Department Of Oral Pathology, ITS Dental College, Hospital and Research Center, Greater Noida, India.
Department of Oral Pathology, Manipal College of Dental Sciences, Manipal University, Manipal, India.
J Oral Pathol Med. 2017 Jul;46(6):424-430. doi: 10.1111/jop.12513. Epub 2016 Nov 4.
Limited mouth opening (LMO) in oral submucous fibrosis (OSF) has been attributed to both the submucosal and muscle fibrosis (MF). While reflectory trismus was proposed before as an auxiliary mechanism by another group, the stretch-mediated muscle damage (MSD), histopathological changes in blood vessels (such as endothelial dysfunction, endothelial hypertrophy, and endarteritis obliterans), and upregulated anaerobic isoforms of lactate dehydrogenase (LDH) have been proposed by us as complementary events leading to MF. Additionally, the amount of hypoxia-mediated upregulation of anaerobic isoforms of LDH determines the extent of MF. Radiotherapy (RT)-mediated release of reactive oxygen species causes vascular damage thereby worsening hypoxia. While the alteration in LDH levels secondary to hypoxia enhances fibrosis, RT worsens it. Oral squamous cell carcinoma occurring in the background of OSF is an absolute contraindication for RT as it augurs unfavorable prognosis. An algorithm to demonstrate this with evidence is clearly depicted. The role of HIF-1α in the progression of OSF and its malignant transformation, and the consideration of hyperbaric oxygen therapy as a therapeutic remedy in OSF are underscored.
口腔黏膜下纤维性变（OSF）中的张口受限（LMO）归因于黏膜下和肌肉纤维化（MF）。虽然反射性牙关紧闭之前被另一组提出作为辅助机制，但我们提出了由伸展介导的肌肉损伤（MSD）、血管的组织病理学变化（如内皮功能障碍、内皮细胞肥大和闭塞性动脉内膜炎）以及上调的无氧乳酸脱氢酶（LDH）同工型作为导致 MF 的补充事件。此外，缺氧介导的无氧 LDH 同工型上调的程度决定了 MF 的程度。放射治疗（RT）介导的活性氧释放会导致血管损伤，从而加重缺氧。虽然缺氧引起的 LDH 水平改变会增强纤维化，但 RT 会使其恶化。在 OSF 背景下发生的口腔鳞状细胞癌是 RT 的绝对禁忌证，因为它预示着预后不良。本文用证据清晰地展示了一个算法。强调了 HIF-1α 在 OSF 进展及其恶性转化中的作用，以及将高压氧治疗作为 OSF 的治疗方法的考虑。
