Soft Palate Variation in Oral Submucous Fibrosis

One among the most prevalent precancerous disorders affecting oral cavity in those who consume arecanut and gutka is oral submucous fibrosis (OSMF). The anatomy of the soft palate alters as this illness proceeds and can act as a marker for disease. OSMF prevalence varies by area and ethnicity, and is closely linked to behaviours, culture, and cuisine. People in South and Southeast Asia have the greatest frequency of OSMF.OSMF has afflicted 2.5 million individuals globally, with a total of five million in the Indian individuals. The percentage of OSMF patients with dysplasia might range from 12 to 15 percent. Malignant changes occurs at a rate of 4–13 percent around world, but 7.6 percent in the Indian subcontinent. The anatomy of the soft palate in OSMF patients has been studied in a number of ways. Cephalometric analysis is highly used methods for measuring the soft palate in both healthy and OSMF patient. On lateral cephalometry, the soft palate shows a variety of radiographic appearances. Early cephalometry diagnosis of OSMF plays a vital role in treatment of disease. Soft palate becomes thick and heavy as OSMF advances, and considerable changes in soft palate dimensions occur, which may be better assessed by CBCT. This review work compared studies from several researchers, and observed that Type 1soft palate is the most prevalent, while type 6 soft palate is the least common. Review Article Chitlange and Panchbhai; JPRI, 33(60B): 3575-3581, 2021; Article no.JPRI.79525 3576


INTRODUCTION
One among the most prevalent precancerous disorders affecting the oral cavity in those who consume arecanut and gutka is OSMF. OSMF is a well-known potentially neoplastic oral cavity disorder characterised by lamina propria and deeper connective tissue inflammation and fibrosis. Even before the OSMF manifests clinically, alterations in soft palate morphology will begin. Sleep apnea, difficulties speaking, swallowing, and breathing can all result from the changes occurring in soft palate. Schwartz proposed the term "Atrophica idiopathica mucosa oris" to characterise an oral fibrosing condition that he identified in five Indian women in Kenyain 1952 [1]. In 1953, Joshi used the term "oral submucous fibrosis" to describe the disorder [2].

SOFT PALATE
In mammals, the soft palate is also known as the, velum, or Muscular palate, is a muscle &connective tissue structure that forms the roof of the posterior (rear) section of the oral cavity. The palate, or roof of the mouth, is formed by the soft and hard palates, which divide the oral and nasal cavities. The soft palate and the hard palate, which develop in the anterior roof of the mouth, are connected Because it prevents food and other substances from entering the nasal passages after swallowing, the soft palate is essential for speech production. It also helps with the formation of certain sounds. This area is usually reddish pink in colour and has slightly less vascularity than the oropharynx. As the patient says "ah," look around the surroundings. During function, the tissue should seem loose, mobile, and symmetrical. On palpation, the tissue will have a homogeneous, spongy consistency.
The palatine aponeurosis is made up of a strong, thin, fibrous sheet as well as the glossopalatine and pharyngopalatine muscles. The uvula is a tiny protrusion that hangs freely at the back of the soft palate. The fibrous foundation of the palate is formed by the palatine aponeurosis, which is the flattened tendon of the tensor veli palatine. The aponeurosis separates along the median plane to encompass the musculus uvulae. The palatal muscles are a group of five paired muscles that are known as the muscles of soft palate The soft palate is a mucous membrane fold that has the following components. On the superior surface of the palatine aponeurosis, the levatorveli palatine and the palatopharyngeus are located.
The palatoglossus is located on the palatine aponeurosis' inferior or anterior side. There are many mucous glands and taste buds present.
Radiographic imaging is now used extensively in the first and second levels of dental diagnosis and treatment planning [3]. In recent years, there has been a growing focus on the use of noninvasive diagnostic radiology and its applications in every field of dentistry [4].
Various radiographs can be used to evaluate the soft palate, as well as any changes in anatomy of soft palate. Presently, cone beam computed tomography (CBCT), ultrasonography and magnetic resonance imaging (MRI) techniques are being used to get three-dimensional pictures of the head and neck region including soft palate. The advantages of CBCT in treatment planning over traditional two-dimensional radiography imaging are astounding [3].
The radiographic examination of the soft palate may reveal changes in the soft palate in addition to the clinical examination of oral cavity.

INCIDENCE OF OSMF
OSMF is an irreversible oral disease that causes scarring and, eventually, soft tissue fibrosis. OSMF is a neoplastic lesion of the oral cavity that may lead to the transformation in to oral carcinoma. Because of its high incidence of malignant change, the illness has a major impact on mortality (1.5-15%) [5]. OSMF prevalence varies by area and ethnicity, and is closely linked to behaviours, culture, and cuisine [6,7,8]. People in South and Southeast Asia have the greatest frequency of OSMF [7]. Furthermore, South Africa has a significant incidence of OSMF patients, with increase in number of Indian migrants. The incidence of OSMF differs by country in Southeast Asia. In India, China, and Vietnam, the illness prevalence was found to be 0.62-6.42 percent, 0.9-4.7 percent, and 0.15-14.6 percent, respectively [9,10,11]. According to WHO figures, there are more than 5 million OSMF sufferers globally [12,13]. The OSMF patients range in age from their early twenties to their late eighties, with a range of mean ages amongst studies [14]. OSMF has afflicted 2.5 million individuals globally, with a total of five million in the Indian individuals [15]. The OSMF patients with dysplasia might range from 12 to 15 percent. Malignant changes occurs at the rate of 4-13 percent around world, but 7.6 percent in the Indian subcontinent [15].

AETIOLOGY OF OSMF
Based on epidemiological and clinical research, causative factors such as nutritional inadequacies, areca nut consumption, chilly consumption, genetic susceptibility, autoimmune conditions, and collagen abnormalities can be regarded progressive variables in the pathogenic process of OSMF result. Areca nut / betel nut consumption is associated with an increased risk of OSMF [16]. Arecoline, an alkaloid present in the entire areca nut and betel nut, encourages fibroblasts to produce more collagen. Because the areca nut has a significant quantity of copper, it raises the amounts of dissolved copper in saliva, which might be the precursor to OSMF [17]. The oral mucosa is irritated more by frozen dry varieties of mawa, gutka, and pan masala than by self-made betel quid [18].
OSMF can also be caused by a lack of vitamin B complex. The healing of inflammatory oral mucosa is disrupted because of anaemia (Fe deficiency), vitamin B complex insufficiency, and poor nutrition, resulting in scarring and slowed healing [18,19] Because of usage of betel quid, the levels of TGF-beta and interferon-gamma are low in instances with oral submucous fibrosis. Other illnesses, such as rheumatoid arthritis, SLE, and scleroderma, have been linked to certain human leukocyte antigen -DR antigens, and OSMF has a similar link [23].  [38]. In addition, the most common shape of soft palate in the normal individual was leaf shape, which was seen in 19 case (38.0 percent), which was common with You et al. [26], Kumar and Gopal, [39], and Verma et al. [40] However, according to Raja Lakshmi et al. [36] and Praveen et al. [41], Rat-tail shaped was the most common type in the control group.

OSMF AND VARIANTS OF SOFT PALATE
Moreover, Shah et al. [24] in 2021examine soft palate shape and dimensions at different phases of oral submucous fibrosis, using radiographic control. A lateral cephalogram and CBCT were used to analyse and compare 60 individuals (CBCT) [42][43][44]. Leaf shaped soft palates is shown to be the most prevalent in both groups and by both radiography modalities. With higher grades of OSMF group, there was a significant drop in length and a breadth was increased. According to the p value, CBCT provided a more precise result [45][46][47].

CONCLUSION
Considering that soft palate becomes thick and heavy as OSMF advances, and changes in soft palate dimensions occur, the examination of soft palate in OSMF cases may be done using CBCT or lateral cephalometry. Radiographs are utilised as the diagnostic tools in oral submucous fibrosis patients since changes of soft palate is the first alteration to be seen. Cephalometry may analyse the alteration of the soft palate in those who have the habit even before they develop oral submucous fibrosis. As a result, cephalometry can be useful in detecting fibrosis in those who smoke, which can aid prognosis. Type 1 soft palate is the most prevalent as shown in both radiographic techniques, while type 6 soft palate is the least common, as demonstrated in previous studies. S-shaped and hooked-shaped soft palates are more likely to develop obstructive sleep disorder and velopharyngeal insufficiency. Early radiographic diagnosis of OSMF may play an important role in diagnosis, progression and treatment of disease.

CONSENT
It is not applicable.

ETHICAL APPROVAL
It is not applicable.