Submucous fibrosis (SF) is a diffuse fibrosing condition in the mouth and oropharynx that occurs in patients who have chewed betel nuts. Once established the disease tends to be progressive, especially if the habit is continued.


Presenting symptoms:

(1) pain, burning or other oral discomfort

(2) blanching of the cheek and soft palate

(3) palpable fibrous bands in the cheek, lips and palate


Late sequelae:

(1) diffuse fibrosis

(2) difficulty in opening the mouth, with trismus

(3) difficulty protruding the tongue

(4) difficulty in eating, swallowing and speaking


The patients can be monitored by measuring the distance between the edges of the upper and lower incisor teeth, which correlates with the limitation in mouth opening.


Histologic features of mucosal biopsies:

(1) epithelial atrophy

(2) hyperkeratosis and epithelial dysplasia

(3) dense fibrosis in the lamina propria with hypertrophic collagen bands

(4) variable chronic inflammation


NOTE: The histologic findings are somewhat reminiscent of lichen sclerosus et atrophicus.


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