Evaluation of Maxillofacial Soft Tissue Calcifications in Edentulous Patients on Panoramic Radiographs

Year 2023, , 103 - 113, 31.08.2023

Ali Altındağ , Ayşe Hanne Cora

https://doi.org/10.47141/geriatrik.1292936

Abstract

Aim: It is aimed to evaluate the prevalence, and types of soft tissue calcifications (STCs) on panoramic radiographs of edentulous patients.

Material and Methods: 1308 images were randomly selected from patients who applied to Necmettin Erbakan University for various dental problems in 2020 and 2021. In these radiographs, tonsillolith, sialolith, calcified atherosclerotic plaque (CAP), and stylohyoid ligament calcification (SLC), calcified lymph node, phleboliths, antroliths, rhinoliths, and triticeous and thyroid cartilage calcifications were evaluated. Data were categorized according to gender, systemic disease and calcification type. Descriptive statistics were determined for all parameters. The status of the data according to gender, age group and systemic disease were analyzed by chi-square test (p<0.05).

Results: Soft tissue calcifications was found in 478 (36.6%) of 1308 patients. Calcified atherosclerotic plaque was detected in 30.4%, stylohyoid ligament calcification in 27.0%, calcified lymph node in 16.1%, tonsillolith in 15.4%, tritiseous cartilage calcification in 12.3%, sialolith in 0.5%, arteriosclerosis in %0.3 of patients. There was a significant difference when soft tissue calcifications are evaluated according to age groups (p<0.05). However, there was no difference in the appearance of soft tissue calcifications based on gender or systemic disease (p>0.05).

Conclusion: Calcified atherosclerotic plaque and stylohyoid ligament calcification were detected most frequently, and sialolith and atherosclerosis were detected least on panoramic radiography. Physicians should be able to recognize incidentally detected soft tissue calcifications during radiographic examination and distinguish them from normal anatomical structures and pathologies in the relevant region.

Keywords

calcification, edentulous, elderly, panoramic, soft tissue

Dişsiz Hastaların Panoramik Radyograflarında Yumuşak Doku Kalsifikasyonlarının Değerlendirilmesi

Abstract

Amaç: Dişsiz hastaların panoramik radyografilerinde yumuşak doku kalsifikasyonlarının prevalansını ve tiplerini değerlendirmek amaçlanmıştır.

Gereç ve Yöntemler: 2020 ve 2021 yıllarında kliniğimize çeşitli diş problemleri için başvuran hastalardan rastgele seçilen 1308 görüntüde tonsillolit, sialolith, kalsifiye aterosklerotik plak, stylohyoid ligament kalsifikasyonu, kalsifiye lenf nodu, flebolit, antrolit, rinolit, tritiköz ve tiroid kıkırdak kalsifikasyonları değerlendirildi. Veriler cinsiyet, sistemik hastalık ve kalsifikasyon tipine göre kategorize edildi. Tüm parametreler için tanımlayıcı istatistikler belirlendi. Verilerin cinsiyet, yaş grubu ve sistemik hastalığa göre durumu ki-kare testi ile analiz edildi (p<0,05).

Bulgular: 1308 hastanın 478’inde (%36,6) yumuşak doku kalsifikasyonu saptandı. Hastaların %30,4’inde kalsifiye aterosklerotik plak, %27,0’sinde stylohyoid ligament kalsifikasyonu, %15,4’ünde tonsillolit, %13,9’unda kalsifiye lenf nodu, %12,3’ünde tritisöz kıkırdak kalsifikasyonu, %0,5’inde sialolit, %0,3’ünde arterioskleroz tespit edildi. Yaş gruplarına göre yumuşak doku kalsifikasyonları değerlendirildiğinde istatistiksel olarak anlamlı fark olduğu gözlendi (p<0,05). Ancak yumuşak doku kalsifikasyonları varlığı ile cinsiyet veya sistemik hastalık arasında fark tespit edilmedi (p>0,05).

Sonuç: Panoramik radyografide en sık kalsifiye aterosklerotik plak ve stylohyoid ligament kalsifikasyonu, en az sialolith ve ateroskleroz tespit edildi. Hekimler tesadüfen saptanan yumuşak doku kalsifikasyonlarını radyografik muayene sırasında tanıyabilmeli ve ilgili bölgedeki normal anatomik yapılardan ve patolojilerden ayırt edebilmelidir.

Keywords

kalsifikasyon, panoramik, yumuşak doku, yaşlı

References

• Ivanhoe JR, Cibirka RM, Parr GR. Treating the modern complete denture patient: A review of the literature. J Prosthet Dent. 2002;88(6):631-5.
• Haikola B, Oikarinen K, Söderholm AL, Remes‐ Lyly T, Sipilä K. Prevalence of edentulousness and related factors among elderly Finns. J Oral Rehabil. 2008;35(11):827-35. Nalçacı R, Erdemir EO, Baran I. Evaluation of the oral health status of the people aged 65 years and over living in near rural district of Middle Anatolia, Turkey. Arch Gerontol Geriatr .2007;45(1):55-64.
• Yeşilova E, Bayrakdar İŞ. Radiological evaluation of maxillofacial soft tissue calcifications with cone beam computed tomography and panoramic radiography. Int J Clin Pract. 2021;75(5):e14086.
• Ezoddini Ardakani F, Navab Azam AR. Radiological findings in panoramic radiographs of Iranian edentulous patients. Oral Radiol. 2007;23:1-5.
• Sumer AP, Sumer M, Güler AU, Biçer I. Panoramic radiographic examination of edentulous mouths. Quintessence Int. 2007;38(7).
• Şahin SC, Özdede M. Analysis of digital panoramic imaging findings of completely edentulous patients applying for prosthetic treatment. Ann Med Res 2020;27(9):2285-91.
• Haştar E, Yılmaz H, Orhan H. Findings from panoramic radiographs on the edentulous elderly patients. SDU Sağlık Bil Ens Derg. 2010;1(2):82-7.
• Vengalath J, Puttabuddi JH, Rajkumar B, Shivakumar GC. Prevalence of soft tissue calcifications on digital panoramic radiographs: A retrospective study. J Indian Acad Oral Med Radiol. 2014;26(4):385.
• Garay I, Netto HD, Olate S. Soft tissue calcified in mandibular angle area observed by means of panoramic radiography. Int J Clin Exp Med. 2014;7(1):51-6.
• Sutter W, Berger S, Meier M, Kropp A, Kielbassa AM, Turhani D. Cross-sectional study on the prevalence of carotid artery calcifications, tonsilloliths, calcified submandibular lymph nodes, sialoliths of the submandibular gland, and idiopathic osteosclerosis using digital panoramic radiography in a Lower Austrian subpopulation. Quintessence Int. 2018;49(3).
• Haghighat ASJ, Nikbin A, Sajedikia S. Prevalence of Soft Tissue Calcifications in Panoramic Radiographs of Patients Referred to Guilan School of Dentistry Within 1 Year and its Relationship With Systemic Diseases. Avicenna J Dent Res. 2019;11(1):15-20.
• Icoz D, Akgunlu F. Prevalence of detected soft tissue calcifications on digital panoramic radiographs. SRM J Res Dent Sci. 2019;10(1):21.
• Atalay Y, Asutay F, Agacayak KS, Koparal M, Adali F, Gulsun B. Evaluation of calcified carotid atheroma on panoramic radiographs and Doppler ultrasonography in an older population. Clin Interv Aging. 2015:1121- 9.
• Ohba T, Takata Y, Ansai T, Morimoto Y, Tanaka T, Kito S, et al. Evaluation of calcified carotid artery atheromas detected by panoramic radiograph among 80-year-olds. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(5):647-50.
• Bayer S, Helfgen E-H, Bös C, Kraus D, Enkling N, Mues S. Prevalence of findings compatible with carotid artery calcifications on dental panoramic radiographs. Clin Oral Invest. 2011;15:563-9.
• Friedlander AH, Maeder LA. The prevalence of calcified carotid artery atheromas on the panoramic radiographs of patients with type 2 diabetes mellitus. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2000;89(4):420-4.
• Baumann-Bhalla S, Meier RM, Burow A, Lyrer P, Engelter S, Bonati L, et al. Recognizing calcifications of the carotid artery on panoramic radiographs to prevent strokes. Schweiz Monatssch Zahnmed. 2012;122(11):1016-29.
• Çitir M, Gündüz K. The prevelance of soft tissue calcification/ossification on panoramic radiography. Selcuk Dent J. 2020;7(2):226-32.
• Carter LC. Soft tissue calcifications and ossifications. White SC, Pharoah MJ, eds. Oral Radiology: Principles and Interpretation. St. Louis, MO: Mosby Elsevier; 2014.p.524-41.
• More CB, Aarani MK. Evaluation of the styloid process on digital panoramic radiograph. Indian J Radiol Imaging. 2010; 20(4): 261–5.
• Phulambrikar T, Rajeshwari A, Rao BB, Warhekar AM, Reddy P. Incidence of elongated styloid process: a radiographic study. J Indian Acad Oral Med Radiol. 2011;23(3):344–6.
• Roopashri G, Vaishali MR, David MP, Baig M, Shankar U. Evaluation of elongated styloid process on digital panoramic radiograph. J Contemp Dent Pract. 2012;13(5):618–22.
• AlZarea BK. Prevalence and pattern of the elongated styloid process among geriatric patients in saudi Arabia. Clinical Interventions in Aging. 2017:12;611– 7.
• Altındağ A, Eren H, Küçükkalem MF, Altındağ Ö. Prevalence and Pattern of Stylohyoid Chain Complex on Panoramic Radiographs: A Retrospective Study. Clin Exp Health Sci. 2022;12(4):906-12.
• Scarfe WC, Farman AG. Soft tissue calcifications in the neck: Maxillofacial CBCT presentation and significance. AADMRT Currrents 2010;2:1-15.
• Ahmad M, Madden R, Perez L. Triticeous cartilage: Prevalence on panoramic radiographs and diagnostic criteria. Oral Surg Oral Med Oral Pathol Oral Radiol Oral Endod. 2005;99:225-30.
• Nasseh I, Sokhn S, Noujeim M, Aoun G. Considerations in detecting soft tissue calcifications on panoramic radiography. J Int Oral Health. 2016;8(6):742-6.
• de Oliveira Cde N, Amaral TM, Abdo EN, Mesquita RA. Bilateral tonsilloliths and calcified carotid atheromas: case report and literature review. J Craniomaxillofac Surg. 2013;1(2):179-82.
• Aoun G, Nasseh I, Diab HA, Bacho R. Palatine Tonsilloliths: A Retrospective Study on 500 Digital Panoramic Radiographs. J. Contemp. Dent. Pract. 2018;19(10):1284-7.
• Fauroux MA, Mas C, Tramini P, Torres JH. Prevalence of palatine tonsilloliths: a retrospective study on 150 consecutive CT examinations. Dentomaxillofac Radiol. 2013;42(7): 20120429.
• Oda M, Kito S, Tanaka T, Nishida I, Awano S, Fujita Y, et al. Prevalence and imaging characteristics of detectable tonsilloliths on 482 pairs of consecutive CT and panoramic radiographs. BMC Oral Health. 2013;13(1):1-8.
• Omezli M, Ayranci F, Sadik E, Polat M. Case report of giant sialolith (megalith) of the Wharton’s duct. Niger J Clin Pract. 2016;19(3):414-7.
• Tahmasbi-Arashlow M, Barghan S, Kashtwari D, Nair MK. Radiographic manifestations of Mönckeberg arteriosclerosis in the head and neck region. Imaging Sci Dent. 2016;46(1):53-6.
• Castling B, Bhatia S, Ahsan F. Mönckeberg’s arteriosclerosis: vascular calcification complicating microvascular surgery. Int J Oral Maxillofac. 2015;44(1):34-6.
• Lanzer P, Boehm M, Sorribas V, Thiriet M, Janzen J, Zeller T, et al. Medial vascular calcification revisited: review and perspectives. Eur Heart J. 2014;35(23):1515-25.
• Sunil M, Trivedi A, Sharma R. Evaluation of Soft Tissue Calcifications on Digital Panoramic Radiographs. J Pearldent. 2017;8(2):22-7.
• Maia PRL, Tomaz AFG, Maia EFT, Lima KC, Oliveira PTD. Prevalence of soft tissue calcifications in panoramic radiographs of the maxillofacial region of older adults. Gerodontology. 2022;39(3):266-72.
• Bayramov N, Öztürk AÜ, Yalçinkaya ŞE. Incidental Soft Tissue Calcifications in Cone- Beam Computed Tomography Images: A Retrospective Study. Turkiye Klinikleri J Dental Sci. 2022;28(2).