![Copyright © Mohit Srivastava
Mohit Srivastava*, Veenita Singh, Rajesh Roshan, Faisal Taufiq
Meerut University, India
*Corresponding author: Mohit Srivastava, Meerut University, House No. 1153, Mohan Meekins Society, Sector 5, Vasundhara Ghaziabad, India,
Tel: 01204319096; Email:
Submission: March 14, 2018; Published: April 20, 2018
Premalignant Lesions of Oral Cavity - A
Clinicopathological Study
Introduction
A precancerous lesion is a morphologically altered tissue in
which oral cancer is more likely to occur than in its apparently
normal counterpart. It poses a threat to convert to frank malignancy
if not treated. However, in a World Health Organization Workshop,
held in 2005, it was decided to use the term “potentially malignant
disorders. The same workshop identified following condition
as potentially malignant disorders: Leukoplakia, Erythroplakia,
Palatal lesion of reverse cigar smoking, oral lichen planus, Oral
submucous fibrosis, And Discoid Lupus Erythematosus. However
out of these WHO has given special stress on leukoplakia which
has many a times been attributed to the habits an addictions of the
people and has also been reflected in the findings of this paper.
Material and Methods
The study period duration was one year starting from 1st
February 2014 to 31st
January 2015. A total of 360 patients who
were suspected of premalignant disorders were subjected to either
incisional or excisional biopsy and out of them 87 were found to
be PMDs as proved by biopsy report. Out of them 53(60.9%) were
male and 34 (39.08%) females. In all these cases detailed history
which included addiction to various kinds of known carcinogens
was taken and routine blood examinations, Urine examination,
VDRL, x-ray were done.
Observation
Of all the 87 patients that were detected belong to the age group
28 years to 78 years and mostly belong to middle and lower socio-
economical class as per kuppuswamy classification. Most of them
were asymptomatic with only few having some symptoms. Out of
216 male patients 53(24.53%) and out of 144 females 34(23.6%)
were found to be affected [1-4].
Age wise distribution (in years)
Among males the number of patients found were 6(2.77%),
13(6.01%), 16(7.4%), 12(5.55%), 6(2.77%) and in females
2(1.3%), 5(3.4%), 9(6.25%), 11(7.6%), 7(4.86%) in the age groups
28-38, 39-48, 49-58, 59-68, and 69-78 years respectively.
Types of lessons found
Leukoplakia was most common of all lesions 76(87.35%),
erythroplakia 1(1.155%), OSMF 6(6.89%), and lichen planus
4(4.59%).
Sites of involvement: Buccal mucosa was found to be involved
in 60(68.9%), mandibular mucosa 38(43.6%), maxillary mucosa
19(21.8%), retromolartrigone 9(10.3%), floor of mouth 5(5.7%),
tongue 3(3.4%), palate 1(1.1%), lip 13(14.9%) and bilateral
involvement was found in 58(66.6%) of the cases.
PMDs and oral cavity hygiene: 78(89.65%) patients were
found to have unhealthy oral cavity, while 6(6.89%) were found
to be having healthy oral hygiene and 4(4.59%) had edentulous
condition.
Symptomatology of the patients: White mucosal patch
was found in 85(97.7%), burning sensation in 8(9.19%), pain in
5(5.7%), restricted movement in 6(6.8%) and red patch in 1(1.1%)
of the patients.
Addictions and PMDs: Among males 50(94.33%), 45(84.9%),
40(75.47%), 43(81.13%) and in females 31(91.17%), 22(64.7%),
2(5.88%), 10(29.41%) were betel nut chewers, tobacco chewers,
alcoholics and smokers respectively.
PMD’s and socioeconomic status of the patients: In our
study 56(64.36%) of the patients were from lower social class,
29(33.33%) from middle class and 2(2.29%) from upper class as
per modified kuppuswamy classification (Figure 1).
Research Article
1/3Copyright © All rights are reserved by Mohit Srivastava.
Volume 1 - Issue 3
Abstract
We conducted a study on a total of 360 patients to find out the incidence of premalignant disorders in the oral cavity who attended the ENT opd of
Saraswathi Institute of Medical Sciences, Hapur. The study design was cross sectional in nature. Out of all the 360 patients who were suspected to have
premalignant disorders of oral cavity were subjected to biopsy and 87 of them were found to be premalignant. Incidence was found to be 24.53% in
males and 23.6% in females. Buccal mucosa was most common site of involvement.
Experiments in
Rhinology & OtolaryngologyC CRIMSON PUBLISHERS
Wings to the Research
ISSN 2637-7780](https://image.slidesharecdn.com/ero-181212082559/85/Crimson-Publishers-Premalignant-Lesions-of-Oral-Cavity-A-Clinicopathological-Study-1-320.jpg)
![Exp Rhinol Otolaryngol
2/3How to cite this article: Mohit S, Veenita S, Rajesh R, Faisal T. Premalignant Lesions of Oral Cavity - A Clinicopathological Study. Exp Rhinol Otolaryngol.
1(3). ERO.000515.2018. DOI: 10.31031/ERO.2018.01.000515
Volume 1 - Issue 3
Copyright © Mohit Srivastava
Figure 1: Age wise distribution (in years).
Discussion
The data showed the mean age (mean +/-2SD) as 53.4 +/-
12.76) with median to be as 53.5 years. Total number of patients
increased as the age progressed and maximum numbers of patients
were found in the age group 49- 58 years (25 or 28.73%) which is
slightly less than what was reported by Iype et al. (50-59 years) in
2001 but more than Saraswthi et al. 2006 which stated it as 40-61
years. However the number of patients started decreasing after 49-
58 years and the least were found in the age group 69-78 years [5,6].
Incidencewasmoreorlessthesameinmales(24.53%)ascompared
to females (23.6%). The incidence in males went on increasing till
age group 49 -58 years (11.11%) but in females it increased till age
group 59-68 years (7.6%). The incidence of leukoplakia was found
to be 21.11% which was higher than Bhonsle et al. [2] 18%, Crivelli
et al. 1990 20.5%, Petit JC et al. 1989 0.2-11.70% and Platkaj et al.
1979 9%. The incidence of lichen planus was 0.925% among the
males and 1.3% among the females while overall it was 1.1% which
islessthanthatfoundbyCharlesAWaldronetal.19751.5%.OSMF’s
incidence overall was 1.66% which is much higher than what was
found by Murty et al. 1990 0.02%. In our study most common site
of involvement was found to be buccal mucosa (68.9%) followed
by mandibular mucosa (43.6%) then maxillary mucosa (21.8%),
retromolartrigone (10.3%), floor of mouth (5.7%), tongue (3.4%),
palate (1.1%), lip (14.9%) while bilateral involvement was found
to be (66.6%). Our study found more or less the same data that
coincides with that of Shafer Waldron et al. 1975, Bhonsle et al. [7],
Pindborg et al. [2], Soames southan et al. 1984.
Around 85 patients (97.7%) presented with whitish mucosal
patch while 8 (9.19%) complained of burning sensation and 5
(5.7%) complained of pain, 6 (6.16%) had restricted mouth opening
and 1(1.1%) had a red patch which was similar to that of workers
like Pindbarg et al. [2], Seedat et al. 1988. Very high percentages
of patients were addicted to the betel nut chewing (94.13% for
males and 91.17% for females which was consistent with findings
of Seedat et al. 1980, Jian XC et al. 1989. Tobacco chewing among
males stood at 84.19% which was more than that found by Greer et
al. 1990. Alcohol intake was found in 75.47% which was in contrast
with findings of Toru Nagao et al. 2005 who did not found any
relation of premalignant lesions and alcohol intake. Female tobacco
chewers were 64.7% while only few 5.88% were alcoholics but
29.41% of them did smoke [7,8].
Oral hygiene was generally poor in most (89.65%) while
6.89% had healthy oral cavity and 4.59% were edentulous which
was similar to that stated by Mair et al. 1991 who attributed poor
orodental hygiene to self neglect as most patients were chronic
alcoholics. Socioeconomic status of the patients showed that most
of them belonged to lower socioeconomic strata 64.36% followed
by middle class (33.33%) and only few(4.59%) belonged to
upper class as was found by Kamel et al. 2013 who found most of
premalignant lesions in the lower socioeconomic group.
Conclusion
Incidence of premalignant disorders is very high in this part
of the country. Most of these disorders can easily be attributed to
betel nut chewing which is almost like a social tradition in this part
of the country. Tobacco chewing, quid, smoking and alcohol intake
all play important role in the development of these lesions. No
sexual predilection was found in the study. Most of these disorders
occurred in elderly persons.
References
1. Sanghvi LD, Notani PP (1989) Tobacco related cancers, Tobacco and
Health: The Indian Scene. Bombay Tata Memorial Center, pp. 9-15.
2. Pindborg JJ, Murthi PR, Bhonsle RB, Gupta PC (1987) Global aspects of
tobacco use and its implications for oral health. pp. 13-23.
3. Bentall WC (1908) Cancer in Travancore, South India- A summary of
1,700 cases. Br Med J 2: 1428-1431.
4. Orr IM (1933) Oral cancer in betel nut-chewers in Tranvancore: Its
aetiology, pathology and treatment. Lancet 2: 575-580.
5. Sanghvi LD, Rao KC, Khanolkar VR (1955) Smoking and chewing of
tobacco in relation to cancer of the upper alimentary tract. Br Med J
1(4922): 1111-1114.
6. Shanta V, Krishnamurthi S (1959) A study of aetiological factors in oral
squamous cell carcinoma. Br J Cancer 13(3): 381-388.](https://image.slidesharecdn.com/ero-181212082559/85/Crimson-Publishers-Premalignant-Lesions-of-Oral-Cavity-A-Clinicopathological-Study-2-320.jpg)
Crimson Publishers-Premalignant Lesions of Oral Cavity - A Clinicopathological Study
- 1. Copyright © Mohit Srivastava Mohit Srivastava*, Veenita Singh, Rajesh Roshan, Faisal Taufiq Meerut University, India *Corresponding author: Mohit Srivastava, Meerut University, House No. 1153, Mohan Meekins Society, Sector 5, Vasundhara Ghaziabad, India, Tel: 01204319096; Email: Submission: March 14, 2018; Published: April 20, 2018 Premalignant Lesions of Oral Cavity - A Clinicopathological Study Introduction A precancerous lesion is a morphologically altered tissue in which oral cancer is more likely to occur than in its apparently normal counterpart. It poses a threat to convert to frank malignancy if not treated. However, in a World Health Organization Workshop, held in 2005, it was decided to use the term “potentially malignant disorders. The same workshop identified following condition as potentially malignant disorders: Leukoplakia, Erythroplakia, Palatal lesion of reverse cigar smoking, oral lichen planus, Oral submucous fibrosis, And Discoid Lupus Erythematosus. However out of these WHO has given special stress on leukoplakia which has many a times been attributed to the habits an addictions of the people and has also been reflected in the findings of this paper. Material and Methods The study period duration was one year starting from 1st February 2014 to 31st January 2015. A total of 360 patients who were suspected of premalignant disorders were subjected to either incisional or excisional biopsy and out of them 87 were found to be PMDs as proved by biopsy report. Out of them 53(60.9%) were male and 34 (39.08%) females. In all these cases detailed history which included addiction to various kinds of known carcinogens was taken and routine blood examinations, Urine examination, VDRL, x-ray were done. Observation Of all the 87 patients that were detected belong to the age group 28 years to 78 years and mostly belong to middle and lower socio- economical class as per kuppuswamy classification. Most of them were asymptomatic with only few having some symptoms. Out of 216 male patients 53(24.53%) and out of 144 females 34(23.6%) were found to be affected [1-4]. Age wise distribution (in years) Among males the number of patients found were 6(2.77%), 13(6.01%), 16(7.4%), 12(5.55%), 6(2.77%) and in females 2(1.3%), 5(3.4%), 9(6.25%), 11(7.6%), 7(4.86%) in the age groups 28-38, 39-48, 49-58, 59-68, and 69-78 years respectively. Types of lessons found Leukoplakia was most common of all lesions 76(87.35%), erythroplakia 1(1.155%), OSMF 6(6.89%), and lichen planus 4(4.59%). Sites of involvement: Buccal mucosa was found to be involved in 60(68.9%), mandibular mucosa 38(43.6%), maxillary mucosa 19(21.8%), retromolartrigone 9(10.3%), floor of mouth 5(5.7%), tongue 3(3.4%), palate 1(1.1%), lip 13(14.9%) and bilateral involvement was found in 58(66.6%) of the cases. PMDs and oral cavity hygiene: 78(89.65%) patients were found to have unhealthy oral cavity, while 6(6.89%) were found to be having healthy oral hygiene and 4(4.59%) had edentulous condition. Symptomatology of the patients: White mucosal patch was found in 85(97.7%), burning sensation in 8(9.19%), pain in 5(5.7%), restricted movement in 6(6.8%) and red patch in 1(1.1%) of the patients. Addictions and PMDs: Among males 50(94.33%), 45(84.9%), 40(75.47%), 43(81.13%) and in females 31(91.17%), 22(64.7%), 2(5.88%), 10(29.41%) were betel nut chewers, tobacco chewers, alcoholics and smokers respectively. PMD’s and socioeconomic status of the patients: In our study 56(64.36%) of the patients were from lower social class, 29(33.33%) from middle class and 2(2.29%) from upper class as per modified kuppuswamy classification (Figure 1). Research Article 1/3Copyright © All rights are reserved by Mohit Srivastava. Volume 1 - Issue 3 Abstract We conducted a study on a total of 360 patients to find out the incidence of premalignant disorders in the oral cavity who attended the ENT opd of Saraswathi Institute of Medical Sciences, Hapur. The study design was cross sectional in nature. Out of all the 360 patients who were suspected to have premalignant disorders of oral cavity were subjected to biopsy and 87 of them were found to be premalignant. Incidence was found to be 24.53% in males and 23.6% in females. Buccal mucosa was most common site of involvement. Experiments in Rhinology & OtolaryngologyC CRIMSON PUBLISHERS Wings to the Research ISSN 2637-7780
- 2. Exp Rhinol Otolaryngol 2/3How to cite this article: Mohit S, Veenita S, Rajesh R, Faisal T. Premalignant Lesions of Oral Cavity - A Clinicopathological Study. Exp Rhinol Otolaryngol. 1(3). ERO.000515.2018. DOI: 10.31031/ERO.2018.01.000515 Volume 1 - Issue 3 Copyright © Mohit Srivastava Figure 1: Age wise distribution (in years). Discussion The data showed the mean age (mean +/-2SD) as 53.4 +/- 12.76) with median to be as 53.5 years. Total number of patients increased as the age progressed and maximum numbers of patients were found in the age group 49- 58 years (25 or 28.73%) which is slightly less than what was reported by Iype et al. (50-59 years) in 2001 but more than Saraswthi et al. 2006 which stated it as 40-61 years. However the number of patients started decreasing after 49- 58 years and the least were found in the age group 69-78 years [5,6]. Incidencewasmoreorlessthesameinmales(24.53%)ascompared to females (23.6%). The incidence in males went on increasing till age group 49 -58 years (11.11%) but in females it increased till age group 59-68 years (7.6%). The incidence of leukoplakia was found to be 21.11% which was higher than Bhonsle et al. [2] 18%, Crivelli et al. 1990 20.5%, Petit JC et al. 1989 0.2-11.70% and Platkaj et al. 1979 9%. The incidence of lichen planus was 0.925% among the males and 1.3% among the females while overall it was 1.1% which islessthanthatfoundbyCharlesAWaldronetal.19751.5%.OSMF’s incidence overall was 1.66% which is much higher than what was found by Murty et al. 1990 0.02%. In our study most common site of involvement was found to be buccal mucosa (68.9%) followed by mandibular mucosa (43.6%) then maxillary mucosa (21.8%), retromolartrigone (10.3%), floor of mouth (5.7%), tongue (3.4%), palate (1.1%), lip (14.9%) while bilateral involvement was found to be (66.6%). Our study found more or less the same data that coincides with that of Shafer Waldron et al. 1975, Bhonsle et al. [7], Pindborg et al. [2], Soames southan et al. 1984. Around 85 patients (97.7%) presented with whitish mucosal patch while 8 (9.19%) complained of burning sensation and 5 (5.7%) complained of pain, 6 (6.16%) had restricted mouth opening and 1(1.1%) had a red patch which was similar to that of workers like Pindbarg et al. [2], Seedat et al. 1988. Very high percentages of patients were addicted to the betel nut chewing (94.13% for males and 91.17% for females which was consistent with findings of Seedat et al. 1980, Jian XC et al. 1989. Tobacco chewing among males stood at 84.19% which was more than that found by Greer et al. 1990. Alcohol intake was found in 75.47% which was in contrast with findings of Toru Nagao et al. 2005 who did not found any relation of premalignant lesions and alcohol intake. Female tobacco chewers were 64.7% while only few 5.88% were alcoholics but 29.41% of them did smoke [7,8]. Oral hygiene was generally poor in most (89.65%) while 6.89% had healthy oral cavity and 4.59% were edentulous which was similar to that stated by Mair et al. 1991 who attributed poor orodental hygiene to self neglect as most patients were chronic alcoholics. Socioeconomic status of the patients showed that most of them belonged to lower socioeconomic strata 64.36% followed by middle class (33.33%) and only few(4.59%) belonged to upper class as was found by Kamel et al. 2013 who found most of premalignant lesions in the lower socioeconomic group. Conclusion Incidence of premalignant disorders is very high in this part of the country. Most of these disorders can easily be attributed to betel nut chewing which is almost like a social tradition in this part of the country. Tobacco chewing, quid, smoking and alcohol intake all play important role in the development of these lesions. No sexual predilection was found in the study. Most of these disorders occurred in elderly persons. References 1. Sanghvi LD, Notani PP (1989) Tobacco related cancers, Tobacco and Health: The Indian Scene. Bombay Tata Memorial Center, pp. 9-15. 2. Pindborg JJ, Murthi PR, Bhonsle RB, Gupta PC (1987) Global aspects of tobacco use and its implications for oral health. pp. 13-23. 3. Bentall WC (1908) Cancer in Travancore, South India- A summary of 1,700 cases. Br Med J 2: 1428-1431. 4. Orr IM (1933) Oral cancer in betel nut-chewers in Tranvancore: Its aetiology, pathology and treatment. Lancet 2: 575-580. 5. Sanghvi LD, Rao KC, Khanolkar VR (1955) Smoking and chewing of tobacco in relation to cancer of the upper alimentary tract. Br Med J 1(4922): 1111-1114. 6. Shanta V, Krishnamurthi S (1959) A study of aetiological factors in oral squamous cell carcinoma. Br J Cancer 13(3): 381-388.
- 3. 3/3How to cite this article: Mohit S, Veenita S, Rajesh R, Faisal T. Premalignant Lesions of Oral Cavity - A Clinicopathological Study. Exp Rhinol Otolaryngol. 1(3). ERO.000515.2018. DOI: 10.31031/ERO.2018.01.000515 Exp Rhinol Otolaryngol Volume 1 - Issue 3 Copyright © Mohit Srivastava For possible submissions Click Here Submit Article Creative Commons Attribution 4.0 International License Experiments in Rhinology & Otolaryngology Benefits of Publishing with us • High-level peer review and editorial services • Freely accessible online immediately upon publication • Authors retain the copyright to their work • Licensing it under a Creative Commons license • Visibility through different online platforms 7. Bhonsle RB, Murti PR, Daftary DK, Mehta FS (1979) An oral lesion in tobacco-lime users in Maharashtra, India. J Oral Pathol 8(1): 47-52. 8. Daftray DK, Bhonsle RB, Murti RB, Pindborg JJ, Mehta FS (1980) An oral lichen planus-like lesion in Indian betel-tobacco chewers. Scand J Dent Res 88: 244-249.