International Journal of Head and Neck Surgery

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VOLUME 12 , ISSUE 3 ( July-September, 2021 ) > List of Articles


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

Shital Patel, Deval Mehta, Taher Rupawala, Naiya Shah, Zenish Bhatti, Kruna Bhimani

Keywords : Elongated styloid process, Oral submucous fibrosis, Orthopantomogram, Pain, Trismus

Citation Information : Patel S, Mehta D, Rupawala T, Shah N, Bhatti Z, Bhimani K. Role of Orthopantomogram as an Invaluable Diagnostic Aid for Satisfactory Evaluation of Elongated Styloid Process: A Review of Literature. Int J Head Neck Surg 2021; 12 (3):121-124.

DOI: 10.5005/jp-journals-10001-1442

License: CC BY-NC 4.0

Published Online: 17-12-2021

Copyright Statement:  Copyright © 2021; The Author(s).


Aim and objective: To scrutinize and conduct a review of the scientific literature describing the visualization of elongated styloid process (ESP) using an orthopantomogram in general population as well as in patients having oral submucous fibrosis (OSMF). Background: The styloid process, arising from the temporal bone and extending up to 25–30 mm in length, can be a cause of chronic pain and suffering. Similarly, OSMF is rapidly emerging as a widespread, debilitating collagen metabolic disorder affecting the younger population, owing to addiction to tobacco and areca nut chewing. The surgical protocol for the treatment of submucous fibrosis demands thorough postoperative physiotherapy, failure of which will lead to reoccurrence of trismus. The physiotherapeutic exercises become particularly challenging if the styloid process exhibits abnormal elongation, due to chronic inflammation and irritation. An ESP, thus, may become an impediment for patients being surgically treated for OSMF. Review results: The review was designed based on the 58 relevant articles obtained after inserting the terms “Elongated Styloid Process and Oral submucous Fibrosis” and “Elongated Styloid Process and Orthopantomogram” in the databases of PubMed and ScienceDirect, respectively during the period of September 2017 till September 2020. Conclusion: Orthopantomogram was widely used as a primary imaging investigation to evaluate the styloid process. An ESP, measuring more than 30 mm, was commonly observed in the older population and in men. The use of cone beam computed tomography and three-dimensional computed tomography was highly limited yet universally advocated in long-term studies for a more detailed scientific explanation of the occurrence and angulation of an ESP both in general population and in patients exhibiting OSMF. Clinical significance: The co-incidental finding of an ESP and OSMF must be carefully diagnosed before planning the surgical intervention in patients having submucous fibrosis. Such cases must be managed with multidisciplinary setting using single-stage procedure to maximize treatment outcome and ensure patient wellbeing.

  1. Wollina U, Verma SB, Ali FM, et al. Oral submucous fibrosis: an update. Clin Cosmet investig Dermatol 2015;8:193. DOI: 10.2147/CCID.S80576
  2. Rajalalitha P, Vali S. Molecular pathogenesis of oral submucous fibrosis–a collagen metabolic disorder. J Oral Pathol Med 2005;34(6):321–328. DOI: 10.1111/j.1600-0714.2005.00325.x
  3. Passi D, Bhanot P, Kacker D, et al. Oral submucous fibrosis: newer proposed classification with critical updates in pathogenesis and management strategies. Natl J Maxillofac Surg 2017;8(2):89. DOI: 10.4103/njms.NJMS_32_17
  4. Chiu CJ, Lee WC, Chiang CP, et al. A scoring system for the early detection of oral submucous fibrosis based on a self-administered questionnaire. J Public Health Dent 2002;62(1):28–31. DOI: 10.1111/j.1752-7325.2002.tb03417.x
  5. Pandya S, Chaudhary AK, Singh M, et al. Correlation of histopathological diagnosis with habits and clinical findings in oral submucous fibrosis. Head Neck Oncol 2009;1(1):10. DOI: 10.1186/1758-3284-1-10
  6. VanWyk CW. Oral submucous fibrosis. The South African experience. Indian J Dent Res. 1997 Apr-Jun;8(2):39–45. PMID: 9495135.
  7. Merchant A, Husain SS, Hosain M, et al. Paan without tobacco: an independent risk factor for oral cancer. Intl J Cancer 2000; 86(1):128–131. DOI: 10.1002/(sici)1097-0215(20000401)86:1<128::aid-ijc20>;2-m
  8. Srinivasan M, Jewell SD. Evaluation of TGF-α and EGFR expression in oral leukoplakia and oral submucous fibrosis by quantitative immunohistochemistry. Oncology 2001;61(4):284–292. DOI: 10.1159/000055335
  9. Haider SM, Merchant AT, Fikree FF, et al. Clinical and functional staging of oral submucous fibrosis. Br J Oral Maxillofac Surg 2000;38(1):12–15. DOI: 10.1054/bjom.1999.0062
  10. Monsour PA, Young WG. Variability of the styloid process and stylohyoid ligament in panoramic radiographs. Oral Surg Oral Med Oral Pathol 1986;61(5):522–526. DOI: 10.1016/0030-4220(86)90399-3
  11. Shivakumar HR, Batra J, Upasi AP, et al. Evaluation of elongated styloid process in patients with oral submucous fibrosis using panoramic radiographs. J Maxillofac Oral Surg 2014;13(4):556–559. DOI: 10.1007/s12663-013-0529-0
  12. Hallikainen D. History of panoramic radiography. Acta Radiol 1996;37(3):441–445. DOI: 10.1177/02841851960373P207
  13. Vakil K. Radiographical aspects of orthopantomography. J Indian Dent Assoc 1995 8; 66: 239–242.
  14. Langlais RP, Miles DA, Van Dis ML. Elongated and mineralized stylohyoid ligament complex: a proposed classification and report of a case of Eagle's syndrome. Oral Surg Oral Med Oral Pathol 1986;(5):527–532. DOI: 10.1016/0030-4220(86)90400-7
  15. More CB, Asrani MK. Evaluation of the styloid process on digital panoramic radiographs. Indian J Radiol Imaging 2010;20(4):261. DOI: 10.4103/0971-3026.73537
  16. Correll RW, Jensen JL, Taylor JB, et al. Mineralization of the stylohyoid-stylomandibular ligament complex: a radiographic incidence study. Oral Surg Oral Med Oral Pathol 1979;48(4):286–921. DOI: 10.1016/0030-4220(79)90025-2
  17. Magat G, Ozcan S. Evaluation of styloid process morphology and calcification types in both genders with different ages and dental status. J Istanbul Univ Fac Dent 2017;51(2):29. DOI: 10.17096/jiufd.35768
  18. Keur JJ, Campbell JP, McCarthy JF, et al. The clinical significance of the elongated styloid process. Oral Surg Oral Med Oral Pathol 1986;61(4):399–404. DOI: 10.1016/0030-4220(86)90426-3
  19. Roopashri G, Vaishali MR, David MP, et al. Evaluation of elongated styloid process on digital panoramic radiographs. J Contemp Dent Pract 2012;13(5):618–22. DOI: 10.5005/jp-journals-10024-1197
  20. Bruno G, De Stefani A, Balasso P, et al. Elongated styloid process: an epidemiological study on digital panoramic radiographs. J Clin Exp Dent 2017;9(12):e1446. DOI: 10.4317/jced.54370
  21. Savranlar A, Uzun L, Ugur MB, et al. Three-dimensional CT of Eagle's syndrome. Diagnost Intervent Radiol 2005;11(4):206.
  22. Ferrario VF, Sigurta D, Daddona A, et al. Calcification of the stylohyoid ligament: incidence and morphoquantitative evaluations. Oral Surg Oral Med Oral Pathol 1990;69(4):524–529. DOI: 10.1016/0030-4220(90)90390-e
  23. Jung T, Tschernitschek H, Hippen H, et al. Elongated styloid process: when is it really elongated? Dentomaxillofac Radiol 2004; 33(2):119–124. DOI: 10.1259/dmfr/13491574
  24. Guo YX, Sun ZP, Liu XJ, et al. Surgical safety distances in the infratemporal fossa: three-dimensional measurement study. Int J Oral Maxillofac Surg 2015;44(5):555–561. DOI: 10.1016/j.ijom.2014.06.004
  25. McDavid WD, Tronje G, Welander U, et al. Dimensional reproduction in rotational panoramic radiography. Oral Surg Oral Med Oral Pathol 1986;62(1):96–101. DOI: 10.1016/0030-4220(86)90079-4
  26. Rizzatti-Barbosa CM, Ribeiro MC, Silva-Concilio LR, et al. Is an elongated stylohyoid process prevalent in the elderly? A radiographic study in a Brazilian population. Gerodontology 2005;22(2):112–115. DOI: 10.1111/j.1741-2358.2005.00046.x
  27. Chen G, Deng C, Li YP. TGF-β and BMP signaling in osteoblast differentiation and bone formation. Int J Biol Sci 2012;8(2):272. DOI: 10.7150/ijbs.2929
  28. Okabe S, Morimoto Y, Ansai T, et al. Clinical significance and variation of the advanced calcified stylohyoid complex detected by panoramic radiographs among 80-year-old subjects. Dentomaxillofac Radiol 2006;35(3):191–199. DOI: 10.1259/dmfr/12056500
  29. Kundu S, Dutta M, Adhikary BK, et al. Encountering chronic sore throat: how challenging is it for the otolaryngologists? Indian J Otolaryngol Head Neck Surg 2019;71(1):176–181. DOI: 10.1007/s12070-017-1191-5
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