Oral Submucous Fibrosis is a premalignant condition affecting a considerable population around the world. The surge in the use of arecanut and tobacco products has led to monumental rise in young patients complaining of trismus and inability to eat. Although, the condition can be effectively managed through surgery followed by physiotherapy, its incessant subclinical progression often restores the intraoral fibrosis once physiotherapy is discontinued, most commonly due to pain. In this respect, it was intriguing to notice many such patients eliciting an elongated styloid process which may be consequent to activation of Transforming Growth Factor-beta due to chronic trauma or inflammation. This growth factor is also involved in marked deposition of collagen forming intraoral fibrous bands. Hence, if a definite association can be delineated between the two conditions, through radiographic examination on an orthopantomogram, clinicians can be alerted to diagnose an elongated styloid process whenever a case of oral submucous fibrosis presents in the clinical practice. This simple yet significant protocol shall eliminate a prominent cause of pain during mouth opening exercises thus making the chances of treatment failure negligible.

Oral Submucous Fibrosis (OSMF) is a widely prevalent, premalignant condition which adversely affects the quality of life of an individual and can warrant stringent surgical regimen for its treatment. An Elongated Styloid Process (ESP), if coexisting, can invariably impair the post-surgical mandatory physiotherapy necessary to maintain the mouth-opening achieved intraoperatively. To evaluate digital Orthopantomograms (OPGs) of patients having OSMF and to observe presentations of various combinations of calcification types and patterns of ESP in them. Patients with clinically diagnosed OSMF (Grade III and IV according to Khanna and Andrade 1995) were advised a digital OPG to measure and observe the ESP using the C.S. Imaging Software 7.0.3.The digitized OPGs were converted into KODAK large format prints and then ESP was measured starting from the point where it is visualized to leave the tympanic plate extending upto its tip and its myriad of combinations of calcification patterns were recorded by a single observer.The presence of unilateral and bilateral elongation along with the type and pattern of calcification was effectively noted using the C.S. Imaging Software 7.0.3. Visualization of various unique, varying patterns of ESP was noted. Sixteen such different radiological presentations were shown, captured through digital OPGs. An undetected ESP can prove to be detrimental for a patient who is recently treated for OSMF as it hinders efficient postoperative mouth opening exercises. This can easily be prevented by a simple maneuver of identifying the ESP on a digital OPG using computer aided software. The presence of assorted radiographic patterns in patients having OSMF indicate that extensive research should be directed to identify and categorize such patterns which do not conform to the past methods of classification. This study hints towards the existence of a scope to study the factors responsible for the occurrence of the varied combinations of calcification and thickness of the ESP and their clinical relevance.

cessation of habit but becomes gradually progressive adversely affecting the quality of life of the individual. 6 Over and above that, chewing betel quid containing tobacco is a prime risk factor for occurrence of oral carcinoma, which is reflected by the fact that a patient having OSMF is 19.1 times more likely to be diagnosed with oral malignancy than the normal counterpart. 1,7,8 Hence, it becomes pivotal to emphasize the significance of prevention to combat its potentially malignant nature and silent BackgroundWith approximately 600 million people around the world actively engaged in the daily consumption of betel nut in its various formations, it is not surprising that betel nut is the fourth most consumed drug in the world. 1 The chewing of betel quid is accomplished by inserting a mixture of areca nut, slaked lime, catechu, and other condiments wrapped in a betel leaf in the buccal vestibule for 15 minutes to 1 hour and repeated five to six times a day. Owing to the continuous contact of the mixture with oral mucosa, the alkaloids and flavonoids become a source of constant irritation leading to chronic inflammation as the habit becomes persistent. 2 In conjunction to this juxtaepithelial inflammatory reaction, arecaidine and tannin present in the betel nut mixture increase the cross-linking of the fibers and obstruct collagenase activity leading to fibrosis and accompanying trismus. [2][3][4] This insidious, chronic, scarring condition, seen predominantly across the South Asian population is labeled as oral submucous fibrosis (OSMF).Reportedly, trismus is the primary cause of clinical presentation in 37.2-90.8% of the patients, but other symptoms such as burning sensations, recurrent ulcerations, and excessive salivation are also manifested in 14.2-25.9% of the patients. 1,5 Also alarmingly, more than often the subjects are younger, have shorter history of usage of tobacco products, and the disease process does not reverse on