THESIS – SYNOPSIS

DR. MANASWITA TRIPATHY

POST GRADUATE STUDENT

DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY

K.V.G. DENTAL COLLEGE & HOSPITAL

KURUNJIBAGH, SULLIA – 574327

DAKSHINA KANNADA

RAJIVGANDHIUNIVERSITY OF HEALTH SCIENCES

BANGALORE, KARNATAKA

ANNEXURE II

PROFORMA FOR REGISTRATION OF SUBJECT FOR DISSERTATION

1. / NAME OF THE CANDIDATE AND ADDRESS / : / DR.MANASWITA TRIPATHY
POST GRADUATE STUDENT
DEPT OF ORAL MEDICINE AND RADIOLOGY
K.V.G DENTAL COLLEGE & HOSPITAL
KURUNJIBAGH, SULLIA – 574 327
2. /

NAME OF THE INSTITUTION

/ : / K.V.G. DENTAL COLLEGE & HOSPITAL
KURUNJIBAGH, SULLIA – 574 327.
3. / COURSE OF THE STUDY AND SUBJECT / : / MASTERS IN ORAL MEDICINE AND RADIOLOGY
4. / DATE OF ADMISSION TO COURSE / : / 1st JUNE 2013
5. / TITLE OF THE TOPIC / : / MORPHOMETRIC EVALUATION OF SOFT PALATE IN VARIOUS STAGES OF ORAL SUBMUCOUS FIBROSIS-A DIGITAL CEPHALOMETRIC STUDY
6. / BRIEF RESUME OF THE INTENDED STUDY
6.1 Need for the Study
Soft palate plays a significant role in various important functions in the head and neck region.1Dimensions of soft palate and its dynamic relations with the pharyngeal space have a vital role in deglutition,respiration, and phonation.2Its varied morphology is implicated in a variety of diseases.1
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. The hallmark of the disease is the fibrosis in the submucosal layers and the muscles of mastication leading to varying degrees of trismus.The fibrosis of the mucosa over and around the uvula leads to certain characteristic abnormalities in the uvula, such as forward pointing uvula or a vanishing uvula.3
Knowledge about the varied morphological pattern of soft palate in OSMF patients can give us a clear understanding about disease progress in oropharyngeal region. Thorough understanding and knowledge of changes associated with OSMF in soft palate will help the Maxillofacial Surgeon in successful structural and functionalcorrections associated with this disorder.This study will also help inproper diagnosis of conditions which are associated with OSMF such as obstructive Sleep Apnoea due to increased airway resistance.3
The present study aims to investigate the variations of the soft palate morphology in normal individuals and oral sub mucous fibrosis patients.
6.2Review of the Literature
A study conducted by Taylor et al describes the pattern of bony and soft tissue growth of the oropharynx in orthodontically untreated children. The sample consisted of 16 males and 16 females with lateral cephalograms at 6, 9, 12, 15 and 18 years of age, for a total of 160 lateral cephalometric radiographs. Four linear (Ar-H,S-H,Go-H, Gn-H) and three angular (N-S-H, SN-ArH,GoGn-H) measurements demonstrated that the hyoid bone descends and moves slightly anteriorly up to age 18.The soft palate (PNS-P) increased 1 mm in length and 0.5 mm in thickness every 3 years after age 9.4
In acephalometric studyconducted by Johnston and Richardson investigatedthe morphological changes occurring in thepharynx between early andmiddle adult life. A sample of 16 young adults (mean age 20.2 years)had cephalometric films taken and repeated after an interval of 32 years. Changes in pharyngeal skeletal size,pharyngeal soft tissue thickness, pharyngeal airway depth and softpalate dimensions were examined, in addition to the standard craniofacial measurements.The results showed increase in maxillary prominence and upper and lower anterior faceheight. The nasopharyngeal skeletal dimensions were unchanged over the 32-year interval, while the anterioposterior depth of the nasopharyngeal lumen increased as a result of reduction in thickness of the posterior nasopharyngeal wall. In the oropharynx, the depth of the airway decreased with age and the soft palate became longer and thicker.5
A cross sectional study was carried out by Satoh et al to clarify the changes associated with the growth of nasopharyngeal structures. The study group comprised of 61 patients from early childhood to puberty, with repaired unilateral cleft lip and palate showing complete velopharyngeal closure (cleft group) and 82 controls without cleft (control group).Measurements of the nasopharyngeal area were derived from a coordinate system and landmarks on lateral cephalograms and results were analysed by multivariate analysis andttest. The vertical position of posterior maxilla, pharyngeal depth and velar length in the cleft group showed a different pattern of growth from those in the control group.6
Akcam et aldescribed the relationship between the soft palate and the nasopharyngeal airway in different mandibular growth rotation models. A total of 72 lateral cephalograms were obtained three years longitudinally from 24 individuals.A linear increase in the soft palate length (SPL) was observed in all groups, with the posterior mandibular rotation group showing the largest increase within the observation period.2
You et al reportedthat the morphology of the soft palate has a variable presentation on lateral cephalogram. The study group comprised 200 normal subjects with age ranging from 5–48 years (mean 19.37 years). The morphology of the soft palate in different age and gender on lateral cephalometry was studied and classified into six types. There was a significant difference between the pre-adult and adult groups and also between male and female groups in proportion to velar type.The classification system and statistical findings here may help the research of velopharyngeal closure in cleft palate individualsand aetiological study of obstructive sleep apnoea syndrome.8
Praveen et al described the morphological diversity of soft palate in adult population.The study comprised of 80 individuals requiring orthodontic treatment but without any speech abnormality, with age rangingfrom 9 to 31 years. Velar shape was examined on digital lateral cephalograms and was allocated to one of the six patterns as described by You et al. The difference in proportion of each type and also difference between genders were studied. Type 2 rat-tail shape is most common in both the genders. There is no significant difference in proportion of various shapes of soft palate between genders.7
Kumar and Saraswathi Gopal analysed the variation in the morphology of the soft palate.In this study, the sample comprised 100 normal subjects aged between15 and 35 years. The morphology of the soft palate on lateral cephalometry were examined and classified into six types. The variations of the soft palate between groups were also studied. There was a significant difference in the morphology of soft palate and also between male and female groups in proportion to velar type. The soft palate has variable radiographic appearances on lateral cephalometry. The classification system and
proportional findings here may help the research of velopharyngeal closure in cleft palate
individualsand aetiological study of obstructive sleep apnoea syndrome and other conditions.9
Kruthika et al reported the variation of the soft palate morphology in Indian subpopulation and classified types of soft palate, to evaluate the dimensional differences of the soft palate between each type and to investigate the proportional differences in different age and gender groups.Two hundred digital lateral cephalograms were analysed for the velar morphology and categorized into different types. In addition length and thickness of the soft palate was also measured.The velar length was significantly higher in males and the velar width was significantly less in females. Also a significant increase in velar length was observed with increase in age.Type 1 was the most common of all the variants.1
Shankar et al evaluated the morphology of soft palate in OSMF patients using digital lateral cephalogram. A total of 70 patients included in the study(Control group had 35 patients and study group had 35 OSMF patients) were evaluated for soft palate by digital lateral cephalogram. The anterio-posterior length and superio-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 OSMF. The study observed that there was gradual reduction in the length of soft palate in anterio-posterior direction in OSMF patient.
6.3AIM & OBJECTIVES OF THE STUDY
Aim
  • To evaluate the morphology of soft palate in different stages of oral
submucous fibrosis(OSMF) patients using digital lateralcephalogram.
Objectives
  • To evaluate the morphology of soft palate inOSMF patients using digital lateral cephalogram.
  • To compare the soft palate morphology in different stages of OSMF patients using digital lateral cephalogram.
  • To correlate the morphology of soft palate in controls and different stages of OSMF in digital lateral cephalogram.
MATERIAL & METHODS
7.1 Source of the Data :
Study subjects will be selected from the outpatient department of Oral Medicine and Radiology, KVG Dental College, Sullia.60 subjects will be selected randomly. The clinical diagnosis of OSMF will be confirmed by history and clinical examination. An informed consent will be obtained from all the participants.
The study mainly included 2 groups :
1-30 Healthy individuals
2-30 Patients with different stages of OSMF
  • Stage 1
  • Stage 2
  • Stage 3
7.2 Methods of Collection of Data:
Materials Required:
Planmeca Proline XC with dimax 3 ceph
Digital lateral cephalogram:
Patients will be positioned in cephalostat with Frankfort plane parallel to the floor. They are asked to swallow any saliva once to clear the oral cavity and pharynx and then to close their mouth lightly to place their upper and lower teeth in centric occlusion with their oropharyngeal musculature relaxed. Digital lateral cephalograms will be taken with Planmeca Proline XC with dimax 3 ceph System. The morphology of the soft palate on lateral cephalogram will beexamined. The length of the soft palate will be evaluated by measuring the linear distance from the posterior nasal spine (PNS) to the tip of the uvula of the resting soft palate. Superio-inferior dimension of soft palate will be measured at the thickest area of soft palate. Morphology of soft palates was classified based on their morphology according to You et al. as :
Types: 1- Leaf-shaped
2 - Rat-tail shaped
3 - Butt-like
4 - Straight line
5 - S- shaped
6- Crook-shaped
EVALUATION
  • Evaluation of the data will bebased on the results obtained from the digital lateral cephalogram.
  • The length of the soft palate will be evaluated by measuring the linear distance from the posterior nasal spine (PNS) to the tip of the uvula of the resting soft palate.
  • Superior-inferior dimension of soft palate was measured at the thickest area of the soft palate.
  • Morphology of soft palates will be classified based on their morphology according to You et al.7
  • Oral submucous fibrosis will be classified clinically according to Durgesh Bailoor.
Inclusion Criteria:
  • Clinically diagnosed patients with OSMF.
  • Patient free from any other systemic diseases.
Exclusion Criteria:
Patients with known history of
  • Surgery of palate
  • Cleft lip and palate
  • Scleroderma
Statistical Analysis
The results will be statistically evaluated using ANOVA and t test.
7.3 Dose the study require anyinvestigations or interventions to be conducted in patient or other humans
YES. Digital lateral cephalograms will be taken with Planmeca Proline XC with dimax 3 ceph System, for all patients participating in the study. The morphology of the soft palate on lateral cephalogram will be examined.
7.4 Has ethical clearance been obtained from your institution
YES. Institutional ethical committee clearance copy is enclosed.
REFERENCES :
  1. Guttal KS, Breh R, Bhat R, Burde KN, Naikmasur VG. JIAOMR 2012; 24;1:15-19
  1. Akcam MO, Toygar TU, Wada T. Longitudinal investigationof soft palate and nasopharyngeal airway relations in differentrotation types. Angle Orthod 2002;72;6:521-26.
  1. Shankar VN, Hegde K, Ashwini NS, Praveena V, Prakash SMR.Morphometric evaluation of soft palate in oral submucous fibrosis-A digital cephalometric study.Journal of Cranio-Maxillo-Facial Surgery (2013) (In press)
  1. Taylor M, Hans MG, Strohl KP, Nelson S, Broadbent BHSoft tissue growth of the oropharynx. Angle Orthod 1996;66:393-400.
  1. Johnston CD, Richardson A. Cephalometric changes in adult pharyngeal morphology. Eur J Orthod 1999;21:357-62
  1. Satoh K, Wada T, Tachimura T, Shiba R. The effect of growthof nasopharyngeal structures in velopharyngeal closure inpatients with repaired cleft palate and controls without clefts: Acephalometric study. Br J Oral Maxillofac Surg 2002;40:105-09.
  1. Praveen BN, Amrutesh S, Sumona P, AR Shubhasini, Vaseemuddin Syed, Various shapes of soft palate: A lateral cephalometric study.World Journal of Dentistry, 2011;2;3:207-210
  1. You M, Li X, Wang H, Zhang J, Wu H, Liu Y, et al. Morphologicalvariety of the soft palate in normal individuals: A digitalcephalometric study. Dentomaxillofac Radiol 2008;37:344-49.
9. Kumar DK, Gopal KS. Morphological variants of soft palate in
normal individuals: A digital cephalometric study. Journal of Clinical and
Diagnostic Research. 2011 Vol- 5;6:1310- 1313
INFORMED CONSENT FOR PARTICIPATION IN RESEARCH
I Dr. MANASWITA TRIPATHY Post Graduate Student in Department of Oral Medicine and Radiology am conducting a dissertation work for award of M.D.S degree in Oral Medicine and Radiology. The topic for the study is-
MORPHOMETRIC EVALUATION OF SOFT PALATE IN VARIOUS STAGES OF ORAL SUBMUCOUS FIBROSIS-A DIGITAL CEPHALOMETRIC STUDY
AIMS AND OBJECTIVES OF THE STUDY:
AIM
To evaluate the morphology of soft palate in different stages of oral
submucous fibrosis (OSMF) patients using digital lateral cephalogram.
OBJECTIVES
  • To evaluate the morphology of soft palate in OSMF patients using digital lateral cephalogram.
  • To compare the soft palate morphology in different stages of OSMF using digital lateral cephalogram.
  • To compare the morphology of soft palate in controls and different stages of OSMF in lateral cephalogram.
MR/MS______, we are requesting you to enroll yourself
in the study conducted by Dr. Manaswita Tripathy, post Graduate Student in
Department of Oral Medicine and Radiology under the guidance of Dr.Jayaprasad Anekar, t K. K.V. G. Dental College and Hospital, Sullia D.K.
You are requested to participate. During the study you will be asked some questions and you are supposed to answer to the best of your knowledge.
Your participation in this research is voluntary. Your decision whether to participate will not affect your relationship with K. V. G. Dental College and Hospital, Sullia. If you decide not to participate you are free to withdraw at any time.The purpose of research is to evaluate the morphology of soft palate in different stages of oral submucous fibrosis (OSMF) patients using digital lateral cephalogram.
PROCEDURE INVOLVED:
If you agree to participate in this research study we would need to take a radiograph.
RISK AND BENEFITS:
This procedure isdone in routine radiographic examination and do not cause any harm to you.
ALTERNATIVES:
Even if you decline in participation, you will get the routine line of management.
PRIVACY AND CONFIDENTIALITY:
The only people to know that you are a research subject are members of the research team.
No information about you or provided by you during the research will be disclosed to others without your written permission except:
1. in emergency to protect your rights and welfare.
2. If required by law.
AUTHORIZATION TO PUBLISH RESULTS:
When the results of the research are published or discussed, in a conference, no information will be displayed that would disclose your identity. Any information that is obtained in a connection with this study and that can be identified with you will remain confidential.
FINANCIAL INCENTIVES FOR PARTICIPATION:
You will not be paid/offered any free gifts for participating in the research. You will not be reimbursed for expenses.
Name
Address
Signature of investigator
Phone no.
I have been told in a language that I understand
( ) about the study. I have been told that this is for a research procedure, that my participation is voluntary and I/he/she reserve the full right to withdraw from the study at my own initiative at any time, without having to give any reason, and that right to participate or withdraw from study at any stage will not prejudice my/his/her, rights and welfare. I have been assured by the investigator that confidentiality will be maintained and only be shared for academic purposes. Also I have been told that no incentive either in the form of cash or gift for participating in the study will be given
I hereby give consent to participate in the above study. I am also aware that I can withdraw this consent at any later date, if I wish to. This consent form being signed voluntarily indicating my agreement to participate in the study, until I decide otherwise. I understood that I will receive a signed and dated copy of this form.
If I have any doubts/questions pertaining to the above study, I have been asked to contact
Dr.Manaswita Tripathy,Mobile no: 08904755997.
Signature of the research subject:
Date :
Place:
Signature of the witness:
Date:
Place:
9. / SIGNATURE OF CANDIDATE
10. /

REMARKS OF THE GUIDE

11. / NAME AND DESIGNATION OF
11.1 GUIDE / DR. JAYAPRASAD ANEKAR,M.D.S.
PROFESSOR AND HOD,
DEPARTMENT OF ORAL MEDICINE & RADIOLOGY,
K.V.G DENTAL COLLEGE AND HOSPITAL, KURUNJIBAGH, SULLIA
11.2 SIGNATURE
11.3 CO-GUIDE / DR. RAJ A.C MDS
PROFESSOR
DEPARTMENT OF,ORAL MEDICINE AND RADIOLOGY ,
KVG DENTAL COLLEGE AND HOSPITAL.
SULLIA
11.5 SIGNATURE
11.6 HEAD OF THE DEPARTMENT / DR. JAYAPRASAD ANEKAR, M.D.S.
PROFESSOR AND HOD,
DEPARTMENT OF ORAL MEDICINE & RADIOLOGY,
K.V.G DENTAL COLLEGE AND HOSPITAL, KURUNJIBAGH, SULLIA,
11.7 SIGNATURE
12. /

PRINCIPAL

/ DR. MOKSHA NAYAK, M.D.S.
PRINCIPAL,
K.V.G. DENTAL COLLEGE AND HOSPITAL, KURUNJIBAGH, SULLIA.
12.1 REMARK
12.2 SIGNATURE