Clinical Review Significance of incidental and a Review findings of Incidental Findings in CBCT
Familiarity with the radiographic appearance of cosmetic fillers is necessary in order for practitioners to distinguish them from true pathology . Clinicians must be able to recognize complications of dermal fillers like filler migration , tissue necrosis , allergic and sensitivity reactions , and inflammatory nodule and granulomatous reactions that may show up in CBCT images . 38
Figure 10
3D reconstruction of CBCT image showing radiopaque gold susuk wires in the maxillary , nasal , and mandibular regions .
Gold Susuk Gold susuk , or charm needles ( Figure 10 ), are metal pins implanted under the skin and act as talismans in Malay culture . It is also used as adjuvant therapy for pain managemnet 39 and for cosmetic enhancement ( wrinkle reduction ). 40 The charm needles are most commonly gold and the insertion is believed to enhance attributes such as beauty and charm and offer protection against injury . Radiographically , susuk appear as radiopaque objects resembling thin metal needles and can be found in areas throughout the maxillofacial complex including the frontal , mandibular , and maxillary regions . 41 Susuk may resemble foreign bodies introduced during trauma . They seldom are symptomatic and typically do not lead to any complications . 42 No treatment is usually indicated after radiographic identification . Familiarity with the radiographic appearance is necessary in order for practitioners to distinguish them from true pathology .
Figure 11
Sagittal view of CBCT image showing radiopaque thyroid cartilage calcification .
Thyroid Cartilage Calcifications The thyroid cartilage is located anterior to the larynx and superior to the thyroid gland . Calcification ( Figure 11 ) often begins in the second decade and first appears in the posterior part of the cartilage . 43 Physiologic calcification continues throughout life and appears radiographically as discrete radiopaque entities in the thyroid region . Calcification may represent a variation of normal and no treatment is usually indicated . If thyroid ossification in noted at an young age further
imaging might be required to rule out serious issues like parathyroid adenomas . 44 Further care must be taken to differentiate thyroid cartilage calcification from carotid arterial calcification especially in panoramic radiographs . Thyroid cartilage calcifications are bilateral , vertical crescent soft tissue calcification and are medial to C4 in the soft tissue whereas carotid artery calcifications are irregular , heterogenous radiopacities at the level of C3-C4 . 45
Triticeous Cartilage Calcifications The triticeous cartilage is located within the thyrohyoid ligament and exhibits patterns of calcification similar to other laryngeal cartilages . Calcification ( Figure 12 ) exhibits significant individual variation but usually begins in the second decade of life and concludes around the middle of the seventh decade . 46
Figure 12
Sagittal view of CBCT image showing radiopaque triticeous cartilage calcification .
Radiographically , triticeous cartilage calcifications appear as ovoid , radiopaque masses in the area of the thyrohyoid ligament . Similar to thyroid cartilage calcification , it is important to differentiate between triticeous calcification and carotid arterial calcifications in panoramic radiographs . Triticeous calcifications are bilateral , well-defined , ovoid radiopacities and are in an imaginary line which connects the superior cornu of thyroid with the greater cornu of the hyoid . 45
Figure 13
Axial view of CBCT image showing radiopaque vertebral artery calcification in the right and left side .
Vertebral Artery Calcification Chen et al . reported that ischemic stroke patients had a statistically significant higher frequency of vertebral artery calcifications compared to a control group ( 46.9 % vs . 24.7 %). 47 Radiographically , vertebral artery calcifications ( Figure 13 ) appear as curvilinear , tubular , or nodular calcifications in the region of
28 MAY / JUNE 2022 | PENNSYLVANIA DENTAL JOURNAL