ABSTRACT
Background:
To assess the role of physiotherapy in human papillomavirus (HPV) proven cases of oral submucous fibrosis (OSMF).
Materials and Methods:
Overall, 100 patients got recruited. Only histopathologic confirmed cases of OSMF were enrolled. Purified DNA of tissue blocks was quantified by spectrophotometry. Prevalence of HPV was evaluated. The participants got randomized into 2 cohorts: HPV positive cases and HPV negative cases. Physiotherapy was done and outcome was done and outcome was assessed and compared. Assessment of results was done by SPSS software followed by statistical evaluation.
Results:
HPV was seen in 80% of the patients. Mean mouth opening pretreatment and postphysiotherapy among patients with HPV positive status was 26.31 mm and 30.12 mm, respectively. Mean mouth opening pretreatment and postphysiotherapy among patients with HPV negative status was 25.11 mm and 29.74 mm, respectively. Nonsignificant results were obtained while comparing the outcome of physiotherapy among HPV positive and negative groups.
Conclusion:
Outcome of physiotherapy among OSMF patients is independent of HPV status.
KEYWORDS: HPV, oral submucous fibrosis, physiotherapy
INTRODUCTION
The sixth most prevalent form of cancer, oral cancer, is a serious issue for global health.[1] Pre-existing oral lesions known as potentially malignant diseases of the oral mucosa frequently precede more than 90% of such malignancies that reflect squamous cell carcinoma in the oral cavity. The etiopathogenesis of oral Squamous cell carcinoma (SCC) is multiphasic and complex. It is the most common kind of neoplasm in India and other Southeast Asian countries, responsible for up to 50% of all cancerous tumors.[2,3] A disease known as oral submucous fibrosis (OSMF) causes the oral mucosa to become stiff and also is characterized by epithelial immune cell infiltration, followed by a fibro-elastic alteration in the lamina propria and submucosa.[4,5] Expression of the viral E6 and E7 oncoproteins that result in cell cycle dysregulation by inactivating p53 and pRb, accordingly, is what drives HPV-associated carcinogenesis. By ubiquitin-mediated proteolysis, the E6 protein causes p53 to be degraded, significantly decreasing p53 function.[6-8] The typical role of p53 is to initiate apoptosis or to hold cells in the G1 phase, which enables host DNA to be repaired. The presence of HPV seems to have a significant impact on patient characteristics and clinical implications.[9] To determine the incidence of HPV in OSMF and the impact of physiotherapy on the intensity of the condition, this research was carried out.
MATERIALS AND METHODS
Overall, 100 patients got recruited. Only histopathologic confirmed cases of OSMF were enrolled. Biopsy specimens were obtained and were sent for assessment of HPV. DNA extraction was done from paraffin-embedded tissue blocks. Purified DNA was quantified by spectrophotometry. Prevalence of HPV was evaluated. The participants got randomized into 2 cohorts: HPV positive cases and HPV negative cases. Physiotherapy was done and outcome was done and outcome was assessed and compared. The exercises included in this study were tongue blade exercise, china ball exercise, blowing the mouth, and tongue protrusion exercises. Assessment of results was done by SPSS software followed by statistical evaluation.
RESULTS
HPV was seen in 80% of the patients. Mean mouth opening pretreatment and postphysiotherapy among patients with HPV positive status was 26.31 mm and 30.12 mm, respectively. Mean mouth opening pretreatment and postphysiotherapy among patients with HPV negative status was 25.11 mm and 29.74 mm, respectively. Nonsignificant results were obtained while comparing the outcome of physiotherapy among HPV positive and negative group [Tables 1 and 2].
Table 1.
Prevalence of HPV
| HPV | Number | Percentage |
|---|---|---|
| Present | 80 | 80 |
| Absent | 20 | 20 |
| Total | 100 | 100 |
Table 2.
Effect of physiotherapy on mean mouth opening
| Time interval | HPV positive | HPV negative | P |
|---|---|---|---|
| Baseline (mm) | 26.31 | 25.11 | 0.1158 |
| Postphysiotherapy | 30.12 | 29.74 | 0.3257 |
| P | 0.001 (Significant) | 0.001 (Significant) | - |
DISCUSSION
The chronic condition OSMF, which possesses a 7.6% malignant transition rate, has been linked to the Indian subcontinent over the past 17 years. The certain causal component is the areca nut. Nevertheless, other elements, such as viruses, particularly HPV, may potentially contribute to the beginning or progression of cancer in these lesions. The possible involvement of HPV in possibly cancerous oral lesions is currently little understood. To determine the incidence of HPV in OSMF and the impact of physiotherapy on the seriousness of the condition, this research was carried out.[8-10]
In the present study, HPV was seen in 80% of the patients. Mean mouth opening pretreatment and postphysiotherapy among patients with HPV positive status was 26.31 mm and 30.12 mm, respectively. Mean mouth opening pretreatment and postphysiotherapy among patients with HPV negative status was 25.11 mm and 29.74 mm, respectively. As per previous research by Jalouli J et al., 62 people with OSCC had DNA from HPV, HSV, and EBV found in 15, three, and 18, accordingly, of the 12 samples taken from individuals having OSMF. Sixty seven percent of the members of the OSMF cohort and 16% of the members of the OSCC cohort had HPV 16 and 18 DNA found in them. While there was no numerically noteworthy variation in the HSV and EBV DNA contents in the OSMF and OSCC categories, there was a variation in the existence of HPV DNA in the two cohorts.[11]
In the present study, nonsignificant results were obtained while comparing the outcome of physiotherapy among HPV positive and negative group. High-risk HPV-16 was discovered to be affirmative in 35% of OSCC instances in another previous investigation, where authors demonstrated a numerically substantial link between HPV 16 and OSCC. HPV 16 infection was most prevalent in verrucous cancer, accompanied by SCC with 40%. This connection, although, lacked statistical significance. None of the OSCC samples had HPV18 infection. We found that only 5% of PMD patients had HR-HPV 16 infection that was not noteworthy. While tobacco and alcohol use are blamed for OSCC, it has been shown that HPV types are present in a large portion of OSCC cases. In instances of OSCC, the high-risk HPV type 16 is frequently the most prevalent kind found.[12] A persistent condition called OSMF causes tissue fibrosis, precancerous lesions, and scarring. The buccal mucosa is where it commonly exists.[13]
As per previous authors, HPV-positive OSCCs typically exhibit a high level of differentiation. It is unclear if whether HPV causes epithelial cells to undergo alterations that cause them to differentiate into neoplastic cells capable of producing keratin or just because this particular virus has a preference for keratinized cells.[14,15]
CONCLUSION
Outcome of physiotherapy among OSMF patients is independent of HPV status.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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