{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,5]],"date-time":"2026-09-05T17:42:36Z","timestamp":1788630156653,"version":"build-2803163510"},"reference-count":68,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2016,11,4]],"date-time":"2016-11-04T00:00:00Z","timestamp":1478217600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Oral Pathology Medicine"],"published-print":{"date-parts":[[2017,7]]},"abstract":"<jats:p>\n                    Limited mouth opening (\n                    <jats:styled-content style=\"fixed-case\">LMO<\/jats:styled-content>\n                    ) in oral submucous fibrosis (\n                    <jats:styled-content style=\"fixed-case\">OSF<\/jats:styled-content>\n                    ) has been attributed to both the submucosal and muscle fibrosis (\n                    <jats:styled-content style=\"fixed-case\">MF<\/jats:styled-content>\n                    ). While reflectory trismus was proposed before as an auxiliary mechanism by another group, the stretch\u2010mediated muscle damage (\n                    <jats:styled-content style=\"fixed-case\">MSD<\/jats:styled-content>\n                    ), histopathological changes in blood vessels (such as endothelial dysfunction, endothelial hypertrophy, and endarteritis obliterans), and upregulated anaerobic isoforms of lactate dehydrogenase (\n                    <jats:styled-content style=\"fixed-case\">LDH<\/jats:styled-content>\n                    ) have been proposed by us as complementary events leading to\n                    <jats:styled-content style=\"fixed-case\">MF<\/jats:styled-content>\n                    . Additionally, the amount of hypoxia\u2010mediated upregulation of anaerobic isoforms of\n                    <jats:styled-content style=\"fixed-case\">LDH<\/jats:styled-content>\n                    determines the extent of\n                    <jats:styled-content style=\"fixed-case\">MF<\/jats:styled-content>\n                    . Radiotherapy (\n                    <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content>\n                    )\u2010mediated release of reactive oxygen species causes vascular damage thereby worsening hypoxia. While the alteration in\n                    <jats:styled-content style=\"fixed-case\">LDH<\/jats:styled-content>\n                    levels secondary to hypoxia enhances fibrosis,\n                    <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content>\n                    worsens it. Oral squamous cell carcinoma occurring in the background of\n                    <jats:styled-content style=\"fixed-case\">OSF<\/jats:styled-content>\n                    is an absolute contraindication for\n                    <jats:styled-content style=\"fixed-case\">RT<\/jats:styled-content>\n                    as it augurs unfavorable prognosis. An algorithm to demonstrate this with evidence is clearly depicted. The role of\n                    <jats:styled-content style=\"fixed-case\">HIF<\/jats:styled-content>\n                    \u20101\u03b1 in the progression of\n                    <jats:styled-content style=\"fixed-case\">OSF<\/jats:styled-content>\n                    and its malignant transformation, and the consideration of hyperbaric oxygen therapy as a therapeutic remedy in\n                    <jats:styled-content style=\"fixed-case\">OSF<\/jats:styled-content>\n                    are underscored.\n                  <\/jats:p>","DOI":"10.1111\/jop.12513","type":"journal-article","created":{"date-parts":[[2016,10,15]],"date-time":"2016-10-15T10:04:54Z","timestamp":1476525894000},"page":"424-430","source":"Crossref","is-referenced-by-count":38,"title":["Limited mouth opening in oral submucous fibrosis: reasons, ramifications, and 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