Clinical Review Significance of incidental and a Review findings of Incidental Findings in CBCT
Figure 2
Coronal view of CBCT image showing lymph node calcifications in right submandibular region .
Lymph Node Calcifications Calcified lymph nodes ( Figure 2 ) contain deposits of calcium and indicate some form of lymph node disease . Lymph node calcification may be the result of benign processes such as chronic inflammation or granulomatous disease , the most common etiology . 13 Calcification in cervical lymph nodes may also represent malignant processes such as lymphoma or metastatic adenocarcinoma , 14 necessitating timely identification and referral for further treatment . Pette et al . 2012 reported that calcified lymph nodes were found in 2.52 % of the sample study . 15 Common location of lymph node calcification is the submandibular region . 9 Radiographically , these calcifications are either in single node or multiple nodes , called lymph node chaining , well defined , with irregular borders and have a lobulated appearance similar to shape of a cauliflower . 9 With the possibility of malignancy existing with these calcifications , it important for the clinician to recognize and report these findings .
Figure 3
Axial view of CBCT image showing carotid artery calcifications bilaterally in neck region .
Carotid Arterial Calcifications Stroke is one of the common causes of death in the USA , accounting for 1 in every 6 deaths from cardiovascular death in 2018 . 16 There exists debate over whether carotid calcification indicates increased risk of ischemia and cerebrovascular accident ( stroke ). Some studies indicate that carotid arterial calcification ( Figure 3 ) may represent an independent marker for stenosis and symptomatic ischemia 17 while others found that calcification scores could not be used to independently predict future stroke risk . 18 Despite this controversy , referral to a physician should be considered when carotid calcifications are identified . Carotid arterial calcification represent calcified atherosclerotic plaque within the cervical carotid arteries . Calcium formation within the walls of the carotid arteries may occur before significant stenosis and therefore may represent subclinical atherosclerosis . 19 The reported incidence in the
literature ranged from 5.3-5.7 %. 12 , 20 Allareddy et al . 2012 noted a significantly higher percentage of cases in males ( 7.3 %) compared to females ( 4.7 %). 12 Radiographically , carotid calcifications appear as radiopaque curvilinear masses in axial views located anterolateral to the transverse process . 21
Figure 4
Coronal view of CBCT images showing bilateral internal carotid artery calcifications .
Intracranial Internal Carotid Calcifications Intracranial internal carotid calcification ( Figure 4 ) has a potential association for increased stroke risk . Debate exists over whether internal carotid calcification is a risk factor for future stroke with some studies indicating an association with stroke risk 22 and others finding no relation with the presence of ischemic cerebrovascular disease . 23 However , due to the potential association with increased stroke risk , identification of calcifications should prompt dental professionals to refer patients for further evaluation . Pette et al . 2012 reported calcifications of the intracranial carotid artery in the middle cranial fossa ( 8.49 %), cavernous sinus ( 3.14 %), carotid canal ( 4.40 %), pituitary fossa ( 0.63 %), and brain ( 3.46 %) and found that subjects over 65 years of age were 5.01 times more likely to exhibit vascular pathology than subjects 65 years and younger . 15 Radiographically , intracranial internal carotid calcifications appear as radiopacities in the area of the cavernous sinus and anterior clinoid process .
Figure 5
Axial view of CBCT image showing well-defined , unilocular , radiolucent Stafne defect in right posterior mandible .
Stafne Defect The Stafne defect ( Figure 5 ) is a non-progressive depression in the lingual surface of the posterior mandible resulting from ectopic submandibular gland salivary tissue or rarely in the anterior mandible , due to the sublingual gland . Radiographically , the Stafne defect classically appears as a unilateral radiolucent oval located below the mylohyoid ridge and inferior alveolar canal in the region of the posterior molars . 24 The reported incidence is 0.1-0.48 % 25 and the lesion is
26 MAY / JUNE 2022 | PENNSYLVANIA DENTAL JOURNAL