Oral submucous fibrosis (OSF) is an insidious chronic progressive precancerous condition of the oral cavity and oropharynx. Although it is reported in many parts of the world, including the UK,1
and many southeast Asian countries,3,4
it is mainly prevalent in the Indian subcontinent in all age groups and across all socioeconomic strata.3,4
A large proportion of these precancerous lesions convert to squamous cell carcinoma, the malignant transformation rate being in the order of 7.6%.5
The aetiology of OSF is ill understood, but chewing of the areca nut in isolation or in combination with betel leaf or other tobacco products6,7
has been implicated in the disease. Other factors such as ingestion of chillies, deficiencies of nutrients, trace elements, vitamins, hypersensitivity to various dietary constituents, genetic and immunologic predisposition have also been suggested to be involved in the progression of this disease.5,7–10
The basic change is a fibro-elastic transformation of the connective tissue in the lamina propria preceded by vesicle formation. In its later stages the oral mucous membrane becomes stiff and the patient suffers from trismus or difficulty in opening his or her mouth and a resultant difficulty in eating.11
No satisfactory treatment for OSF has been described, although a wide range of treatment modalities have been proposed. Treatment with steroids, enzymes, micronutrients and minerals, turmeric, IFN-γ and multiple surgical modalities have been tried.
The purpose of the present study is to monitor seven cases before and after administration of zinc acetate along with vitamin A supplement, after motivating the patients to stop chewing areca nut. Following treatment, the patients reported significant increased mouth opening and reduced burning sensation. Re-epithelialisation was clearly evident histologically. Quantitative image analysis noted a significant increase in epithelial thickness following treatment. This case report is intended to create awareness of the beneficial effect of zinc acetate and vitamin A in the treatment of this precancerous condition.