Evaluation of Elongated Styloid Process in Patients with Oral Submucous Fibrosis Using Panoramic Radiographs

Int J Otorhinolaryngol Head Neck Surg

et al. 2020

<p class="abstract">Oral submucous fibrosis is a widespread, premalignant disorder causing severe difficulty in mastication and speech. With high rate of malignant conversion, it demands aggressive surgical therapy followed by mandatory long-term physiotherapy. An elongated styloid process, if present, could pose a strong hindrance to movement of mandible, leading to complete relapse of trismus in such cases. The purpose of this report is to elaborate on such co-existence in patients having oral submucous fibrosis using digital orthopantomogram. 3 patients suspected to have an elongated styloid process were referred to maxillofacial surgical unit and diagnosed with grade 4A oral submucous fibrosis. Digital orthopantomogram revealed elongated styloid process which was measured using the C. S. imaging software 7.0.3. Consequently, patients were operated by a team of maxillofacial surgeons and otolaryngologists to relieve trismus and tonsillo-styloidectomy respectively. The measured lengths of the styloid process on digital orthopantomogram were considered elongated, if exceeding the normal length of 30 mm. The measured lengths of the styloid process were found to be at 52.7 mm, 50.1 mm and 57 mm on the right side and 51 mm, 46.8 mm and 37 mm on left side respectively in our cases. These elongated styloid processes observed in all three cases of submucous fibrosis indicates that progressive fibrosis may exert significant influence on the ossification of styloid complex. Hence, a routine preoperative screening in all patients of oral submucous fibrosis is imminent to avoid postoperative failure, pain or discomfort to the patient owing to an elongated styloid process. </p>

Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Is elongated styloid process a potential forewarning for failure in oral submucous fibrosis management?

Patel¹,

Mehta²,

Int J Otorhinolaryngol Head Neck Surg

et al. 2020

“…25 This interrelation warrants further research, specifically in patients having chronic habit of chewing tobacco products as the only previous study on similar lines done by Shivakumar et al consisted of a too small sample size to provide any definite inference. 11 Moreover, it presented a harmonious result to the other studies pertaining to the general population wherein bilateral elongation was found to be more common than unilateral elongation.…”

Section: Discussionsupporting

confidence: 68%

Role of Orthopantomogram as an Invaluable Diagnostic Aid for Satisfactory Evaluation of Elongated Styloid Process: A Review of Literature

Patel¹,

Mehta²,

International Journal of Head and Neck Surgery

et al. 2021

cessation of habit but becomes gradually progressive adversely affecting the quality of life of the individual. 6 Over and above that, chewing betel quid containing tobacco is a prime risk factor for occurrence of oral carcinoma, which is reflected by the fact that a patient having OSMF is 19.1 times more likely to be diagnosed with oral malignancy than the normal counterpart. 1,7,8 Hence, it becomes pivotal to emphasize the significance of prevention to combat its potentially malignant nature and silent BackgroundWith approximately 600 million people around the world actively engaged in the daily consumption of betel nut in its various formations, it is not surprising that betel nut is the fourth most consumed drug in the world. 1 The chewing of betel quid is accomplished by inserting a mixture of areca nut, slaked lime, catechu, and other condiments wrapped in a betel leaf in the buccal vestibule for 15 minutes to 1 hour and repeated five to six times a day. Owing to the continuous contact of the mixture with oral mucosa, the alkaloids and flavonoids become a source of constant irritation leading to chronic inflammation as the habit becomes persistent. 2 In conjunction to this juxtaepithelial inflammatory reaction, arecaidine and tannin present in the betel nut mixture increase the cross-linking of the fibers and obstruct collagenase activity leading to fibrosis and accompanying trismus. [2][3][4] This insidious, chronic, scarring condition, seen predominantly across the South Asian population is labeled as oral submucous fibrosis (OSMF).Reportedly, trismus is the primary cause of clinical presentation in 37.2-90.8% of the patients, but other symptoms such as burning sensations, recurrent ulcerations, and excessive salivation are also manifested in 14.2-25.9% of the patients. 1,5 Also alarmingly, more than often the subjects are younger, have shorter history of usage of tobacco products, and the disease process does not reverse on

“…Such an interconnection has been previously conclusively stated in a single research paper which highlighted a positive rate of 31.4% of patients with OSMF exhibiting an ESP as opposed to 2-4% of the general population. 11 This coupled with our observations signals an absolute need to stringently screen each and every patient of OSMF using a simple OPG so as to obviate any postoperative complication in the form of hindrance to physiotherapy due to overlapping pain of an ESP.…”

Section: Discussionmentioning

confidence: 57%

“…The aim of this paper was to identify the presence and morphology of ESP specifically in patients having OSMF based on this hypothesis. 10,11…”

Section: Introductionmentioning

confidence: 99%

Varied presentations of a mineralized styloid process in oral submucous fibrosis patients visualized on digital panoramic radiographs

Patel¹,

Mehta²,

et al. 2021

IJMI

Oral Submucous Fibrosis (OSMF) is a widely prevalent, premalignant condition which adversely affects the quality of life of an individual and can warrant stringent surgical regimen for its treatment. An Elongated Styloid Process (ESP), if coexisting, can invariably impair the post-surgical mandatory physiotherapy necessary to maintain the mouth-opening achieved intraoperatively. To evaluate digital Orthopantomograms (OPGs) of patients having OSMF and to observe presentations of various combinations of calcification types and patterns of ESP in them. Patients with clinically diagnosed OSMF (Grade III and IV according to Khanna and Andrade 1995) were advised a digital OPG to measure and observe the ESP using the C.S. Imaging Software 7.0.3.The digitized OPGs were converted into KODAK large format prints and then ESP was measured starting from the point where it is visualized to leave the tympanic plate extending upto its tip and its myriad of combinations of calcification patterns were recorded by a single observer.The presence of unilateral and bilateral elongation along with the type and pattern of calcification was effectively noted using the C.S. Imaging Software 7.0.3. Visualization of various unique, varying patterns of ESP was noted. Sixteen such different radiological presentations were shown, captured through digital OPGs. An undetected ESP can prove to be detrimental for a patient who is recently treated for OSMF as it hinders efficient postoperative mouth opening exercises. This can easily be prevented by a simple maneuver of identifying the ESP on a digital OPG using computer aided software. The presence of assorted radiographic patterns in patients having OSMF indicate that extensive research should be directed to identify and categorize such patterns which do not conform to the past methods of classification. This study hints towards the existence of a scope to study the factors responsible for the occurrence of the varied combinations of calcification and thickness of the ESP and their clinical relevance.