Document Type : Original Research


1 Lecturer, Department of Oral Pathology & Microbiology, Tatyasaheb Kore Dental College & Research Centre, New paragon, Kolhapur, India

2 Professor, Department of Oral Pathology & Microbiology, KLE University, KLE VK Institute of Dental Sciences, Belgaum, India


Background and Objective: This study was aimed to evaluate the collagen fibers qualitatively and its correlation with microvascular density in various grades of oral submucous fibrosis (OSMF).  
Material and Methods: The present study comprised of total 40 cases of oral submucous fibrosis. Picrosirius red staining was done on all the specimens’ sections. They were analyzed for the colour and orientation of collagen fibers. Morphometric measurements were done using image analysis on immunohistochemical stained sections for Factor VIII-related antigen and analyzed for microvascular density.
Results: Picrosirius red polarizing microscopy results revealed that there was a shift in the colour of collagen fibers from greenish yellow to orange red and red colour as the severity of the oral submucous fibrosis increased. The collagen fibers showed mixed orientation in early oral submucous fibrosis and parallel orientation in advanced oral submucous fibrosis. There was a significant decrease in microvascular density from early to advanced oral submucous fibrosis.
Conclusion: The change in the colours and orientation of collagen fibers in early and advanced oral submucous fibrosis could be attributed to the fibre thickness, type of collagen, alignment and packing, cross-linking of the fibers and the section thickness. However, in advanced cases the vascularity is reduced which may predispose to epithelial atrophy and subsequent malignant changes.


Main Subjects

  1. J Rajendran R. Oral submucous fibrosis. JOMFP.2003;7 (1):1-4
  2. Angadi PV, Rao SS. Areca nut in pathogenesis of oral submucous fibrosis: revisited. Oral Maxillofac Surg. 2011;15:1–9.
  3. Rajendran R. Oral submucous fibrosis: etiology, pathogenesis, and future research. Bulletin of the World Health Organization. 1994;72(6):985.
  4. Rajalalitha P, Vali S. Molecular pathogenesis of oral submucous fibrosis–a collagen metabolic disorder. Journal of oral pathology & medicine. 2005 Jul;34(6):321-8.
  5. Rich L, Whittaker P. Collgen and picrosirius restaining: A polarised light assessment of fibrillar hue and spatial distribution. Braz j morphol sci. 2005; 22 (2): 97-104.
  6. Constantine VS, Mowry RW. Selective staining of human dermal collagen. The  use of picrosirius red F3BA with polarization microscopy. J Invest Dermatol.   1968; 50:419- 423.
  7. Sabarinath B, Sriram G, Saraswati TR, Sivapathasundharam B. Immunohistochemical evaluation of mast cells and vascular endothelial proliferation in oral submucous fibrosis. Indian J Dent Res 2011; 22:116-121.
  8. Johnstone S, Logan RM. The role of vascular endothelial growth factor (VEGF) in oral dysplasia and oral squamous cell carcinoma. Oral oncol 2006; 42:337-342.
  9. Wang D, Stockard CR, Harkins L, Lott P, Salih C, Yuan K, Buchsbaum D, Hashim A, Zayzafoon M, Hardy RW, Hameed O. Immunohistochemistry in the evaluation of neovascularization in tumor xenografts. Biotechnic & Histochemistry. 2008 Jan 1;83(3-4):179-89.
    PMID:18846440 PMCid:PMC2651088
  10. Sadler JE. Biochemistry and genetics of von Willebrand factor. Annu Rev Biochem. 1998;67:395-424.
  11. Babji DV, Kale AD, Hallikerimath SR, Kotrashetti VS. Histomorphometric study to compare histological changes between oral squamous cell carcinoma and apparently normal adjacent oral mucosa. Indian J Otolaryngol Head Neck Surg. 2015;67(Suppl 1):21-8.
    PMID:25621249 PMCid:PMC4298603
  12. Pindborg JJ, Sirsat SM. Oral submucous fibrosis. Oral Surgery, Oral Medicine, Oral Pathology. 1966 Dec 1;22(6):764-79.
  13. Szendroi M, Vajta G, Schaff Z, Kovacs L, Lapis K. Polarization colors of collagen fibers: a sign of collagen production activity in fibrotic processes. Acta morologica Hungarica. 1984; 32(1); 47-55.
  14. Desai RS, Mamatha GS, Khatri MJ, Shetty SJ. Immunohistochemical expression of CD34 for characterisation and quantification of mucosal vasculature and its probable role in malignant transformation of atrophic epithelium in oral submucous fibrosis. Oral oncology. 2010; 46: 553-558.
  15. Ceena DE, Bastain TS, Ashok L, Annigeri RG. Comparative study of clinicofunctional staging of oral submucous fibrosis with qualitative analysis of collagen fibers under polarising microscopy. Indian J Dent Res 2009; 20:271-76.
  16. Dayan D, Hiss Y, Hirshberg A, Bubis JJ, Wolman M. Are the polarization colors of picrosirius red-stained collagen determined only by the diameter of the fibers? Histochemistry 1989; 93:27–9.
  17. Smitha B, Donoghue M. Clinical and histopathological evaluation of collagen fiber orientation in patients with oral submucous fibrosis. J Oral Maxillofac Pathol. 2011;15(2):154-60.
    PMID:22529573 PMCid:PMC3329688
  18. Parveen S, Ahemad AS, Tanveer S. A Study on Orientation of Collagen Fibres in Oral Submucous Fibrosis. International Journal of Scientific and Research Publications . 2013; 3:1-4.
  19. Sudarshan R, Vijayabala GS, Dinesh Raj KS. Diagnostic approaches for oral submucous fibrosis. UJP.2013; 2(2):37-41.
  20. Debnath S, Mitra B, Paul B, Saha TN, Maity A. Morphometric analysis of oral submucous fibrosis and its correlation with histological staging and clinical severity of trismus. Egyptian Journal of Ear, Nose, Throat and Allied Sciences. 2013:1-4.
  21. Singh M, Chaudhary AK, Pandya S, Debnath S, Singh M, Singh PA, Melhotra R. Morphometric Analysis in Potentially Malignant Head and Neck Lesions: Oral Submucous Fibrosis. Asian Pac J Cancer. 2010; 11(1): 257-60.
  22. Murgod VV, Kale AD, Angadi PV, Hallikerimath S. Morphometric analysis of the mucosal vasculature in oral submucous fibrosis and its comparison with oral squamous cell carcinoma. Journal of oral science. 2014; 56 (2):173-178.