A Digital Cephalometric Study on The Morphometric Evaluation of Soft Palate in Oral Submucous Fibrosis.

OBJECTIVE: Oral submucous fibrosis (OSMF) is a chronic precancerous condition affecting the oral cavity, which is progressive and characterised by burning sensation and fibrotic change leading to restriction of mouth opening. This study evaluated the morphology of soft palate in different stages of OSMF patients using digital lateral cephalogram and compare it with healthy individuals. METHODS: The study included 60 subjects, who were grouped as 30 OSMF and 30 healthy subjects from the same geographic population. Digital lateral cephalograms were taken with Planmeca Proline XC (Oy, Helsinki, Finland). Soft palate morphology was evaluated using Lateral Cephalogram, and the results were analysed statistically. RESULTS: Leaf-shaped (Type 1) soft palate was commonly seen in the control group and stage I and II OSMF. Stage III OSMF patients presented with a butt-shaped (Type 3) soft palate. As the disease progressed, there was a conversion of Type 1 variety of soft palate to Type 3 variety. There was a gradual reduction in the length of the soft palate in the anteroposterior direction in OSMF patients compared to the control group. CONCLUSION: Early cephalometric diagnosis of soft palate changes may play a pivotal role in the overall management of OSMF.
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Sonographic imaging of fibrosis of oral mucosa and its correlation with clinical staging in oral submucous fibrosis.

BACKGROUND AND OBJECTIVES: To evaluate the efficacy of ultrasonography (USG) as a noninvasive tool in assessing the severity of oral submucous fibrosis (OSMF) by measuring the submucosal thickness and also to correlate the sonographic changes with clinical staging. MATERIALS AND METHODS: The submucosal thickness of the upper and lower labial mucosa, anterior and posterior portions of the right and left buccal mucosa were measured using ultrasound in 64 patients comprising of 32 OSMF patients and 32 controls. Among the controls, 16 were with a habit of chewing gutkha and 16 were without any habit history. RESULTS: In OSMF group, four patients were with Stage I, 13 were with Stage II, 11 were with Stage III, and four with Stage IV. Results were analyzed by one-way analysis of variance for the significance of difference among the groups in submucosal thickness. As the stages of OSMF advanced, there was an increase in submucosal thickness of the buccal mucosa in the study group when compared with controls (P< 0.005). CONCLUSION: USG is an effective noninvasive zero radiation tool for assessing the progression of OSMF.

Correlation of ultrasonographic measurements, histopathological grading, and clinical staging in oral submucous fibrosis.

AIMS AND OBJECTIVES: To evaluate the presence and thickness of submucosal fibrosis in oral submucous fibrosis (OSMF) patients ultrasonographically and to correlate these findings with the clinical stage and histological grade of OSMF. MATERIALS AND METHODS: Forty participants (twenty cases and twenty controls) were included in the study. The patients diagnosed clinically as having OSMF and consented for biopsy were included in the cases, and completely healthy individuals with no habit history or oral lesions were included in the control group after matching the body mass index. After clinically staging, the patients' transcutaneous ultrasonography (USG) was performed and after that punch biopsy was taken and the specimen was graded histopathologically. RESULTS: The data were statistically analyzed using Mann-Whitney test and Spearman's rank correlation. The cases showed increased submucosal thickness as compared to the controls. The USG measurements statistically correlated with the clinical stage and histopathological grade of OSMF. CONCLUSION: USG proves to be a valuable adjunctive modality in diagnosing, staging and also evaluating the prognosis of OSMF.

Using pneumo-computerized tomography as a quantitative assessment of result in submucous fibrosis patients treated with surgical release and free flap reconstruction.

OBJECTIVE: This study investigates the efficacy of oral submucous fibrosis release and free flap reconstruction. STUDY DESIGN: Pneumo-computerized tomography (pneumo-CT) was used to evaluate postoperative changes in the buccal vestibular volume during maximum blowing. METHODS: From March 2003 to November 2008, 9 patients underwent 18 microvascular flap reconstructions after oral submucous fibrosis release. The preoperative and postoperative buccal vestibular volumes were determined by capturing the air density in the selected region on CT images, which were composed of 0.75-mm-thick slices that were then summated using analysis software (Biomedical Imaging Resource; Mayo Foundation, Rochester, MN). RESULTS: Postoperative results were measured for a mean follow-up period of 15 months (range, 6-36 mo). There was significant improvement in the interincisal distance from 12.44 (8.35) mm preoperatively to 32.56 (7.322) mm postoperatively (P = 0.000). There was an accompanying significant increase in the buccal vestibular volume from 5.66 (3.92) mL preoperatively to 9.38 (4.96) mL postoperatively on the right side (P = 0.032) and from 6.44 (4.20) mL preoperatively to 9.64 (4.65) mL postoperatively (P = 0.048) on the left side. CONCLUSIONS: Adequate release of the mucosa and resurfacing with a free flap can increase the interincisal distance and improve the maximal buccal vestibular volume. Air-contrast pneumo-CT studies demonstrate an improvement in buccal mucosal elasticity.

Assessment of cross-sectional thickness and activity of masseter, anterior temporalis and orbicularis oris muscles in oral submucous fibrosis patients and healthy controls: an ultrasonography and electromyography study.

OBJECTIVES: Oral submucous fibrosis (OSMF) is an insidious chronic disease that is associated with significant functional morbidity and an increased risk for malignancy. It initially affects the lamina propria of the oral mucosa, and, as the disease progresses, it involves the submucosa and deeper tissue, including muscles of the oral cavity, resulting in loss of fibroelasticity. OSMF is a pre-malignant condition mainly caused by areca nut chewing. The aim of this study was to find out the involvement of muscles of mastication and facial expression in patients with OSMF by assessing the cross-sectional thickness and activity of the masseter, anterior temporalis and orbicularis oris muscles by ultrasonography and electromyography and comparing with healthy controls and also to find out any correlation between the ultrasonographic cross-sectional thicknesses of the masseter, anterior temporalis and orbicularis oris muscles with electromyographic activity. METHODS: 40 patients with OSMF were included in the study group, and the patients were divided into four groups on the basis of interincisal mouth opening, i.e. Group I (mouth opening >35 mm), Group II (mouth opening between 30 and 35 mm), Group III (mouth opening between 20 and 30 mm) and Group IV (mouth opening <20 mm). Ultrasonographic cross-sectional thickness and electromyographic activity (amplitude and duration) of the masseter, anterior temporalis and orbicualris oris muscles were recorded in patients with OSMF and 20 controls. Intergroup comparison of ultrasonographic cross-sectional thickness and activity (amplitude and duration) was done, and Pearson's correlation coefficient was applied to find out any relation between ultrasonographic and electromyographic findings. RESULTS: Thickness and activity of the masseter muscle was significantly reduced in Group IV (mouth opening <20 mm) when compared with the control group. The anterior temporalis and orbicularis oris muscles remained unaffected. A positive correlation was observed between the thicknesses of the masseter muscle and the amplitude in Groups I, II and III; the anterior temporalis muscle in Group II and the control group; and the orbicularis oris muscle in Groups II, III and IV. CONCLUSIONS: It was concluded that, among the muscles studied, there was an early involvement of the masseter muscle in patients with OSMF compared with that of other muscles.

Morphometric evaluation of soft palate in oral submucous fibrosis--a digital cephalometric study.

The Present study was carried out to evaluate the morphology of soft palate in Oral Submucous Fibrosis (OSF) patients using digital lateral cephalogram. A total number of 70 patients were included in the study (Control group had 35 patients and Study group had 35 OSF patients) were evaluated for soft palate by digital lateral cephalogram. The anterio-posterior length and superior-inferior length of soft palate were measured. The morphology of soft palate was categorized as type 1, to type 6. Different types of soft palate were compared with stages of OSF. Among the Study group (35 patients) 62.9% had Stage 2 OSF. Leaf shaped (Type 1) soft palate was seen commonly in stage 2 OSF whereas butt shaped (Type 3) in stage 3 OSF. In the present study there was statistically significant difference in length (anterio-posterior) of Type 1 soft palate of OSF patients. In the present study as the OSF progressed to advanced stage there was gradual change from Type 1 and Type 2 variety of Soft palate to Type 3 and Type 6 variety of soft palate. The study observed that there was gradual reduction in the length of soft palate in anterior-posterior direction in OSF patients.

Use of extraoral periapical radiography in Indian population: technique and case reports.

Performing intraoral radiography in certain patients is difficult as these patients are unable to tolerate intraoral film placement. To assist such patients a new technique has been innovated using extraoral film placement. Use of this technique has been documented in Caucasian and Taiwanese populations. In this paper we report use of this technique for Indian population. We have done about 40 cases using this technique and have found the average angulation for maxillary (-25+/-5 degrees) and mandibular (-15+/-5 degrees) teeth for Indian population. We recommend use of this technique in the personal dental clinics where panoramic radiographic machines are not readily available. Here we report the technique and cases where diagnostic imaging was performed in patients using the extraoral periapical technique.

Evaluation of oral submucous fibrosis using ultrasonographic technique: a new diagnostic tool.

AIM: The aim of this study is to evaluate oral submucous fibrosis (OSMF) by clinical and histopathological examination, and compare the results with those from ultrasonographic technique. MATERIALS AND METHODS: 30 clinically diagnosed OSMF patients were subjected to both ultrasonographic and histopathological evaluation before treatment. Later, only ultrasonographical examination was done during 4 th and 8 th week of treatment. Prognosis of the lesion for the treatment was evaluated. Peak systolic velocity (PSV) of blood in the lesional area was statistically analyzed. 10 normal individuals without any mucosal lesions were considered as the control group. RESULTS: In normal individuals, ultrasonography delineates normal mucosa with uniform fine mottled appearance with interspersed hypoechoic areas. Color Doppler and spectral Doppler depicts uniform distribution of blood vessels and normal peak systolic velocity of blood respectively. All OSMF patients were diagnosed upon clinical and histopathological examination. Clinical examination revealed 14 individuals with unilateral palpable fibrotic bands and 16 individuals with bilateral fibrotic bands whereas, ultrasonographic evaluation revealed 6 individuals with unilateral fibrotic bands and 24 individuals were with bilateral fibrotic bands, which was statistically significant. Ultrasonography demonstrated number, length and thickness of the fibrotic bands. Color Doppler and spectral Doppler showed decreased vascularity and PSV in lesional area. Prognosis evaluation revealed 25 cases of good prognosis and 5 cases were showed poor prognosis. Wilcoxon Signed Ranks Test revealed no significant difference of PSV was seen in poor prognosis patients. CONCLUSION: Ultrasonography is a non-invasive diagnostic tool for OSMF. It could be a better diagnostic tool compared to clinical and histopathological examination.

In vivo autofluorescence spectroscopy of oral premalignant and malignant lesions: distortion of fluorescence intensity by submucous fibrosis.

BACKGROUND AND OBJECTIVES: To test whether autofluorescence spectroscopy can be used for the diagnosis of oral neoplasia in a high-risk population, we characterized the in vivo autofluorescence spectra from oral submucous fibrosis (OSF) lesions and oral premalignant and malignant lesions in both OSF and non-OSF patients. STUDY DESIGN/MATERIALS AND METHODS: Autofluorescence emission spectra were measured under the excitation wavelength of 330 nm, using a Xenon lamp-based fluorospectrometer coupled to a handheld optical fiber probe. Autofluorescence spectroscopies were analyzed among patients with OSF lesions, and oral lesions of epithelial hyperkeratosis (EH), epithelial dysplasia (ED), and squamous cell carcinomas (SCC) and normal oral mucosa (NOM) of healthy volunteers. RESULTS: We found that the most intensely autofluorescence emission peaks occurred at 380 nm and 460 nm. For comparing the spectral patterns among different groups of oral lesions and NOM, ratios of the area under the spectrum of 460+/-10 nm to that under the spectrum of 380+/-10 nm (denoted as A(460+/-10nm)/A(380+/-10nm)) were calculated. The mean ratio values increased gradually from OSF to NOM, to EH and ED, and to SCC. The ANOVA test showed significant differences in the ratio value among all categories of samples (P<0.01). On the other hand, we found that EH, ED, and SCC lesions on OSF patients had distorted autofluorescence intensity. The mean ratio values of EH, ED, and SCC between non-OSF and OSF patients show significant differences. Furthermore, an ANOVA test showed NOM is not distinguishable from EH and ED lesions on oral fibrotic mucosa (P>0.05). CONCLUSIONS: Autofluorescence spectroscopy can be used to diagnose EH, ED, and SCC lesions in non-OSF patients but not in OSF patients.

Liver ultrasound and faecal copper estimation in oral submucous fibrosis.

There is no evidence of an increased quantity of ingestion of copper in areca nut chewers by way of habitually swallowing the 'quid juice' allegedly contain 'appreciable quantity' of soluble copper. Our experimental findings are favour of assuming that the amount of copper ingested, if at all, is well within the threshold limit of tolerance and therefore of no clinical significance. In conjunction with our earlier observation this study again proved the absence of visible and clinically/diagnostically detectable fibrosis in visceral organs, that includes liver, in patients suffering from advanced oral submucous fibrosis.