A 9-year-old boy presented with a chief complaint of gradual reduction in mouth opening since the last 6 months (). History of present illness revealed decrease in mouth opening since 1 year with inability to eat and maintain proper oral hygiene. He also complained of burning sensation in the mouth since 1 year while consumption of spicy food and decreased salivation since 7–8 months.\nThe patient gave a history of tobacco and betel nut chewing, 20–25 times per day since 4 years and used to keep it in buccal vestibule on both sides for about 3–4 min before swallowing.\nClinical examination revealed a maximum interincisal distance of 11 mm. On intraoral examination, labial and buccal mucosa were blanched and inelastic, with vertical and circular fibrous bands palpable on both sides, including the lower lip, upper lip, () buccal mucosa and reteromolar region. Vestibular mucosa, palatal mucosa and floor of the mouth also showed blanching. Tongue had restricted movements.\nHistopathologically, H&E-stained section showed juxtaepithelial hyalinisation and collagen fibres were arranged in separate bundles with dense inflammatory infiltrate.
An 11-year-old boy presented with a chief complaint of difficulty in eating and restricted mouth opening () since 1 year. On asking leading questions, the patient gave a history of burning sensation over buccal mucosa while consuming spicy food since 1 year. The patient had a habit of tobacco and betel nut chewing 15–20 times per day since 5 years. He also had a habit of keeping the quid in the buccal vestibule.\nOn clinical examination, maximum interincisal distance was 13 mm. Intraoral examination revealed palpable fibrous bands over labial and buccal mucosa along with blanching of palate, soft palate and floor of mouth (). Tongue movements were restricted and the uvula was shrunken. Histopathological examination showed moderately hyalinised collagen in connective tissue stroma. Few areas show thickened collagen bundles. Inflammatory exudate chiefly consists of lymphocytes and plasma cells.