Limited mouth opening in oral submucous fibrosis: reasons, ramifications, and remedies
Areca nut when chewed alone or in combination with betel quid leads to physical and chemical injury of oral mucosa causing mucositis (Fig. 1). Radiation therapy (RT) in these patients besides intensifying mucositis worsens the existing mouth opening (MO) (Fig. 1). A progressive decrease in the MO even after the cessation of RT 1 and linear decrease in MO with an increase in radiation dose 1 substantiates its deleterious effects. A fact, which is often overlooked in oral submucous fibrosis (OSF), is the direct effect of mucositis on MO 5. A mechanistic link between the reflectory trismus leading to LMO and unabated inflammation causing muscle fibrosis (MF) in OSF, and the relevance of RT in patients with oral squamous cell carcinoma (OSCC) associated with OSF, is the premise for this review.