Morphometric analysis of connective tissue in oral submucous fibrosis using open-source software

Objectives: Oral submucous fibrosis (OSF) is a potentially malignant condition that affects the buccal mucosa, lips, retromolar areas, palate, and pharynx. OSF is predominant in Southeast Asian countries such as India, China, and Taiwan. It carries an increased risk of malignant transformation to oral squamous cell carcinoma. The stromal vasculature in OSF shows dilation of blood vessels in the initial stages and constriction of blood vessels in the advanced stages of OSF. Although these variations are present in various stages of OSF, it is also observed that the same microscopic fields of OSF also show both dilated and constricted blood vessels. The objective of this study was to assess the vasculature in the OSF and compare it with normal mucosa using computer-aided image analysis software (ImageJ) Materials and Methods: A retrospective cross-sectional study comprising 15 OSF and 10 normal buccal mucosal samples was conducted. Blood vessel morphology - mean vascular area (MVA) and mean lumen area (MLA), and the number of blood vessels in the connective tissue of OSF patients were quantified by ImageJ software and compared with those of normal tissue. Blood vessel morphology was measured by tracing the outline of the blood vessels using the software. Results: A significant increase in the number of blood vessels and a decrease in the mean vascular area and mean lumen area were observed in OSF compared to normal mucosa. Conclusion: The quantitative increase in the number of blood vessels suggests angiogenesis. The reduction in the size of the blood vessels in OSF might cause hypoxia, resulting in an increase in the number of blood vessels as a compensatory mechanism. Understanding the concept of fibrogenesis and its association with angiogenesis might develop newer treatment strategies for managing OSF.