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

Abstract

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.