMENT

• Similar to Mukhagata Dushta Vrana and Arbuda.

• Kaval, Gandusha, Pratisarana with healing dravyas.

• Raktashodhana and Rasayana therapy.

MODERN MANAGEMENT

• Surgical excision with reconstruction.

• Radiotherapy in cases of malignant transformation.

• Chemotherapy for advanced or metastatic lesions.

MALIGNANCIES OF THE ORAL MUCOSA

ETIOLOGY

• Tobacco (smoking and smokeless), alcohol.

• HPV infection.

• Chronic trauma from ill-fitting dentures.

• Poor oral hygiene.

CLINICAL FEATURES

• Non-healing ulcer, proliferative or ulcerative growth on buccal mucosa.

• Pain, bleeding, trismus in advanced stages.

• Cervical lymphadenopathy.

• Halitosis and weight loss.

TREATMENT
AYURVEDIC MANAGEMENT

• Shodhana chikitsa (Virechana, Raktamokshana).

• Lepa and Pratisarana with Darvi, Haridra, Yashtimadhu.

• Rasayana therapy post local management.

MODERN MANAGEMENT

• Surgical resection depending on TNM staging.

• Neck dissection for nodal spread.

• Radiotherapy or chemotherapy as adjuvant treatment.

• Nutritional rehabilitation and speech therapy.