← Case library
OMFS-0107OncologyintermediateBuccal mucosa

Progressive trismus in an areca nut chewer

31-year-old male

Draft — educational study aid, pending faculty review.

§Chief complaint

Unable to open the mouth wide and burning on spicy food for 2 years

§Medical & dental history

  • 01Chews betel quid with areca nut 8-10 times daily for 10 years
  • 02No systemic disease
  • 03Difficulty with routine dental treatment due to limited opening

§Clinical examination

  • 01Maximum interincisal opening 21 mm
  • 02Blanched, marble-white buccal mucosa with palpable vertical fibrous bands bilaterally
  • 03Loss of tongue papillae and restricted tongue protrusion
  • 04Uvula shrunken; no ulceration or induration

§ figuresFigures (1)

Fig. 1Generalized submucous fibrosis of oral cavity

“Oral submucous fibrosis” · Saivishnu.ponnapalli · CC BY-SA 4.0 · Wikimedia Commons

Verified open-access images only, reproduced for education under their stated licences · no AI-generated or illustrative artwork · Oral Submucous Fibrosis figures pending faculty review.

§Differential diagnosis

Oral submucous fibrosisPalpable fibrous bands, blanching, areca habit
SclerodermaSkin changes, Raynaud phenomenon, widened PDL
Post-radiation fibrosisHistory of radiotherapy
Extra-articular trismus from infectionAcute, painful, febrile

§Final diagnosis

Oral submucous fibrosis, clinical stage III

Palpable fibrous bands with mucosal blanching in a long-standing areca nut chewer, without skin involvement or radiation history, is diagnostic. Staging is by mouth opening and functional limitation.

§Investigations

  • 01Incisional biopsy — to grade fibrosis and exclude dysplasia or occult carcinoma
  • 02Haemoglobin and iron studies
  • 03Photographic and interincisal opening records

§Treatment plan

  • 01Absolute cessation of areca nut and tobacco
  • 02Intralesional corticosteroid and hyaluronidase injections
  • 03Supervised physiotherapy with mouth-opening exercises
  • 04Surgical band release with grafting if opening remains under 25 mm

§Surgical procedure

  • 01Bilateral fibrotic band release with coronoidectomy
  • 02Defect covered with buccal fat pad flaps
  • 03Aggressive physiotherapy from day 5

§Histopathology report

Atrophic epithelium with loss of rete ridges overlying dense hyalinised, hypovascular collagenous connective tissue with sparse chronic inflammatory cells. No epithelial dysplasia identified.

§Follow-up & outcome

  • 01Mouth opening 35 mm at 6 months with continued exercises
  • 02Lifelong surveillance — malignant transformation risk 7-13 percent

§Clinical pearls / learning points

  • 01OSMF is a potentially malignant disorder; surgery relieves trismus but does not remove cancer risk.
  • 02Relapse is almost guaranteed without habit cessation and sustained physiotherapy.
  • 03Trismus makes any future oral cancer harder to detect early — examine meticulously.

§References

  • Warnakulasuriya S et al. Oral Dis. 2021.
  • More CB et al. Classification systems for OSMF.

§Similar cases

OMFS-0106

Homogeneous white patch of the buccal mucosa

OMFS-0105

Non-healing ulcer of the lateral tongue in a smoker

OMFS-0108

Bilateral reticular white striae with erosive areas

41 cases in the library