Cone beam CT sialography of Stafne bone cavity

Radiological features of Stafne mandibular bone cavity in panoramic image and cone beam computed tomography

BACKGROUND

Stafne mandibular bone cavity (SMBC) is an asymptomatic radiolucent lesion observed in the mandible on X-ray images, with well-defined borders. This lesion does not require treatment, and size changes are very rare. The purpose of this article is to summarize the radiological and clinical features of SMBC, aiming to prevent misinterpretation of this benign lesion as other pathologies and aid in differential diagnosis within the field of dental practice.

METHODS

A total of 32 patients who visited our hospital and were radiologically diagnosed with SMBC based on cone-beam computed tomography (CBCT) and panoramic images between 2005 and 2021 were included in this study. Among them, surgical intervention was performed in one case. Gender and age distribution of the patients, radiographic location and size of the lesion, relationship with the mandibular canal in CBCT, presence of cortical bone erosion in the mandibular lingual area in panoramic images, and the amount of residual cortical bone on the affected side in CBCT were investigated.

RESULT

Patients were 26 men (81.3%) and 6 women, with a mean age of 54.3 years. The average horizontal and vertical length was 16.6 mm and 10.6 mm. Out of a total of 32 cases, 29 cases were found in the posterior region of the mandibular body, while 3 cases were in the angle of the mandible. Lesions located below the mandibular canal were observed in 29 cases, while lesions involving the mandibular canal were present in 3 cases. Erosion of the mandibular lingual cortical bone was observed in 11 cases (34.4%), while 21 cases (65.6%) showed no erosion on panoramic images. Among the total of 14 cases (43.8%) where the cortical bone on the affected side was invaded, the average residual cortical bone thickness was 1.1 mm.

CONCLUSION

SMBC is a benign lesion primarily found in the mandibular angle and posterior body of the mandible. In most cases, treatment is not necessary, and differentiation from other lesions can be achieved by understanding its clinical characteristics and features on panoramic radiographs and CBCT.

Stafne's Bone Defect Correlated with Submandibular Glands: A Case Report and CBCT and MRI Analysis

Stafne's bone defect is a developmental anatomic bone defect in the lingual side of the mandible in the area of the mandibular angle that is filled with proliferation or translocation of adjacent structures such as salivary gland tissue. The etiology is still undefined, and two hypotheses are proposed: one is the glandular related to the submandibular or sublingual glands and the second is ischemic that affects the vascularization of the mandibular lingual. Usually, Stafne's bone defect is accidentally detected on panoramic radiographs during dental treatments as a well-limited radiolucency image with a clear peripheral regular condensation border, located below the mandibular canal. The differential diagnosis includes traumatic bone cyst, odontogenic and nonodontogenic cystic lesions, nonossifying fibroma, focal osteoporotic bone marrow defect, and other lesions. A case of Stafne's bone defect on a 60-year-old male patient extending in the lingual posterior part of the mandibular region was presented. The panoramic radiograph revealed a well-limited radiolucency image with a clear peripheral regular condensation border, located below the mandibular canal. The lesion was discovered in a routine radiographic exam: the cone beam computed tomography gave us more details about the localization, the shape and size, and the relation with the mandibular canal, and the magnetic resonance imaging identifies the nature of the inside soft tissue. The final diagnosis was a Stafne's bone defect resulting of a depression of the lingual cortical plate filled with expansion of the submandibular gland.

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.

Stafne's bone defect with bicortical perforation: a need for modified classification system

Stafne's bone defect (SBD) or salivary gland-related bone defects are asymptomatic bone cavities in the mandible caused by impingement by the salivary glandular tissue. The major salivary glands, particularly the submandibular gland, are in close relation with the mandible and their impingement can produce radiolucent defects on the lingual cortical surface of the mandible. Submandibular gland-related bone defects or depressions are referred as posterior lingual variant of SBD. These are asymptomatic and appear as well-defined radiolucent areas that are incidentally discovered on panoramic radiographs. Three-dimensional imaging may be required to evaluate the extent of cortical involvement and to determine the content of the cavity or defect. Usually, these defects are seen in the lingual cortices and are lined by cortex that causes a smooth radiopaque periphery. The involvement of both the buccal and lingual cortices by the defect is extremely uncommon. Literature has classified cases with buccal cortical expansion but buccal cortical perforation has not been described and classified. This case report describes this uncommon presentation of the salivary gland bone defect and through an in-depth literature review proposes a modification in the existing classification system.

Stafne's bone cyst revisited and renamed: the benign mandibular concavity

OBJECTIVE

Stafne's bone cyst (SBC) is an asymptomatic, round or oval-shaped, well-defined, uniform radiolucent lesion, usually incidentally observed in the posterior aspects of the mandible. Radiographical appearance may be confusing though. This study aimed to review the literature on SBCs and to map the SBC as shown in their respective papers.

METHODS

A Pubmed® search (1/9/2018 till 31/5/2019), mentioning SBC, was carried out. Included papers had to contain: patient's age, gender and radiographs.

RESULTS

In total, 114 papers were found, but only 64 papers were retained, which contained 109 cases (95 males, 14 females). The patients' ages ranged between 14 and 89 years old (mean age being 52 years). Male patients' ages (N = 95) ranged from 14 to 89 years (mean age 52.3 years), whereas the females (N = 14) ages ranged between 22 and 68 (mean age 50.2 years). 28 combinations of locations of SBC were recorded. Only three lesions were located at the symphysis, six were bilateral, 55 appeared on the left hand side and 45 on the right hand side of the mandible.The literature mentioned that these cavities could contain salivary gland tissue, muscular tissue, lymphoid tissue, blood vessels, fat tissue or connective tissue.

DISCUSSION/CONCLUSION

This study illustrates the wide variation of SBC locations across the mandible and leads us to conclude that the differential diagnosis of every asymptomatic, oval or round, well-defined, uniform radiolucent lesion on two-dimensional radiographs of the mandible should include "a benign mandibular concavity", formerly known as SBC.

An unusual case of double stafne bone cavities

Stafne bone cavity (SBC) is a rare lingual bone depression that is asymptomatic and contains salivary glands. Radiographically, an SBC is usually seen as well-defined homogenous oval radiolucency in the mandibular posterior region, below the mandibular canal. In this paper, a rare case of posterior-variant, double SBCs was presented. A 43-year old male patient was referred to our clinic with the complaint of third molar teeth. Panoramic and cone-beam computed tomographic images showed two well-defined oval radiolucencies on the left mandibular molar region, inferior to mandibular canal borders. No pain or swelling was detected in the region of the radiolucencies. Previous dental radiographs had the same images. Magnetic resonance imaging was performed to evaluate the presence of salivary gland in the radiolucent contents. Images showed that the bone cavities were filled with soft tissue having a signal similar to the submandibular gland. The diagnosis was made as double SBCs and the patient was informed about the lesions.

Stafne bone cavity: a rare cadaveric case report

The Stafne bone cavity (SBC), also called the static bone cavity, salivary inclusion cyst, latent cyst, and lingual bone defect is an asymptomatic bony defect that is commonly located inferior to the mandibular canal and slightly above the inferior border of the mandible. It is rare to see the actual bony defect in the cadaver because of its relatively low incidence of 0.1% to 6.06%. We report a unilateral SBC found in a 76-year-old at death male Caucasian cadaver and involving the right mandible. The SBC was oval in shape with a smooth surface and measured 10.8×6.0 mm. The SBC was continuous with the right mylohyoid groove. Since actual photographs of the SBC are lacking in the literature, this report might provide additional insight for better understanding the SBC.

Stafne's bone defect: a case report and review of literatures

Stafne's bone defect (SBD) or Stafne's bone cavity (SBC) is an uncommon bony defect occurred especially only at the lingual cortex of mandible. Clinically, patients with SBD are usually asymptomatic. In most cases, the defect is observed accidentally via X-ray panorama during other dental treatments. Here we presented a female with SBD and we reviewed relevant literatures on SBD, summarized the clinical characteristic and radiographic features with our experiences.

Stafne bone defects radiographic features in panoramic radiographs: Assessment of 91 cases

Background

To evaluate 91 cases of Stafne bone defect (SBD) in panoramic radiographs (PR) to determine the prevalence of different SBD variants, considering age, gender, and side. Additionally, to assess the most frequent imaging features of SBD.

Material and Methods

Participant data were collected from 91 SBD cases with PR imaging. First, SBDs were classified according to their location, as anterior, posterior, or ramus variant. SBD imaging features were classified according to radiographic imaging findings, assessing margins, degree of internal radiolucency, shape, topographic relationship between the defect and mandibular border, location of the defect according to mandibular teeth, and locularity. The topographic relationship between the SBD and the mandibular canal was described for the inferior variant only. Mean sizes were also described.

Results

A total of 92 SBD cases were evaluated from 91 radiographs. One case presented multiple defects. Mean patient age was 60.80 years. Men were more affected than women. The most frequent SBD variant was the posterior variant, and the least frequent was the ramus variant. The most observed radiographic features were thick sclerotic bone margin in the entire contour of the defect, partially radiolucent internal content, oval shape, continuity with mandible base without discontinuity of mandible border, third molar region location, and unilocular shape. With the posterior variant only, the most common topographic relationship between the defect and the upper wall of the mandibular canal was the defect located below the upper wall and continuous with the inferior wall of the mandibular canal.

Conclusions

The knowledge of common SBD radiographic imaging features in PR can help dental practitioners with the differential diagnosis of SBD.

Key words:Panoramic radiograph, mandible, bone cysts, salivary glands, Stafne bone defect.

Radiographic features of lingual mandibular bone depression using dental cone beam computed tomography

OBJECTIVES

To describe accurately the radiographic characteristics of lingual mandibular bone depression (LMBD) using CBCT images.

METHODS

This study included 30 cases of LMBD with CBCT images from 29 patients. Age, sex, location, shape, size, and the relationships of the LMBDs to adjacent anatomical structures such as the mandibular inferior cortex and mandibular canal were recorded. The correlation between age and size was evaluated using Pearson's correlation coefficient.

RESULTS

The average age of the patients was 57 years. LMBDs occurred primarily in males (93%), occurrence in the right (n = 14) and left (n = 16) mandibles was approximately equal. The shapes were ovoid, round, peanut, triangular, or rectangular on panoramic radiographs. The occurrences in the molar, distal to the molar, and ramus regions were 63.3, 33.3, and 3.3% respectively. The mean size on CBCT was 15.4 mm in length, 11.2 mm in height, and 6.4 mm in depth. The relationship to the mandibular canal was categorized as separated (48.2%), contacted (31%), or go-through (20.7%). The relationship to the mandibular inferior cortex was classified as separated (20.7%), contacted (27.6%), or resorbed (51.7%). The Pearson's correlation coefficient showed a positive correlation between age and depth (r = 0.38; p = 0.038).

CONCLUSIONS

The typical features of a LMBD were ovoid, round or mutilobated radiolucent shape, well-defined sclerotic border, and position in the posterior area of the mandible between the mandibular canal and inferior mandibular cortex. The buccolingual depth of LMBD was deeper with increasing age.

"Is Cone Beam Computed Tomography (CBCT) a Potential Imaging Tool in ENT Practice?: A Cross-Sectional Survey Among ENT Surgeons in the State of Odisha, India

This questioner survey aimed about awareness of the Cone Beam Computed Tomography (CBCT) machine and its various clinical applications in ENT, among the ENT surgeons in the state of Odisha. 150 questioner forms on CBCT were distributed to the all the participating ENT surgeons at a state level ENT conference, out of which the response rate was 110. The participants were asked to answer 30 multiple choice questions, which were divided into 3 parts; general information on CBCT, general approach to CBCT and practice related to CBCT. The statistical analysis of the data collected was carried out by a Chi square test to compare the means at a significance level of P < 0.05. The response rate for this study was 73%. The mean age of the participant ENT surgeons was 47.9 (±19.2). Of the study population, 71.2% (89) did not ever advice CBCT in their practice. Only 33.9% (38) of the population believed that CBCT is more beneficial in the field of ENT. Only 25% (28) knew that CBCT requires lower radiation dose than conventional CT. 28.1% (31) of population believed that the spatial orientation is better in CBCT than CT. 62.5% (69) of the population did not knew that CBCT can be used in imaging sinusitis of dental origins. 75% (83) of the population did not knew that CBCT can be used in diagnosis of obstructive sleep apnoea and visualizing airway space. Only 18.8% (21) of the study population agreed that the CBCT has the potential to replace conventional CT in ENT imaging in future. In the conclusion, this study clearly showed that the number of ENT surgeons advising CBCT imaging in their practice is very less. The knowledge about various advantages and clinical applications of CBCT had been very limited. However, through continuing medical education and conducting various seminars and workshops on CBCT, imparting chapters on CBCT, in the undergraduate and post graduate curriculum will definitely help increase the awareness on CBCT among ENT fraternity.

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.

The feasibility of cone beam computed tomographic sialography in the diagnosis of space-occupying lesions: report of 3 cases

Cone beam computed tomography (CBCT) is being widely used in recent years and has modernized the practice of oral and maxillofacial radiology by its inherent advantages, such as short scanning time, high resolution, and low dose of radiation to the patient. Sialography can be considered as the second step of assessment of space-occupying masses after initial diagnosis with ultrasonography. Sialography is combined with plain radiographs in routine practice. It can also be combined with advanced modalities such as computed tomography (CT), magnetic resonance imaging (MRI), and CBCT. In this report, we describe 3 cases to confirm the feasibility and superiority of sialography using CBCT and 3-dimensional (3D) images in space-occupying lesions of major salivary glands when conventional sialography is not diagnostic or MRI and CT are not easily available or affordable. CBCT sialography and its 3D images can be helpful in the diagnosis of space-occupying lesions of major salivary glands.

Assessment of the role of cone beam computed sialography in diagnosing salivary gland lesions

Purpose

The purpose of this study was to assess cone-beam computed (CBCT) sialography imaging in the detection of different changes associated with lesions of salivary glands.

Materials and Methods

This study consisted of 8 cases with signs and symptoms from salivary gland lesions. Conventional sialography using digital panoramic and lateral oblique radiographs and CBCT sialography were performed for each subject. The radiographs were evaluated by 3 radiologists independently of each other. The results were compared between conventional sialography and CBCT sialography in the evaluation of various lesions associated with the salivary glands.

Results

There was an agreement between the radiologists in interpreting the lesions that affected salivary glands with both techniques. The detection of the presence of stones or filling defects, stenosis, ductal evagination, dilatation, and space occupying lesions was 83% for conventional sialography compared with CBCT sialography. CBCT sialography was superior to conventional sialography in revealing stones, stenosis, and strictures, especially in the second and third order branches.

Conclusion

It would be advisable to perform CBCT sialography in cases of obstructive salivary gland diseases for better demonstration of the ductal system of the gland.

An unusual trilobate Stafne bone cavity

This report describes an unusual case of trilobate Stafne bone cavity in a 72-year-old male asymptomatic patient, presenting as a radiolucency in the left mandibular body with an irregular peripheral border and a central area of reduced density on panoramic radiograph.