Oral epithelial changes in thirty indians with oral cancer and submucous fibrosis

Abstract

Among one hundred patients with oral cancer in Trivandrum, South India, 40 suffered from oral submucous fibrosis, a chronic condition characterized by blanching and stiffness of the oral mucosa. Histologically, submucous fibrosis is associated with a marked atrophy of the oral epithelium. Oral biopsies were taken from 30 patients, either in areas remote from the cancer or in the vicinity of the cancer. Epithelial atypia was observed in 11.5% in areas remote from the cancer and in 71.4% in the vicinity of the cancer. Though the biopsies were taken from areas normally unkeratinized, the majority revealed keratinization in varying degrees. Clinically, leukoplakias were found in 46.7%. Since all patients chewed tobacco, it is most likely that the epithelial changes and the cancers are the results of this habit, primarily because the atrophic oral epithelium in submucous fibrosis is more vulnerable to action of carcinogens. The authors postulate that submucous fibrosis is due to a hypersensitivity to chilli, a theory supported by the occurrence of submucous fibrosis among chillieating populations in South East Asia.

Upper alimentary tract cancer in Natal Indians with special reference to the betel-chewing habit.

“…An association between poor oral hygiene, oral submucous fibrosis, leukoplakia 55 and oropharyngeal cancer has been noted by workers in Asia (Paymaster, 1956 and1962;Pindborg, 1965;Pindborg et al, 1967;Wahi et al, 1965). Oral submucous fibrosis, first described by Joshi in 1953, was considered to be caused by the betel chewing habit by some observers (Shear et al, 1966;Paymaster, 1962;Pindborg, 1965;Pindborg et al, 1967) but not by others (Tennekoon and Bartlett, 1969;Balendra, 1949;Khanolkar, 1944).…”

“…Oral submucous fibrosis, first described by Joshi in 1953, was considered to be caused by the betel chewing habit by some observers (Shear et al, 1966;Paymaster, 1962;Pindborg, 1965;Pindborg et al, 1967) but not by others (Tennekoon and Bartlett, 1969;Balendra, 1949;Khanolkar, 1944). All workers agree that oropharyngeal cancers are common in countries where betel-chewing is a habit.…”

“…It is unlikely that poor oral hygiene, deficient diets, and curry or chilli consumption, which have been suggested to be cancer-promoting by several workers (Paymaster, 1956;Pindborg et al, 1967;Wahi et al, 1965;Balendra, 1949) are relevant, because these elements are equally present between males and females in Natal, and yet the incidence of upper alimentary tract cancer is not. Muir and Kirk (1960), Orr (1933) and Davidson (1923) have given careful descriptions of the leaf, the nut and lime, as follows:…”

“…(Indian name: paan.) (b) The nut: The dried areca nut contains many alkaloids (arecoline, arecaine, guvacaine, arecolidine, guvacoline, iso-guvacine and choline) chief among which is arecoline, which has a muscarinic (cholinergic) effect (Pffeiffer et al, 1967) which is glandular secreting, gut-stimulating, vasodepressant, and has a direct cortical arousal effect. Muir and Kirk (1960) state that it is sialogogic and diaphoretic, and that very large amounts depress the central nervous system.…”

“Bilateral Coronoidotomy in Conjunction With Submucous Fibrous Bands Release As A Treatment Modality for Oral Submucous Fibrosis”

“…Simple release of fibrosis showed recurrence due to scarring. Thus, additional procedures, such as splitting the temporalis tendon, coronoidectomy and masseter muscle stripping 6,7 have also been described to enhance mouth opening.…”