RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES
BENGALURU, KARNATAKA
ANNEXURE-II
PROFORMA FOR REGISTRATION OF SUBJECTS FOR DISSERTATION
1. / NAME OF THE CANDIDATEAND ADDRESS
(IN BLOCK LETTERS) / DR. SOUJANYA REDDY
H. No. 3, Chinmayi Nivasa, Pearl Garden, Munnekolala, Marathahalli, Bangalore-37
2. / NAME OF THE INSTITUTION / Bangalore Institute of Dental Sciences and Hospital and Post Graduate Research Center, 5/3, Hosur Road, Bengaluru-560029.
3. / COURSE OF THE STUDY
AND SUBJECT / Master of Dental Surgery(MDS)
Oral Medicine and Radiology
4. / DATE OF ADMISSION TO
COURSE / 29-7-2013.
5. / TITLE OF THE TOPIC / STYLOID PROCESS ELONGATION ON DIGITAL PANORAMIC RADIOGRAPH - A CROSS SECTIONAL STUDY
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6. / BRIEF RESUME OF INTENDED WORK:6.1 NEED FOR STUDY
The styloid process is a long slender and pointed bony projection extending downwards, forwards, and slightly medially from the temporal bone. The term styloid process is derived from the Greek word “stylos” meaning "pillar” which usually serves as point of attachment for muscles, ligaments and bones. It is developed from Reichert’s cartilage of 2nd brachial arch.
Normal length of styloid process is 25mm with its tip located between the external and internal carotid arteries, lateral to the pharyngeal wall and tonsillar fossa according to EAGLE (1948). Elongation of the styloid process >30mm along with signs and symptoms like dysphagia ,pain in throat, referred pain to the ear and mastoid region, or an abnormal sensation of a foreign body in the pharynx is known as eagle syndrome1. These signs and symptoms originate from the compression of the styloid process on the neural and vascular structures. Most of the cases with elongated styloid process are asymptomatic. Diagnosis is made by both radiological and clinical examination. More commonly, a panoramic radiograph is used to determine the styloid process elongation.
Styloid process pathology is usually overlooked as a possible source of symptom referral. Investigation of the styloid process is rarely included in patients with facial pain, mandibular dysfunction and/or pain in the cervical region. The close proximity of the styloid process to many of the vital neurovascular structures in the neck makes it clinically significant2. The presice knowledge of the clinical appearance and radiographic characteristics of styloid process would enable the differential diagnosis of different pathological changes in the orofacial and perioral area. Thus is important for clinicians, surgeons, and radiologists.
Hence the present study evaluates and classifies the radiographic appearance of styloid process elongation calcification according to age, gender, site and correlating with clinical symptoms.
6.2 REVIEW OF LITERATURE:
1. The purpose of the study3 was to evaluate the magnitude of occurrence of elongated styloid process of the patients who were attending the dental OPD of Oral Medicine and Radiology, department of Jaipur dental college. 52.43% subjects had elongation in the styloid process with an increase in the length of styloid process as age increased and was most commonly seen in the age group between 61 to 70 years.
2. The study4 was conducted to investigate the incidence of elongated styloid process and classify according to its length, type and pattern of calcification. The mean age of the patients with elongated styloid process was 43±14 years and the mean length of the styloid process was 38 ± 8mm on the left side and 35 ± 15 on the right side. No statistically significant differences were found between the types of styloid process the pattern of calcification and the age of the patients.
3. In a study5 carried out to investigate the prevalence, morphology and calcification pattern of the elongated styloid process in the Mathura population. It was reported that bilateral elongation having an elongated type styloid process with a partially mineralized pattern was the most frequent type of styloid process. Elongated styloid was found to be more prevalent in older and male populations with no effect on mandibular movement.
4. The study6 was done to investigate the prevalence of elongation and calcification pattern and the result showed the mean average length of elongated styloid process was 3.67±0.62 cm. There was no significant association obtained between age and length of styloid process and the type of elongation pattern had no effect on the calcification pattern. The results suggested that Type I elongated styloid processes was most likely to be completely calcified (type D).
5. The purpose of the study7 was to assess the styloid process on digital panoramic radiograph. The average length of the left styloid was 25.41 ± 6.32mm and that of the right styloid was 25.53 ± 6.62mm. The length of both styloids increased with age and males had longer styloids than females. Elongated styloids were present in 19.4% of the panoramic radiographs. Langlais type-I elongated styloids and partial calcification patterns were more common than others.
6.3 OBJECTIVE OF THE STUDY
1. To evaluate the magnitude of occurrence of elongated styloid process.
2. To identify the radiographic morphology and patterns of calcifications of the elongated styloid process.
3. To assess the variation in age, gender and sites of elongated styloid process.
4. To correlate with clinical signs and symptoms.
7. / MATERIALS AND METHODS :
7.1 SOURCE OF DATA
Patients reporting to the Out Patient Department of Oral Medicine and Radiology at Bangalore Institute of Dental sciences during the course of my study.
Inclusion criteria
The patients included in the study are:
· Patients who will be advised panoramic radiographs as a part of their dental investigatory procedure.
· Patients presenting with suspected signs and symptoms of elongated styloid process.
· Patient's above 20 years of age.
Exclusion criteria
The patients excluded is the study are:
· Pregnant patients, lactating mothers and Infants
· Medically and mentally challenged patients
· Subjects not willing to be a part of the study
7.2 MATERIALS REQUIRED
Digital Panoramic System (ROTOGRAPH EVO D)
Digital Panoramic Radiographs
Analysis Software (Quick Vision)
Sterile disposable gloves
Sterile disposable masks
7.3 METHOD OF COLLECTION OF DATA (including sampling procedure if any)
Study sample includes all patients visiting the Out Patient Department of Oral Medicine and Radiology, Bangalore Institute of Dental Science, Bangalore with age above 20years comprising of both sexes.
An informed consent will be taken from all the study subjects along with the institutional ethical committee approval.
Clinical examination for all patients for signs and symptoms of elongated styloid process like dysphagia, pain in throat, referred pain to the ear and mastoid region, or an abnormal sensation of a foreign body in the pharynx will be done. Also the mandibular protrusive movement, that is the position of the mandible anterior to centric relation, will be measured for all of the suspected patients of elongated styloid process by asking them to slide the mandible forward as far as possible to check for any restriction. Symptomatic patients with elongated styloid process as one of the differential diagnosis will be subjected for panoramic radiograph along with subjects for whom panoramic radiographs will be prescribed for some other dental problems.
All the digital panoramic radiographs will be taken by using a (ROTOGRAPH EVO D) X-ray unit using ccd sensors, operated at 60 to 80kVp and 6 to10 mA with an exposure cycle of 13 Sec as recommended by the manufacturer. To obtain the percentiles for different age groups, the subjects were divided into 20-29, 30-39, 40-49, 50-59, and ≥60 sub age groups.
The apparent length of the styloid process will be measured by one observer with the help of the measuring tools on the accompanying software (Quick vision) with a magnification factor of 1.4. The length of the styloid process will be measured in a similar way described by Ilgüy et al4. as the distance from the point where the styloid left the tympanic plate to the tip of the process.
The styloid process measuring more than 30mm was considered as elongated. To check the intraobserver variations, measurements will be repeated after 1 month by the same observer. The type of the elongation and calcification of the styloid process on right and left side will be evaluated.
The elongation patterns will be graded according to Langlais et al. 8
Ø Type I: elongated (Uninterrupted integrity of styloid process (>30mm))
Ø Type II: pseudo articulated (Styloid process joined to the mineralized stylomandibular or stylohyoid ligament by a single pseudo articulation),
Ø Type III: segmented (segmented styloid process containing multiple pseudo articulations)
The calcification patterns will be divided into
Ø Type A - styloid process showing calcified outline
Ø Type B - partially calcified styloid process with discontinuous radiolucent core
Ø Type C - nodular appearance of styloid process with varying degree of central radiolucency
Ø Type D - Completely Calcified
The relationships between the styloid process elongation on the one hand and gender, age, and clinical symptoms on the other will be correlated. The data will be analyzed by using a ANOVA, PEARSON CORRELATION and CHI-SQUARE tests.
7.4 Does the study require any investigations or interventions to be conducted on patients or both humans or animals? If so, please describe briefly.
Yes, panoramic radiographs will be taken for patients using Rotograph EVO-D digital system.
7.5 Has ethical clearance been obtained from your institute in case of 7.4?
Yes
8. / LIST OF REFERENCES
1. Eagle WW. Elongated styloid processes: Report of two cases. Arch Otolaryngol. 1937;25:584–7.
2. Moffat DA, Ramsden RT, and Shaw HT. The styloid process syndrome. Journal of Laryngology & Otology 1977; 91:279-294
3. Styloid Process Elongation – A Cross Sectional Study in Nort Western Part of India; Smitha R Priyadarshini, Vela D Desai, Rajeev Sharma, Isha Gaurav. International Journal of Scientific Study. July-September 2013 | Volume 01 | Issue 02.
4. Incidence of the Type and Calcification Patterns in Patients with Elongated Styloid Process; M Ilgüy, D Ilgüy, N Güler and G Bayirli. Journal of International Medical Research 2005 33: 96.
5. Clinicoradiologic evaluation of styloid process calcification; Mun Bhawni Bagga, C. Anand Kumar and Garima Yeluri. Department of Oral Medicine Diagnosis and Radiology, M.N. D.A.V. Dental College and Hospital, Solan, India. Imaging Sci Dent. 2012 Sep;42(3):155-161.
6. Prevalence of elongation and calcification patterns of elongated styloid process in south india. R Sudhakara Reddy 1, Ch. Sai Kiran 2, N. Sai Madhavi 2, M.N. Raghavendra 3, A.Satish 2; J Clin Exp Dent. 2013;5(1):e30-5.
7. Evaluation of the styloid process on digital panoramic radiographs; Chandramani B More and Mukesh K Asrani. India J Radiol Imaging.2010 November; 20(4):261-265.
8. 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.13986;61:527-32.
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9. / SIGNATURE OF CANDIDATE10. / REMARKS OF THE GUIDE / The study so far is not done at university level. Very few studies done hence, it will be an excellent prevalence study.
11. / 11.1 NAME AND DESIGNATION OF GUIDE
(IN BLOCK LETTERS) / DR. JAYANTHI. K
PROFESSOR & H.O.D.
DEPARTMENT OF ORAL MEDICINE AND RADIOLOGY
BANGALORE INSTITUTE OF DENTAL SCIENCES AND HOSPITAL,
BENGALURU – 560 029.
11.1 SIGNATURE
12. / 12.1 REMARKS OF THE PRINCIPAL / DR.VINAYA S. PAI
PRINCIPAL,
BANGALORE INSTITUTE OF DENTAL SCIENCES AND HOSPITAL,
BENGALURU- 560 029
12.2 SIGNATURE
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