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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 31  |  Issue : 1  |  Page : 51-56

Morphological evaluation of soft palate in various stages of oral submucous fibrosis and normal individuals: A digital cephalometric study


Department of Oral Medicine and Radiology, Rajasthan Dental College and Hospital, Ajmer National Highway NH-8, Bagru, Jaipur, Rajasthan, India

Date of Submission12-Dec-2018
Date of Acceptance15-Feb-2019
Date of Web Publication23-Apr-2019

Correspondence Address:
Dr. Supriya Rathore
Department of Oral Medicine and Radiology, Rajasthan Dental College and Hospital, Ajmer National Highway NH-8, Bagru, Jaipur - 302026, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jiaomr.jiaomr_209_18

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   Abstract 


Aim of Study: The aim of the study was to evaluate the morphology of soft palate in different stages of oral submucous fibrosis (OSMF) patients using digital lateral cephalogram. Materials and Methods: Total 100 participants were enrolled for the study. They were divided into two groups, Group 1 consisted of first 50 patients diagnosed with OSMF and Group 2 consisted of first 50 non-OSMF patients. Results: Morphology of soft palate was divided into eight types and was compared. Leaf shape (Type 1) was found to be most common and bifid shape least common. It was observed that as the grade of OSMF increases, the size of soft palate also shortens and becomes bulkier as compared to initial stages or non-OSMF group, and results were highly significant with a P value of > 0.05. Conclusion: The soft palate has variable radiographic appearances on lateral cephalometry. The classification system and statistical findings here may help the research of velopharyngeal closure in cleft palate individuals and etiological study of obstructive sleep apnea syndrome and other conditions.

Keywords: Lateral cephalogram, oral submucous fibrosis, soft palate morphology


How to cite this article:
Rathore S, Patil N, Sareen M, Meena M, Baghla P, Tyagi N. Morphological evaluation of soft palate in various stages of oral submucous fibrosis and normal individuals: A digital cephalometric study. J Indian Acad Oral Med Radiol 2019;31:51-6

How to cite this URL:
Rathore S, Patil N, Sareen M, Meena M, Baghla P, Tyagi N. Morphological evaluation of soft palate in various stages of oral submucous fibrosis and normal individuals: A digital cephalometric study. J Indian Acad Oral Med Radiol [serial online] 2019 [cited 2019 Dec 10];31:51-6. Available from: http://www.jiaomr.in/text.asp?2019/31/1/51/256899




   Introduction Top


The soft palate is the posterior fibrovascular part of the palate that is attached to the posterior edge of the hard palate. It participates in most of the oral functions like speech, swallowing, and respiration. Oral submucous fibrosis (OSMF) is a chronic progressive disorder of oral cavity, which includes buccal mucosa, tongue, lips, anterior faucial pillars, soft palate, and oropharynx. Changes in soft palate morphology will start even before the OSMF, present itself clinically. Lateral cephalometry is good diagnostic aid to assess the soft palate and its morphology or any changes in morphology, which can lead to various conditions such as obstructive sleep apnea, difficulty in swallowing, speech, and respiration.[1]


   Aim and Objectives Top


The present study aims to investigate the variations of the soft palate morphology in normal individuals and in oral submucous fibrosis patients by lateral cephalogram with following objectives: to compare the soft palate morphology in different stages of OSMF patients, to correlate the morphology of soft palate in controls and different stages of OSMF, to compare the morphology of soft palate in controls and different stages of OSMF with various age groups and gender in digital lateral cephalograms, and to compare and correlate the size of soft palate in case and control study groups.


   Materials and Methodology Top


This study was conducted in the Department of Oral Medicine and Radiology at Rajasthan Dental College and Hospital Bagru Jaipur Rajasthan. A total of 100 subjects participated in the study and were divided into 2 groups (case and control). Each group consisted of 50 participants. Case group consisted of 50 patients with OSMF. Control group consisted of 50 subjects who were non-OSMF patients, or healthy patients with inclusion criteria of age ranging from 15 to 70 years which were further divided into five age groups- 15–30, 31–40, 41–50, 51–60, and 61–70 years age group. Participants with history of trauma of head and neck, history of surgery of cleft lip and palate, trismus, fracture of head and neck, systemic diseases, any syndromic cases, reduced mouth opening due to impacted third molar or any space infections, patients with Tempromandibular joint pathology, pregnant and lactating mothers, patient who underwent surgeries for carcinoma of soft palate, hard palate of tongue were excluded from the study. Informed consent was taken from each participant. On the basis of classification proposed by Pradhuman Passi et al. (2017),[2] OSMF patients were divided and marked into four grades. Digital lateral cephalograms were taken using SIRONA OPG (MODEL ORTHOPHOS DG, 64 kV, 8 mA) machine. The length of the soft palate was evaluated by measuring linear distance from posterior nasal spine to tip of uvula in anteroposterior length and the greatest width was measured for the superior–inferior diameter of the soft palate. Thus, different shapes and measurement were obtained digitally on screen. The obtained results were tabulated and statistically analyzed. The probability value (P value) of obtained values was determined by referring to respective tables and results of the study were evaluated.


   Results and Discussion Top


In the present study, in the case group, the most common shape of soft palate seen was Type 1 (leaf shape) found in 21 cases (42.0%) [Table 1], [Graph 1]. These findings were consistent with the study conducted by Raja Lakshmi et al.,[3] Shankar et al.,[1] Mohan et al.,[4] and Tekchandani et al.[5] Type 5 (S shape) was also reported in one case (2.0%), which was not mentioned by Raja Lakshmi et al.[3].
Table 1: Comparison of OSMF grades and morphology of soft palate in study group

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In the control group, most commonly seen shape of soft palate was Type 1 (leaf shape) found in 19 cases (38.0%) which was consistent with You et al.,[6] Kumar and Gopal,[7] and Verma et al.[8] But according to Raja Lakshmi et al.[3] and Praveen et al.,[9] most common variant in the control group was Type 2 (rat tail shape).

In the present study, grade I OSMF was predominantly seen in 22 patients, in which Type 1 (leaf shape) was seen in 15 cases (68.0%), Type 2 (rat tail) in 5 cases (22.0%), and Type 3 (butt shape) and Type 5 (S shape) in 1 case each (4.5%). Grade II OSMF was observed in 17 cases, in which again Type 1 (leaf shape) was most commonly seen in 6 cases (35.0%) followed by Type 7 (U shape) in 6 cases (35.0%) and Type 3 (butt shape) in 2 cases (11.0%). Grade III OSMF was observed in nine cases, in which most commonly seen shape was Type 3 (butt shape) in eight cases (88.88%) and Type 7 (U shape) in one case (11.11%). Grade IV OSMF was seen in two cases, in which one had Type 3 (butt shape) (50.0%) and other had Type 7 (U shape 50.0%). Based on the above findings, the soft palate shows morphological changes with the progression of disease. In our study, as the disease progresses, the long narrow type gets transformed into a short thick pattern. These changes were attributed to the fibrosis of the mucosal covering of soft palate and uvula. These findings were in accordance with Shankar et al.,[1] Mohan et al.,[4] Raja Lakshmi et al.,[3] and Chaturvedi et al.[10]

The mean anteroposterior length of Type 1 (leaf shape) [Figure 1] soft palate in the present study in case group was found to be 32.81 mm and superoinferior width was 12.21 mm, whereas in control group, anteroposterior length was found to be 35.21 mm and superoinferior width was 10.92 mm. There was a significant reduction in the length of the soft palate in case group when compared with the control group.
Figure 1: Type 1 leaf shape on soft palate

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The mean anteroposterior length of Type 2 (rat tail shape) [Figure 2] in the present study was found to be 35.76 mm and superoinferior width was 12.37 mm, whereas in control group, mean anteroposterior length was 33.70 mm and superoinferior width was 9.96 mm. This shape of soft palate was seen as the second most common type after leaf shape in the control group. This finding was consistent with the findings of You et al.[6]
Figure 2: Type 2 rat-tail shape of soft palate

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The mean anteroposterior length of Type 3 (butt shape) [Figure 3] was 25.84 mm and superoinferior width was 11.96 mm in the case group. Butt-shaped soft palate was seen only in one case in the control group with a mean anteroposterior length of 31.32 mm and mean superoinferior width of 12.06 mm. The reason behind less prevalence of butt-shaped soft palate can be attributed to the fact that as the fibrosis increases, the width of soft palate increases. Same results were also stated by Patil et al.[11] and Khaitan et al.[12]
Figure 3: Type 3 butt shape of soft palate

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Type 4 (straight line) [Figure 4] variant was not seen in any case of study group but was seen in nine cases in the control group with a mean anteroposterior length of 36.04 mm and mean superoinferior width of 8.86 mm. The reason behind not finding a straight line in any case group can be due to the fact that as the OSMF progresses, the size of soft palate decreases in terms of anteroposterior length and increases in terms of superoinferior width. This finding was in accordance with Patil et al.[11]
Figure 4: Type 4 straight-line shape of soft palate

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Type 5 (S shape) [Figure 5] variant of soft palate was seen in one case of study group with mean anteroposterior length of 33.62 mm and mean superoinferior width of 6.5 mm, whereas in the control group again, S shape was seen in one case only with mean anteroposterior of 40.15 mm and mean superoinferior width of 10.16 mm. Type 6 (crook shape) of soft palate was not seen in any cases of our study, neither in study group nor in the control group. Our result was in contrary with You et al.,[6] Guttal et al.,[13] and Praveen et al.[9]
Figure 5: Type 5 S-shape of soft palate

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Type 6 (crook shape) [Figure 6] is not seen in our study.
Figure 6: Type 6 crook shape of soft palate

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Type 7 (U shape) [Figure 7] of soft palate was seen in eight cases of study group with mean anteroposterior length of 28.69 mm and mean superoinferior width of 11.08 mm, whereas U shape was seen in three cases of the control group with a mean anteroposterior length of 39.4 mm and mean superoinferior width of 12.95 mm. Type 7 soft palate was also seen by Guttal et al.[13] in their study but was not seen by Khaitan et al.;[12] Instead, they found a completely new variant, triangular-shaped soft palate which they stated Type 7 in their study.
Figure 7: Type 7 U-shape of soft palate

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Type 8 (bifid shape) [Figure 8] of soft palate was seen only in two cases in the control group with a mean anteroposterior length of 36.05 mm and mean superoinferior width of 10.68 mm. Bifid shape was not seen in any patient of the study group. This type of soft palate was described by Khaitan et al.[12] but was not mentioned by You et al.[6] and Raja Lakshmi et al.[3] in their studies.
Figure 8: Type 8 bifid shape of soft palate

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In the present study, a significant increase in velar length was noted with an increase in age in the control group only. Chi-square test was applied and results were significant with a P value of 0.048. This is in correlation with the findings of Taylor et al.[14] [Table 2], [Graph 2]. According to them, there was 1 mm of increase in the length of soft palate and 0.5 mm increase in thickness of soft palate every 3 years after the age of 9 years. These observations were made by Johnston et al.[15] suggesting that nasopharyngeal skeletal dimension remains unchanged but the depth of airway in the oropharyngeal region decreases and soft palate become longer and thicker with the advancement of age. Significant results were also mentioned by Guttal et al.[13] with P value of 0.0162.
Table 2: Association of age and morphology of soft palate in control group

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Dimensional changes in soft palate among males and females were found to be nonsignificant in our study in both case groups with P value 0.579 and control group with P value 0.870, which was inconsistent with the results seen in the study done by Kollias et al.[16] They inferred that increase in length and thickness and sagittal area of soft palate was equal among male and female. But according to Guttal et al.[13] and Verma et al.,[8] velar length and width were significantly greater in males than females with P values of 0.0429 and 0.0000, respectively.

In the present study, the morphology of soft palate was compared with grades of OSMF. A total of 50 patients were diagnosed with OSMF. Chi-square test was applied and results were highly significant with P value of 0.000 (P < 0.001). These findings were in accordance with Raja Lakshmi et al.,[3] Shankar et al.,[1] and Mohan et al.[4]

In the present study, a comparison of soft palate morphology in case and control group was done. A total of 100 participants were included in the study, out of which 40 participants (40%) have Type 1 (leaf shape) soft palate, making it the most common type. Chi-square test is applied and results were highly significant with a P value of 0.000 (P < 0.001) [Table 3], [Graph 3]. This result was also reported by You et al.,[6] Patil et al.,[11] and Praveen et al.[9] On the contrary, conflicted results were reported by Raja Lakshmi et al.[3].
Table 3: Morphology of soft palate in case group and control group

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In our study, the most prevalent shape of soft palate seen was Type 1 (leaf shape) found in 42% of the study group and 38% of the control group. Our result was in accordance with You et al.,[6] Raja Lakshmi et al.,[3] Khaitan et al.,[12] Kumar and Gopal,[7] and Guttal et al.[13] However, our results were in contrary with studies conducted by Praveen et al.,[9] in which Type 2 (rat-tail) shape was described as the most common variant of soft palate. Type 2 (rat-tail shape) of soft palate was the second most common type according to our study [Graph 4].




   Conclusion Top


Cephalometry can be efficiently used to assess the morphology of soft palate in normal as well as a patient suffering from OSMF. Therefore, cephalometry can be beneficial in assessing fibrosis in individuals with the habit at an early stage, which can further help in prognosis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Shankar VN, Hegde K, Ashwini NS, Praveena V, Ravi Prakash SM. Morphometric evaluation of soft palate in oral submucous fibrosis — A digital cephalometric study. J Craniomaxillofac Surg 2014;42:48-52.  Back to cited text no. 1
    
2.
Pradhuman Passi D, Bhanot P, Kacker D, Chahal D, Atri M, Panwar Y. Oral Submucosis fibrosis: Newer proposed classification with critical updates in pathogenesis and management strategies. Natl J Maxillofac Surg 2017;8:89-94.  Back to cited text no. 2
    
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Raja Lakshmi C, Ayesha Thabusum D, Bhavana SM. An innovative approach to evaluate the morphological patterns of soft palate in oral submucous fibrosis patients: A digital cephalometric study. Int J Chronic Dis 2016;2016:5428581. doi: 10.1155/2016/5428581.  Back to cited text no. 3
    
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Mohan RP, Verma S, Singh U, Agarwal N. Morphometric evaluation of soft palate in oral submucous fibrosis—a digital cephalometric analysis. West Afri J Radiol 2014;21:7-11.  Back to cited text no. 4
    
5.
Tekchandani V, Thakur M, Palve D, Mohale D, Gupta R. Co-relation of clinical and histologic grade with soft palate morphology in oral submucous fibrosis patients: A histologic and cephalometric study. J Dent Specialities 2015;3:68-75.  Back to cited text no. 5
    
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You M, Li X, Wang H. Morphological variety of the soft palate in normal individuals: A digital cephalometric study. Dentomaxillofac Radiol 2008;37:344-9.  Back to cited text no. 6
    
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Kumar DK, Gopal KS. Morphological variants of soft palate in normal individuals: A digital cephalometric study. J Clin Diagn Res 2011;5:10-3.  Back to cited text no. 7
    
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Verma P, Gupta Verma K, Kumaraswam KL, Basavaraju S, Sachdeva SK, Juneja S. Correlation of morphological variant of soft palate and need's ratio in normal individuals: A digital cephalometric study. Imaging Sci Dent 2014;44:193-8.  Back to cited text no. 8
    
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Praveen BN, Amrutesh S, Pal S, Shubasini Ar, Vaseemuddin S. Various shapes of soft palate: A lateral cephalometric study. World J Dent 2011;2:207-10.  Back to cited text no. 9
    
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Chaturvedi P. Uvular abnormalities in patients with submucous fibrosis. Oral Dis 2009;15:516.  Back to cited text no. 10
    
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Patil BM, Ara SA, Katti G, Ashraf S, Roohi U. Velar morphological variants in oral submucous fibrosis: A comparative digital cephalometric study. Indian J Dent Res 2017;28:623-8.  Back to cited text no. 11
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12.
Khaitan T, Pachigolla R, Uday G, Balmuri PK, Chennoju SK, Pattipati S. Digital cephalometric analysis illustrating morphological variation of the soft palate. J Indian Acad Oral Med Radiol 2015;27:532-8.  Back to cited text no. 12
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Guttal KS, Breh R, Bhat R, Burde KN, Naikmasur VG. Diverse morphologies of soft palate in normal individuals: A cephalometric perspective. J Indian Aca Oral Med Radiol 2012;24:15-9.  Back to cited text no. 13
    
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Taylor M, Hans MG, Strohl KP, Nelson S, Broadbent BH. Soft tissue growth of the oropharynx. Angle Orthodontist 1996;66:393-400.  Back to cited text no. 14
    
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Johnston CD, Richardson A. Cephalometric changes in adult pharyngeal morphology. Eur J Orthod 1999;21:357-62.  Back to cited text no. 15
    
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Kollias I, Krogstad O. Adult craniocervical and pharyngeal changes: A longitudinal cephalometric study between 22 and 42 years of age: Morphology of uvulo-glossopharyngeal changes (Part II). Eur J Orthod 1999;21:345-55.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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