Treatment of oral submucous fibrosis by collagenase: effects on oral opening and eating function.
OBJECTIVE
Patients with oral submucous fibrosis (OSF) suffer from the limitation of the oral opening. The aim of this study was to develop a simple and rapid method to improve the opening of the oral cavity and determine its effect on the incidence of developing oral carcinoma.


METHODS
We first induced an OSF-like lesion in rabbits which histopathologically resembles OSF in betel nut chewers and evaluated the effects of exogenous collagenase on these lesions. We then applied the collagenase treatment regimen to patients with OSF.


RESULTS
Endogenous collagenase activities in normal oral mucosa of patients exhibited 3- to 5-fold higher levels than that of OSF tissues. The collagenase treatment not only resulted in a significant improvement of oral opening, but patients also experienced a striking reduction in hypersensitivity to spices, sour, cold, and heat which helped restore eating function. Sub-mucosal fibrous proliferation, persistently good vascularization, and a mild increase in thickness of the sub-mucosal fibrous tissues were noticed 10 months after collagenase treatment. Within the 2-year follow-up period none of the treated patients developed an oral squamous cell carcinoma.


CONCLUSIONS
A reduced content of functional collagenase observed in OSF mucosa of patients might be one mechanism responsible for collagen accumulation. Intervention of OSF by collagenase treatment at the early stage may reduce the incidence of developing oral carcinoma.
Lin
H-J
HJ
Department of Pathology, Kaohsiung Medical University, Kaohsiung, Taiwan.
Lin
J-C
JC
D000328:Adult; D000818:Animals; D002294:Carcinoma, Squamous Cell / Q000517:prevention & control; D003080:Cold Temperature / Q000009:adverse effects; D003094:Collagen / Q000032:analysis / Q000648:ultrastructure; D017364:Collagenases / Q000032:analysis / Q000627:therapeutic use*; D004195:Disease Models, Animal; D004435:Eating / Q000187:drug effects*; D004791:Enzyme Inhibitors / Q000627:therapeutic use; D005500:Follow-Up Studies; D006358:Hot Temperature / Q000009:adverse effects; D006801:Humans; D006967:Hypersensitivity / Q000517:prevention & control; D008297:Male; D009055:Mouth / Q000187:drug effects*; D009061:Mouth Mucosa / Q000098:blood supply / Q000201:enzymology / Q000473:pathology; D009062:Mouth Neoplasms / Q000517:prevention & control; D009914:Oral Submucous Fibrosis / Q000188:drug therapy* / Q000201:enzymology / Q000473:pathology; D008249:Protein-Lysine 6-Oxidase / Q000037:antagonists & inhibitors; D011817:Rabbits; D012039:Regional Blood Flow / Q000187:drug effects; D017365:Spices / Q000009:adverse effects; D014221:Triamcinolone / Q000031:analogs & derivatives / Q000627:therapeutic use
D004791:Enzyme Inhibitors; D014221:Triamcinolone; D003094:Collagen; C030262:triamcinolone diacetate; D008249:Protein-Lysine 6-Oxidase; D017364:Collagenases