Pathological calcification of the cervico-facial region

Soft Tissue Calcifications in the Head and Neck Region

This article provides an overview of the soft tissue calcifications in the head and neck region as noted on dental imaging, with particular focus on the radiographic appearance of these entities..

Ultrasonographic Evaluation of Soft Tissue Calcifications in the Head and Neck Region Detected on Panoramic Radiographs

OBJECTIVE

The aim of this study is to present a comparison between panoramic radiographs and USG imaging with a focus on revealing the advantages of USG over radiographs, and to show the distribution of calcifications detected in USG by considering the age and gender.

METHODS

A total of 148 patients with soft tissue calcifications as seen on panoramic radiographs were examined with USG imaging. Sialoliths, carotid artery calcifications, tonsilloliths, phleboliths and lymph node calcifications were examined in terms of anatomical localization, distribution and shape.

RESULTS

In the USG evaluation of these 148 patients, soft tissue calcifications were observed in 113 (76.4%) patients. The mean age of the patients with calcification was 55.6 ± 13.1 (min: 22-max: 77). Bilateral calcifications were detected in 25 (22.1%) patients, whereas unilateral calcifications were found in 88 (77.9%) patients. While the rates of tonsilloliths, sialoliths, phleboliths, and lymph node calcifications were statistically similar in male and female patients, the rate of carotid artery calcifications was found to be higher in men than in women (P = 0.017). No statistical significance was found between age groups in terms of the formation of soft tissue calcifications (P = 0.117).

CONCLUSIONS

Panoramic radiographs may mislead clinicians in the diagnosis and differential diagnosis of soft tissue calcifications in the head and neck region due to the presence of distortion, superpositions, metal artefacts, and ghost images. USG is an important diagnostic tool in determining the localization of soft tissue calcifications that can be confused on two-dimensional radiographs, their relationship with neighboring structures, and defining calcification. It can be used safely in the detection of soft tissue calcifications as it provides dynamic imaging without the use of radiation or contrast material compared to other advanced imaging methods.

Rare giant frontal sinus osteoma mimicking fibrous dysplasia

OBJECTIVE

To present the first report of a giant frontal sinus osteoma treated by excision and single-stage reconstruction with custom-made titanium cranioplasty and left orbital roof prostheses.

CASE REPORT

A 31-year-old man with a history of chronic frontal sinusitis presented with a deforming, painless, midline forehead swelling of 11 years' duration, which had been treated unsuccessfully in Nigeria. Differential diagnosis included both benign and malignant bony tumours. Computerised tomography revealed a giant bony frontal sinus tumour extending beyond the sinus roof and breaching the left orbit, consistent with fibrous dysplasia. Given the extent of the tumour, open craniectomy was performed for surgical extirpation. Histological analysis identified multiple osteomas. This surgical approach achieved excellent cosmesis, with no evidence of recurrence at 12-month follow up.

CONCLUSION

Forehead swelling may pose diagnostic and management dilemmas for the ENT surgeon; however, effective management is facilitated by a multidisciplinary approach.

Coincidental diagnosis of tuberculous lymphadenitis: a case report

The aim of this case report was to present a case of multiple calcified tuberculous lymph nodes found on a panoramic radiograph coincidently diagnosed in an endodontic clinic. A detailed discussion on the differential diagnosis of similar such calcification found in the same region is also presented. A 14-year-old girl was referred to our department with the complaint of painless swelling in the left side of the lower jaw. Clinical and radiographical examinations were performed, leading to the initial diagnosis of chronic periapical abscess. The patient's medical history was re-evaluated. Advanced imaging and excisional biopsy were performed in order to confirm the final diagnosis. Regarding the presenting signs and symptoms of bilateral carious mandibular molars, a periapical inflammatory process was considered in the provisional diagnosis. A thorough examination and investigations were suggestive of cervical tuberculous lymphadenitis (scrofula), and the patient underwent excision of the same. The clinician should consider the possibility of chronic granulomatous inflammatory lesions in the differential diagnosis of radiopaque lesions.

Osseous choristoma of the submandibular region: case report

This report presents a case of osseous choristoma in the submandibular region of a 33-year-old female. Her chief complaint was painless swelling in the submandibular region. Panoramic radiography showed a well-defined, round, radiopaque lesion near the inferior border of the right mandibular angle. Coronal and sagittal tomographic images indicated a high-density area in the right submandibular region with no bony connection. The lesion was diagnosed as an osseous choristoma based on histopathological examination of the surgical specimen. A 1-year follow-up period was uneventful.

Calcifications simulating sialolithiasis of the major salivary glands

Calcifications found in routine and normal radiographs of the oral and facial region may turn out to be an interesting diagnosis. Although most of the radiopacities may be sialoliths, other differential diagnoses must not be exempted, such as calcified lymph nodes, phleboliths and other vascular calcifications, tuberculosis of lymph nodes or of the salivary gland itself. Several cases are presented which simulated pathological calcifications of the orofacial region and were diagnosed primarily as sialoliths, but further examinations revealed other pathology. These cases together with several suggested diagnostic modalities are discussed in this paper.

Use of a rectus abdominis osteomyocutaneous double island flap based on internal mammary vessels

A very rare condition of osteoma cutis was presented by a patient who required an unusual solution to an unusual problem. Multiple surgical procedures were performed during the treatment of the disease, thereby prohibiting the use of more common regional or distant flaps to achieve successful mandibular reconstruction. Microvascular tissue transfer was also not feasible because of two previously-failed free flaps and an operative field that was densely fibrotic. A pedicled rectus abdominis myocutaneous flap with incorporated vascularized rib graft is described as a last resort approach for simultaneous reconstruction of the mandible and oral soft tissue.