An orthopantomographic study of developmental mandibular bone defects (Stafne's idiopathic bone cavities)

The prevalence of Stafne bone cavity: A meta-analysis of 355,890 individuals

Background/purpose

A Stafne bone cavity (SBC) is an incidental depression in the lingual surface of the mandible. The aim of this study is to provide pooled estimates of the frequency of Stafne bone cavity and to correlate its presence with such variables as sex, laterality, diagnostic methods and population.

Materials and methods

Potential studies were searched through four electronic databases: Google Scholar, PubMed, Scopus, and Journal Storage. Titles, abstracts, and full texts of the articles were screened.

Results

A total of 54 studies relating to 355,890 subjects met the inclusion criteria for meta-analysis. A meta-analysis using the DerSimonian-Laird model revealed an overall prevalence of 0.17% (CI:0.14%-0.21%, I ² = 80.7%). SBC was four times more common in males than females (z = 6.94, P < 0.01), and was unilateral in almost all cases (z = 12.90, P < 0.01). Radiographic studies yielded a lower SBC prevalence at 0.12% (CI:0.09%-0.15%, I ² = 71.7%) than computed tomography studies, skeletal studies and excavation studies. Ancient populations had three times higher SBC prevalences (0.47%, CI:0.21%-0.73%, I ² = 89.5%) than the average populations today (z = 3.21, P < 0.01).

Conclusion

The prevalence of Stafne bone cavity is approximately 0.17%, and was four times more prevalent in males than females. This variant bone cavity was also present unilaterally in the majority of cases. Awareness of SBC is important for dentists, maxillofacial surgeons and other practitioners performing routine dental practices and interpreting panoramic radiographs.

Lingual Mandibular Bone Depression

BACKGROUND/AIM

In the area of the jaw angle, osteolytic lesions can occur, the differential diagnosis of which can be difficult and require very different therapeutic measures. One of these lesions is lingual mandibular bone depression (LMBD). The aim of this study was to present the characteristics of the lesion in a group of LMBD patients and to differentiate it from other lesions.

PATIENTS AND METHODS

Radiological images of 21 patients with LMBD were examined.

RESULTS

The majority of LMBDs were located in the jaw angle. On cross-sectional images, the lesion could be distinguished from salivary tissue (n=2). One case of LMBD had an impact on the course of the fracture line in the mandibular trauma.

CONCLUSION

LMBD is a developmental disorder of the mandible and only rarely of pathological importance. Imaging the lesion with cross-sectional images is preferable to using plain X-ray projections. In some cases, surgical exploration is essential for diagnosis.

The Digital Diagnostic Approach to Stafne’s Bone Cavity (SBC): From a Review of the Literature to the Description of a Clinical Case

Introduction:

Stafne’s Bone Cavity [SBC] is a rare, well-defined, mandibular bone lesion, which was first discovered by Edward C. Stafne in 1942.

Objective:

The purpose of this article is to evaluate a digital diagnostic approach to Stafne’s Bone Cavity (SBC) through a review and description of some clinical cases.

Methods:

The review was conducted through an analysis of the literature of all articles published on Stafne’s Bone Cavity.

We report the case of a 55-year-old male patient who needed tooth implant rehabilitation, and therefore, a panoramic radiograph was taken as part of the routine evaluation and plan of care. After the diagnosis, the focus was on more precise imaging and the merits of choosing Computerized Tomography or Magnetic Resonance Imaging were compared.

Results:

According to our review of the literature, the prevalence of these cavities was found to be 0.14%, while 8% of them were found in male patients and 72% of them were found in male patients older than 44 years of age.

The patient’s panoramic radiograph revealed the presence of an SBC in his left posterior side of the mandible. In order to confirm and improve the diagnosis, the patient underwent a Computer Tomography exam, chosen for its benefits outweighing those of an MRI.

Conclusion:

Stafne’s bone cavity (SBC) is indeed an uncommon finding as it is asymptomatic and is identified only through panoramic imaging, CT scans or MRIs. However, it can pose some logistical problems in the application of dental implants. The typology of this case study confirmed the findings of the systematic review; the patient, being a middle aged male, presented a mandibular SBC, which was discovered only during a routine panoramic x-ray to plan the fitting of dental implants. The use of tomography confirmed the diagnosis of SBC and detailed the anatomical structure, thus guiding the restoration process.

Imaging features of Stafne bone defects on computed tomography: An assessment of 40 cases

Purpose

This study was performed to assess and describe the imaging features of 40 cases of Stafne bone defects (SBDs) on computed tomographic (CT) examinations.

Materials and Methods

This study collected data, including age and sex, from 40 patients with SBDs who underwent CT exams. The imaging features of the SBDs were assessed in terms of their location, average size, the relationship of their contour with the cortical plate of the lingual mandible, bone margins, degree of internal density, shape, topographic relationship between the defect and the mandibular edge, the distance from the SBD to the base of the mandible, and the Ariji classification (type I, II, and III).

Results

The average age was 57.3 years (range, 28–78 years), and the patients were predominantly male (70%). In all cases (100%), the posterior unilateral lingual SBD variant was observed. Within the Ariji classification, type I was the most common (60%). Among the most frequently observed radiographic characteristics were thick sclerotic bone margin across the entire defect contour, completely hypointense internal content, an oval shape, and continuity with the mandibular base with discontinuity of the mandibular edge.

Conclusion

This study showed that posterior SBDs could present with an oval or rounded shape, complete hypodensity, and thick sclerotic margins. Likewise, SBDs could appear almost anywhere, with minor differences from the classic SBD appearance. It is fundamental for dental practitioners to know the imaging features of SBDs, since they are diagnosed primarily based on imaging.

A rare presentation of stafne bone cyst

Stafne bone cysts (SBC) are defined as pseudocysts of the jaw in the literature. These lesions are typically localized at lingual cortical surface of the mandible and generally included normal salivary gland tissue; but they do not contain an epithelial lining. They may contain fat, muscle, connective tissue, lymphatic tissue, nerve bundles, blood vessels or air. In the literature, unlike posterior variant of SBC, anterior type of SBC (aSBC) is almost seven times less common (0.009%-0.3%). Usually, SCBs are identified at dental examination randomly. Since these lesions are mostly asymptomatic, some additional imagining modalities such as magnetic resonance imaging (MRI), computed tomography (CT) or sialography may be useful to confirm the diagnosis for atypical lesions. The aim of this report is to present a new case of aSBC and focuses on differential diagnosis along with alternative diagnostic imaging resources and review current literature.

Evaluation of volumetric measurements on CBCT images using stafne bone cavities as an example

Background

The aim of the present study is to evaluate the efficacy of CBCT in volume measuring using Stafne Bone Cavities (SBC) as an example.

Material and Methods

The study was conducted with 14 subjects with SBC detected on panoramic radiographs. In order to evaluate lesions volumetric dimensions, CBCT images for each patient were captured. Files in Digital Imaging and Communications in Medicine (DICOM) format were transferred into a medical image processing program (ITK-SNAP 2.4.0) and volume in mm3 of the cavities were measured using semi-automatic segmentation procedure by 2 observers blinded to each other over a one-month period. Inter-reliability of volumetric measurements between observers was compared. SBCs relation to mandibular canal was also examined and three types of relation were observed; type 1: mandibular canal is separated from the SBC, type 2: mandibular canal is in contact with SBC, type 3: mandibular canal goes through the SBC.

Results

There were 12 males and 2 females who had SBC in this study (age range: 37-73, mean age: 55.3 years). The total volume of SBC in patients ranged from 160 mm3 to 520 mm3 (mean: 361.7 mm3). There was no significant difference between observers for volume measurements (p>0.05). According to relationship of SBC with mandibular canal, most SBCs were Type 1 (64.3 %) followed by type 3 (21.4 %) and type 2 (14.3 %). Pearson correlation coefficient shows a positive correlation between lesions volumetric size and relation with mandibular canal (pearson correlation = 0.54, sig < 0.05).

Conclusions

Based on the results of this preliminary study, CBCT was considered to be an effective radiographic technic for measuring volumetric sizes of SBCs. However further studies with larger sample sizes are needed to prove the usefulness of CBCT in volume measurements.

Key words:Stafne bone cavity, CBCT, volumetric measurements, image segmentation.

An Unusual Presentation of Stafne Bone Cyst

Stafne bone cyst is a rare mandibular defect. It is a developmental abnormality that commonly presents as a small, well demarcated, and asymptomatic radiolucency seen at the angle of the mandible below the mandibular canal. There are usually no clinical signs nor symptoms. Diagnosis is commonly by plain X-ray, but use of more accurate imaging such as MRI is required in atypical cases. This case study reports an unusual presentation of Stafne bone cyst in the ramus of the mandible in a young man and reviews the relevant literature.

Lingual cortical mandibular bone depression: frequency and clinical-radiological features in a Brazilian population

The aim of this study was to report the frequency and clinical-radiological features of cases of lingual cortical mandibular bone depressions (LCMBD) diagnosed in consecutive panoramic radiographs and cone-beam computed tomography (CBCT) scans from a Brazilian population. The methods included a retrospective analysis of consecutive panoramic radiographs, charts from the Oral Medicine clinic and consecutive CBCT scans. All cases diagnosed as LCMBD were selected and clinical-radiological data were retrieved from the clinical charts and by the analysis of the image exams. Twenty LCMBD cases diagnosed in 18 patients were found, including 2 from 3,000 consecutive panoramic radiographs (0.07%), 6 from 2,421 Oral Medicine patients (0.25%) and 10 from 1,684 CBCT scans (0.59%). The 18 patients had a mean age of 51.5 years and 13 were males. Two patients presented bilateral lesions. Fourteen images (70%) were classified as well-defined. Eighteen affected the posterior area of the mandible and two affected the anterior mandible. Size of the lesions was larger in younger patients. In conclusion, there seemed to be a considerable radiological heterogeneity when comparing the LCMBD cases and it seemed that the images decreased in size with the increase of patient's age.

Radiographic evaluation on prevalence of Stafne bone defect: a study from two centres in Turkey

OBJECTIVES

The aim of this study was to investigate the frequency of Stafne bone defect (SBD) and to describe the clinical and radiological characteristics of detected cases.

METHODS

A retrospective study was performed using panoramic radiographs from 34 221 patients undergoing dental treatment in the Department of Oral and Maxillofacial Radiology at Erciyes University and Ataturk University, Turkey. After finding an image compatible with SBD in the radiographs, multislice CT (MSCT) on seven patients and cone beam CT (CBCT) on six patients were performed to confirm the diagnosis.

RESULTS

Of the 34 221 patients, 29 (0.08 %) had SBDs, of whom 4 were female (13.8%) and 25 were male (86.2 %). The age range of patients with SBD was 18-77 years (mean age 49.6 years). SBD was found in the lingual molar region in 28 patients and in the lingual canine-premolar region of the mandible in 1 patient. The contour of the concavities on CT images (MSCT and CBCT) was detected. The MSCT revealed glandular tissue within the defects.

CONCLUSIONS

According to our results, SBD is an uncommon anomaly. Examination of MSCT images supports the presence of aberrant submandibular glands within these mandibular defects, suggesting that pressure from submandibular gland tissue had caused the SBD, as generally thought. Both CBCT and MSCT can provide adequate support for the detection of SBDs. The CBCT could be suggested as the most suitable non-invasive diagnostic modality for this bony configuration of the mandible since it provides a lower radiation exposure dose than MSCT.

Lingual and buccal mandibular bone depressions: a review based on 583 cases from a world-wide literature survey, including 69 new cases from Japan

OBJECTIVES

To review present knowledge of so-called lingual and buccal mandibular bone depressions (n = 583) based on studies of 247 contemporary and 267 archaeological cases from a world-wide literature survey in addition to 69 new cases from Japan.

METHODS

The 69 cases from Japan were retrieved through examination of 42,600 consecutive panoramic radiographs.

RESULTS

Bone depressions can be divided into four topographical variants: (1) lingual anterior mandibular body (incisor-canine- premolar area) above the mylohyoid muscle; (2) posterior to the mandibular angle-first permanent molar area, below the mandibular canal, and a third located to the ascending, lingual mandibular ramus, posterior to the lingual foramen, just below the neck of the condyle. An excessively rare fourth variant is located to the buccal aspects of the ascending mandibular ramus.

CONCLUSIONS

The present concept favours that all variants have a common origin: a hyperplastic/hypertrophic lobe (or aberrant lobe) of the sublingual, submandibular or parotid salivary gland, exerting pressure upon the cortex of the mandible by the respective gland, leading to focal atrophy or resorption of the bone. The bone depressions take years to develop, appearing radiographically not until the 5th to 6th decades.

Stafne's bone cavity in the anterior mandible: a possible diagnostic challenge

Stafne was the first to report the presence of "bone cavities" in the angle of 35 mandibles. Such cavities generally appear in the area between the mandibular first molar and the mandibular angle, and are not considered rare. One of their primary radiological diagnostic features is the characteristic location below the mandibular canal. Stafne's bone cavity is relatively rare in the anterior mandible. The mandibular canal is not present in the anterior mandible. As a result, diagnosis in the anterior mandible may be missed. Needless treatment modalities such as endodontic treatment, bone trephining, and bone exploration may be conducted. The purpose of the present report is to describe a new case of Stafne's bone cavity in the anterior mandible and discuss the differential diagnosis process. The dental computerized tomography scan is suggested as the most suitable noninvasive diagnostic and follow-up modality for this bony configuration in the anterior mandible.

Lingual mandibular bone defect. Case report and review of the literature

An unusual case of lingual mandibular bone defect (Stafne's bone cavity) is presented in which the lesion extended to above the inferior dental canal and caused expansion of the buccal cortical plate. The literature is reviewed with regard to the incidence, plausible aetiologic factors and methods of investigation of such lesions.

Anterior lingual mandibular salivary gland defect. Evaluation of twenty-four cases

Lingual mandibular salivary gland defects in the posterior part of the mandible are not uncommon. Analogous defects in the anterior region, however, are rare, and the four new cases presented in this report bring the total number of reported cases up to 24. The purpose of the present study was to review and analyze the clinical, radiographic, and histologic features of the previously reported cases together with those of the present study. The majority of these defects were located in the cuspid and/or premolar area and were diagnosed in men in their fifth and sixth decades of life. Almost all defects contained normal salivary gland tissue. The differential diagnosis, treatment, and pathogenesis of these defects are discussed.

An unusual case of lingual mandibular depression

The literature concerning lingual mandibular depressions is briefly presented, and a case of an anterior depression containing salivary gland tissue is described. Since this is a rare condition, the presentation of an additional case is of interest.

An asymptomatic radiolucent lesion in the mandible

The lingual cortical mandibular defect is easily diagnosed radiographically. The key features include: a well-defined radiolucent area, location below the mandibular canal, and placement anterior to the angle of the mandible. Routine surgical exploration is not indicated, but sialography or radiographic follow-up may be useful.

Development of a Stafne mandibular bone cavity. Report of a case

The present study reports a case in which a clinically asymptomatic radiolucent change surrounded by a sclerotic wall developed below the second molar in the mandible of a middle-aged man. The change was diagnosed as a typical case of Stafne bone cavity. In the earlier literature, development of a mandibular bone cavity has been described in only three patients. The appearance of bone cavities in a mandible that has previously been found normal indicates that these defects are not congenital but developmental processes.

Unusual presentation of a Stafne bone cyst

Mandibular radiolucencies are present in a variety of situations. These fall into developmental, metabolic, traumatic, infectious, and neoplastic categories. Differential diagnosis of these "lesions" is arrived at through signs, symptoms, history, radiographic presentation, and other diagnostic tools. This article presents the case of a 77-year-old man with an unusual radiographic presentation of the left posterior mandible.

Idiopathic lingual mandibular bone "depression"

A case of Stafne's idiopathic lingual bone depression is described. This occurred in the classical position below the mandibular molars. On surgical exploration, the defect was found to contain a lymph node rather than the more usual salivary tissue. This may throw some light on the possible etiology of this condition.

Stafne's mandibular lingual cortical defect. Discussion of aetiology

The literature relevant to Stafne's mandibular lingual cortical defect is reviewed. Four case descriptions are added. Aetiological theories are discussed and an alternative hypothesis of circumscribed, localized bone atrophy due to relative ischaemia is proposed.

Stafne's bone cavity: a review of the literature and report of two cases

This paper reports two cases of Stafne's bone cavity, one of which shows apparent regression over a period of 8 years: an unusual feature that has not previously been reported. A comprehensive review of the literature dealing with this well demarcated mandibular radiolucency of unknown aetiology accompanies these two case reports.

Lingual cortical mandibular defects: a radiographic incidence study

Two thousand six hundred ninety-three oral panoramic radiographs were reviewed, and thirteen (0.48 percent) displayed changes characteristic of lingual cortical defects of the mandible. The abnormalities were almost equally distributed on the right and left sides, and none occurred bilaterally. All of the patients with the defects were adult males, and none of the areas was symptomatic. In one patient the defect was determined to have been present for 7 years with no discernible radiographic change.

Radiographic interpretation of so-called developmental defect of mandible

Ten cases of so-called development defect were detected on panoramic radiograms. One of them was bilocular, two were round, three were ovoid, and four were half-ovoid. Eight were in men and two were in women. These cystlike lesions are sometimes misdiagnosed as epithelium-lined cysts or benign tumors, such as ameloblastoma. For the detection of this kind of defect, panoramic radiography is available, and the lesion is differentiated from many cysts and tumors in the jaws by posteroanterior projection and occlusal films. From the published literature, some tendencies of age distribution and sex incidence were reviewed.

A stereosialographic study of developmental mandibular bone defects (Stafne's idiopathic bone cavities)

The purpose of the study was to investigate with the aid of stereosialography and orthopantomography, the connection between developmental mandibular bone defects and the submandibular salivary gland. In sialographies on seven patients, there were two cases in which the contrast medium was found, with certainty, to fill the lobe of the submandibular salivary gland in the area of the bone defect. In four cases the contrast medium ended in the immediate vicinity of the defect. In one case no conclusive result was obtained. The results of the study suggest that the developmental mandibular bone defect and the lobe of the submandibular salivary gland being in close contact with the lingual surface of the mandible have a probable etiologic causal connection, at least in a number of cases.