Analysis of Palatine and Adenoid Calcification in a Sample of the Lebanese Population Using Cone‑Beam Computed Tomography Technology

Objectives

Tonsilloliths and adenoid calcifications are usually an incidental finding in radiologic studies. Several studies were done to evaluate the presence of tonsillar calcifications using different radiological techniques that include panoramic radiographs, computed tomography (CT), and cone-beam computed tomography (CBCT). These percentages varied in different populations and changed with the technique used. A CBCT is used to allow the visualization of the calcifications to make a better diagnosis. To the best of our knowledge, this is the first study conducted in Lebanon to study tonsillar and adenoid calcifications using CBCT. This study aims to assess the epidemiology and the demographic criteria of tonsilloliths and adenoid calcifications in a sample of the Lebanese population using the CBCT.

Methods

In this retrospective study, CBCT images of 125 patients attending a private clinic in Jbeil, Lebanon from May 2016 to July 2019 were selected. Images were evaluated by a maxillofacial radiologist. Adenoid and palatine calcifications were recorded. Statistical analysis was conducted using the Statistical Package for Social Sciences (SPSS) software, version 21 (IBM SPSS Statistics, Armonk, NY, USA). The level of statistical significance was established at a p-value < 0.05.

Results

A total of 21 patients (17.35%) had palatine calcifications and two patients (1.65%) had adenoid calcifications. From those with tonsilloliths, 12 female patients (16.43%) and nine male patients (18.75%) had palatine calcifications. Moreover, one male (2.08%) and one female (1.36%) had adenoid calcifications. There was no statistically significant difference in the distribution of calcifications with respect to gender. There was a non-statistically significant difference in the mean age of the patients with respect to the distribution of palatine and adenoid calcifications. The pattern of palatine calcifications showed a statistically significant difference in various age groups. Palatine calcifications distribution, with respect to the side, were statistically significant.

Conclusion

The prevalence of tonsilloliths in our sample was found to be 17.35%. The high prevalence detected was due to the technique used, the CBCT, which ensured a more detailed examination. The distribution was not affected by gender and age. However, multiple patterns of calcification were identified in younger age groups as opposed to other studies. Moreover, adenoid calcifications were present in 1.65% of the sample.

The Infraorbital Foramen in a Sample of the Lebanese Population: A Radiographic Study

Purpose

The infraorbital foramen (IOF) is an important structure in the maxillofacial region through which important structures pass. Wide variability in the shape and location of the infraorbital foramen among different populations and ethnic groups is present. So we conducted this study to specify the IOF shape, the presence of accessory foramina, and the IOF location with respect to anatomic landmarks in the Lebanese population.

Patients and method

A cross-sectional retrospective study was conducted on cone-beam computed tomography (CBCT) scans of 105 Lebanese adult patients. Images were reviewed and the shape, diameter, and location of the IOF were recorded. The presence of an accessory foramen was also noted. Then, SPSS version 21 (IBM Corp., Armonk, NY, US) was used for the statistical analysis.

Results

Concerning the distances from the IOF to the anatomic landmarks, the distance from the IOF to the infraorbital margin measured 7.98 ± 1.41 mm, to the lateral nasal wall 10.61 ± 2.39 mm, and to the midline 24.71 ± 2.09 mm. When distances were compared, a statistical difference was only identified in the distance between the IOF and the lateral nasal wall (p=0.00), and the distance between the IOF and the middle of the face (p=0.016) between genders. For the shape of the IOF, 54.8% of the IOF were circular in shape, and this shape was the most common shape in females. An accessory foramen was present in 8.6% of the cases. Finally, the mean diameter of the foramina measured 3.71 ± 0.63 mm.

Conclusion

The IOF shows a lot of variability between different populations. Thus, the exact location should always be remembered during an infraorbital nerve (ION) block, during maxillofacial surgeries, and during esthetic procedures involving the facial region in order to prevent unnecessary complications.