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Does Changes in the Muscles Beneath the Submucosal Tissues Necessitate a Novel Strategy in the Medical Management of
1Department of Dentistry, All India Institute of Medical Sciences, Nagpur, India.
Abstract:
This study is envisioned to assess the structural changes the muscles undergo beneath the submucosal tissues and whether these changes necessitate a novel strategy from the existing conventional modality in the treatment of oral submucous fibrosis (OSMF) medically through a systematic literature survey. Literature search was performed electronically using Medline, EMBASE and CENTRAL databases to identify published literature until the end of April 2024 in dental, oral and maxillofacial surgery, plastic surgery and otolaryngology journals containing the terms "oral submucous fibrosis", "muscles of mastication", "muscles of facial expression", "histopathologic study", "ultrasonographic study", "CT", "MRI" in either their titles, abstracts, and keywords with only English being the preferred language. The data was extracted from the selected articles and prudently studied to gather and compile the data. Descriptive data from all the carefully chosen articles were selected and analysed. Seven studies met the inclusion criteria. It was observed that the masseter muscle was the first to be involved in the disease process of OSMF among the muscles of mastication and facial expression. It was observed that the anterior temporalis and orbicularis oris muscles remained unaffected. However, the buccinator muscle which lies in utmost vicinity is not evaluated in the included studies. The degree of muscle degeneration and the degree of disease progression were directly related to the duration of the habit. The restricted mouth opening noticed in OSMF is not only governed by the subepithelial fibrosis but also on the extent of muscle degeneration. The changes the surrounding muscles undergo could be a manifestation of the disease, atrophy as a sequalae to the limited functional activity of the muscles which is brought about by fibrosis or it could be an essential part of the disease itself.
Insights
Oral submucous fibrosis (OSMF) causes muscle degeneration, primarily affecting the masseter muscle. This muscle involvement, linked to habit duration, contributes significantly to restricted mouth opening in OSMF patients.
Area of Science:
- Oral pathology and maxillofacial surgery
- Muscle physiology and disease mechanisms
- Systematic review methodology
Background:
- Oral submucous fibrosis (OSMF) is a chronic, potentially malignant disorder characterized by juxta-epithelial inflammation, fibroblast hyperplasia, and collagen deposition.
- Submucosal fibrosis leads to progressive restriction of jaw movements, significantly impacting patients' quality of life.
- The role of muscle structural changes in OSMF pathogenesis and treatment is not fully elucidated.
Purpose of the Study:
- To systematically review and assess the structural changes in masticatory and facial muscles in oral submucous fibrosis.
- To determine if these muscular alterations necessitate novel treatment strategies beyond conventional modalities.
Main Methods:
- A systematic literature search was conducted across Medline, EMBASE, and CENTRAL databases up to April 2024.
- Included studies focused on oral submucous fibrosis and muscular changes, utilizing histopathologic, ultrasonographic, CT, or MRI data.
- Seven studies met the inclusion criteria for data extraction and analysis.
Main Results:
- The masseter muscle was identified as the most frequently affected masticatory muscle in OSMF.
- Muscle degeneration and disease progression showed a direct correlation with the duration of the causative habit.
- Restricted mouth opening in OSMF is influenced by both subepithelial fibrosis and the extent of muscle degeneration.
Conclusions:
- Muscle degeneration is a significant component of oral submucous fibrosis, contributing to functional impairment.
- The findings suggest that therapeutic strategies for OSMF may need to address muscular changes alongside fibrotic tissue.
- Further research is needed to evaluate the buccinator muscle's involvement and to develop targeted muscle-based treatments.
