IP International Journal of Maxillofacial Imaging 2021;7(2):67–73 Content available at: https://www.ipinnovative.com/open-access-journals IP International Journal of Maxillofacial Imaging Journal homepage: https://www.ijmi.in/ Original Research Article Varied presentations of a mineralized styloid process in oral submucous fibrosis patients visualized on digital panoramic radiographs Shital Patel 1, *, Deval Mehta 2 , Taher Rupawala 1 , Nimesh Patel 3 , Kruna Bhimani 1 , Zenish Bhatti 1 1 Dept. of Oral and Maxillofacial Surgery, Ahmedabad Municipal Corporation Dental College and Hospital, Gujarat University, Ahmedabad, Gujarat, India 2 Dept. of Oral and Maxillofacial Surgery, College of Dental Science and Research Centre, Gujarat University, Ahmedabad, Gujarat, India 3 Dept. of Oral Medicine and Radiology, Goenka Research Institute of Dental Sciences, Gandhinagar, Gujarat, India ARTICLE INFO Article history: Received 06-04-2021 Accepted 21-04-2021 Available online 14-07-2021 Keywords: Orthopantomogram (OPG) Oral submucous fibrosis (OSMF) Elongated styloid process (ESP) Trismus Pain Calcification pattern ABSTRACT Background: 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. Aims: 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. Settings and Design: 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. Materials and Methods: 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. Results: 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. Conclusion: 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. © This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. 1. Introduction With 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 * Corresponding author. E-mail address: drshital18.dp@gmail.com (S. Patel). fourth most consumed addictive substance in the world. 1 Owing to the continuous contact , about 15 minutes to 1 hour, 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, arecaidine and tannin present in https://doi.org/10.18231/j.ijmi.2021.013 2581-382X/© 2021 Innovative Publication, All rights reserved. 67