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Bentin JM, Heegaard S, Jørgensen NR, Grahnemo L, Hamann S. Optic disc drusen: Dystrophic calcification, a potential target for treatment. Eye (Lond) 2024; 38:2359-2364. [PMID: 38778137 PMCID: PMC11306397 DOI: 10.1038/s41433-024-03138-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/05/2024] [Accepted: 05/07/2024] [Indexed: 05/25/2024] Open
Abstract
Optic disc drusen (ODD) are calcified, acellular bodies, seen in the optic nerve head of up to 2% of the population. Although seldomly affecting visual acuity, visual field defects are common, and severe, ischemic complications causing irreversible vision loss are known to occur. Different treatment strategies for ODD have been explored, but so far without success. This review focuses on the unique, calcified property of ODD, describing what we know about ODD pathogenesis and previously tried treatment strategies. In this context, we discuss current knowledge about calcium and pathological calcifications, including intracranial and ocular calcifications. We also explore some of the obstacles that must be addressed to develop a therapy centred on the concept of calcification, should calcification be identified as a pathogenic factor contributing to vision loss.
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Affiliation(s)
- Josephine Mejdahl Bentin
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
| | - Steffen Heegaard
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niklas Rye Jørgensen
- Department of Clinical Biochemistry, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Translational Research Centre, Rigshospitalet, Copenhagen, Denmark
| | - Louise Grahnemo
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Osteoporosis Centre, Centre for Bone and Arthritis Research at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Steffen Hamann
- Department of Ophthalmology, Rigshospitalet, Glostrup, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
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Skhiri W, Allagui H, Bouida A, Salem AB, Aouam A, Saad J, Salem R. Masseter idiopathic calcinosis circumscripta: A rare condition. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2022; 123:e402-e404. [PMID: 35235881 DOI: 10.1016/j.jormas.2022.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/17/2022] [Indexed: 06/14/2023]
Abstract
Calcinosis is defined as a biomineralization occurring in soft tissues leading to ectopic calcification. Isolated and localised calcification in a muscle is rare, and it is called calcinosis circumscripta in opposition to calcinosis universalis wich is seen in juvenile dermatomyositis and polymyositis. According to laboratory findings and clinical history, calcinosis circumscripta can be metastatic, dystrophic or idiopathic. Masseter muscle is rarely involved. Pre-operative diagnosis of masseter idiopathic calcinosis is a challenge because of many differential diagnosis. Here, we report a case of 22 years old women presented with swelling over left middle third of her face. Clinical history, morphologic and laboratory examinations helped considering such a rare diagnosis.
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Kumar G A, Deora SS. Dystrophic Calcification in the Oral Cavity Resulting in Mechanical Dysphagia: A Case Report and Review of Calcification in the Head and Neck Region. Cureus 2020; 12:e7469. [PMID: 32328392 PMCID: PMC7174858 DOI: 10.7759/cureus.7469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Soft tissue calcifications in the oral cavity and maxillofacial region are most often detected as incidental findings on routine radiographic examination. But sometimes these soft tissue calcifications can be serious and may need treatment or follow-up of the underlying cause. Deposition of calcium salt as a result of chronic inflammation, necrosis or scarring in injured tissues despite normal phosphorous and calcium metabolism is called dystrophic calcification. A variety of systemic disorders can be associated with this type of calcification but, still, the pathophysiology is not clear. Here we present a case of dystrophic calcification in the floor of the mouth of an 18-year-old female patient associated with dysphagia which was excised by intraoral route.
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Affiliation(s)
- Anup Kumar G
- Oral and Maxillofacial Surgery, Noorul Islam College of Dental Science, Trivandrum, IND
| | - Shakti Singh Deora
- Oral and Maxillofacial Surgery, OOM Superspeciality Head & Neck Surgical Centre, Ahmedabad, IND
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Çukurova Yilmaz Z, Tekin A. Relationship between the prevalence of soft tissue radiopacities on panoramic radiographs and medical conditions. MINERVA STOMATOLOGICA 2020; 69:235-244. [PMID: 32181615 DOI: 10.23736/s0026-4970.20.04329-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND This study aimed to describe radiographic characteristics and the prevalence of selected anatomical structures and soft tissue radiopacities on panoramic radiographs and their relationship to medical conditions. METHODS A retrospective cross-sectional study was conducted with 814 consecutive patients aged 35-88 years and their panoramic radiographs. Soft tissue calcifications found in the mandibular angle area were recorded according to gender, age, and bilaterally. Patient medical records were reviewed for atherogenic risk factors including hypertension, diabetes, dyslipidemia, chronic renal disease, menopause, drug usage and any other systemic condition. Data were analyzed with the χ<sup>2</sup> test and Fisher's Exact test; P<0.05 was considered statistically significant. RESULTS Among the 814 patients, a total of 74 (9.1%) calcified carotid artery atheromas (CCAA) were identified, of which 34 (4.17%), 40 (3.19%), and 14 (1.7%) were right, left, and bilateral, respectively. Orthopantomographic examination revealed triticeous cartilage (7.3%) in the cervical bifurcation region, asymptomatic styloid process elongation 192 (23.5%), tonsilloliths 27 (3.3%), sialoliths 37 (4.5%), calcified lymph nodes 46 (5.7%), impacted roots 109 (13.4%), and foreign radiopaque materials 23 (%2.8). There was a significant age and gender difference between type II diabetes and CCAA. A positive correlation was found between styloid process elongation and temporomandibular joint disorders and antidepressant use. CONCLUSIONS Soft tissue radiopacities can be a validated risk indicator of cardiovascular events or misdiagnosed pain. Dental practitioners must be aware of these atypical findings as they may be related to serious disease states and may require referral for further investigation.
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Affiliation(s)
- Zeynep Çukurova Yilmaz
- Department of Oral and Maxillofacial Surgery, Medipol University School of Dentistry, Istanbul, Turkey -
| | - Alperen Tekin
- Department of Dentomaxillofacial Radiology, Medipol University School of Dentistry, Istanbul, Turkey
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Kim HY, Park JH, Lee JB, Kim SJ. A case of dystrophic calcification in the masseter muscle. Maxillofac Plast Reconstr Surg 2017; 39:31. [PMID: 29159170 PMCID: PMC5671420 DOI: 10.1186/s40902-017-0130-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 09/18/2017] [Indexed: 11/10/2022] Open
Abstract
Background Dystrophic calcification can occur in any soft tissue with the absence of a systemic mineral imbalance and is often associated with trauma, infection, or inflammation. It is easily found in the site of the heart and skeletal muscles and rarely appears in the head and neck area. Case report We present a rare case of multiple calcified masses in the left masseter muscle of a 26-year-old female with a history of trauma in the area. In computed tomography, multiple radiopaque masses were observed inside the left masseter muscle and blood test results were normal. The calcified masses were diagnosed as dystrophic calcification and removed by surgery without any complications. Conclusion Different types of calcifications may occur in the cheek area, and they need to be distinguished from dystrophic calcification. Thorough clinical examination and history taking is required together with blood testing and radiographic examinations.
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Affiliation(s)
- Heon-Young Kim
- Department of Oral and Maxillofacial surgery, Ewha Womans University Mok-dong Hospital, Mok 5-dong, Yangcheon-gu, Seoul, 158-710 South Korea
| | - Jung-Hyun Park
- Department of Oral and Maxillofacial surgery, Ewha Womans University Mok-dong Hospital, Mok 5-dong, Yangcheon-gu, Seoul, 158-710 South Korea
| | - Jun-Bum Lee
- Department of Oral and Maxillofacial surgery, Ewha Womans University Mok-dong Hospital, Mok 5-dong, Yangcheon-gu, Seoul, 158-710 South Korea
| | - Sun-Jong Kim
- Department of Oral and Maxillofacial surgery, Ewha Womans University Mok-dong Hospital, Mok 5-dong, Yangcheon-gu, Seoul, 158-710 South Korea
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González-Arriagada WA, Santos-Silva AR, Vargas PA, Lopes MA. Diagnostic approach to intramasseteric nodules. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:e16-e21. [DOI: 10.1016/j.oooo.2016.10.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 09/30/2016] [Accepted: 10/08/2016] [Indexed: 10/20/2022]
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Nagaraja A, Kumar NG, Kumar BJ, Naik RM, Sangineedi YJ. A Solitary Phlebolith in the Buccal Mucosa: Report of a Rare Entity and Clinicopathologic Correlation. J Contemp Dent Pract 2016; 17:706-10. [PMID: 27659092 DOI: 10.5005/jp-journals-10024-1916] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pathological conditions can give rise to calcifications within oral mucosa representing either a local or systemic disturbance. Inflammation, trauma, debris acting as nidus and vascular lesions have been attributed as principal causes for occurrence of calcifications within the oral mucosa. Occurrence of multiple calcified thrombi (phleboliths) is considered pathognomonic for hemangiomas and vascular malformations in the oral and maxillofacial region. Isolated occurrence of phlebolith in oral mucosa though very rare, especially without any underlying vascular lesions, can be diagnostically challenging. Either a traumatic association at that site or a hemangioma of childhood that has regressed once the individual became an adult are the possible explanations suggested for the occurrence of these unique solitary phleboliths. Histologically, an "onion-ring"-like concentric lamellar fibrosis around a central core with varying amounts of calcifications and presence of minute vascular channels within or around calcified lamellae is characteristic for phlebolith. There is a high propensity for misdiagnosing solitary phlebolith located in sites like the buccal mucosa where various other pathologic soft-tissue calcifications, such as sialoliths, calcified lymph nodes, traumatic myositis ossificans, etc. can occur and they too appear radiopaque in radiographs. Besides, the absence of any associated underlying vascular lesion adds to the mispercep-tion. In such cases, histopathological examination with routine hematoxylin and eosin staining alone may not be sufficient to determine the accurate diagnosis. Allied clinical history and immunohistochemistry can aid to arrive at the final diagnosis. We report such a case of nonvascular lesion-associated solitary phlebolith in the right buccal mucosa of a healthy 49-year-old male patient and discuss its differential diagnosis with emphasis on histological presentation.
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Affiliation(s)
- A Nagaraja
- Professor, Department of Oral and Maxillofacial Pathology, Vishnu Dental College and Hospital, Bhimavaram, Andhra Pradesh India, e-mail:
| | - N Govindraj Kumar
- Department of Oral and Maxillofacial Pathology, Vishnu Dental College and Hospital, Bhimavaram, Andhra Pradesh India
| | - B Jambukeshwar Kumar
- Department of Oral Surgery, Vishnu Dental College and Hospital, Bhimavaram, Andhra Pradesh, India
| | - Raghavendra M Naik
- Department of Oral Medicine and Radiology, Vishnu Dental College and Hospital, Bhimavaram, Andhra Pradesh, India
| | - Y Jyoti Sangineedi
- Department of Oral and Maxillofacial Pathology, Vishnu Dental College and Hospital, Bhimavaram, Andhra Pradesh India
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Chislett SP, Liming BJ, Rogers DJ. Dystrophic calcification: A rare pediatric parotid mass. Int J Pediatr Otorhinolaryngol 2016; 81:38-40. [PMID: 26810287 DOI: 10.1016/j.ijporl.2015.11.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/26/2015] [Accepted: 11/27/2015] [Indexed: 10/22/2022]
Abstract
Dystrophic calcification, the ectopic deposition of calcium in previously damaged or inflamed tissues, is an uncommon finding in the head and neck. Only a few cases have been reported in the parotidomasseteric region, and all of them have been located within and adjacent to the masseter. We present a case of dystrophic calcification occurring entirely within the parotid gland in a 7-year-old girl without apparent inciting inflammation, infection, or trauma. Our patient's presentation highlights the diagnostic challenge associated with parotid masses in the pediatric population. To our knowledge, this is the first reported case of dystrophic calcification occurring entirely within the parotid gland in a child.
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Affiliation(s)
- Sean P Chislett
- Madigan Army Medical Center, Otolaryngology-Head and Neck Surgery, 9040 Jackson Ave., ATTN: MCHJ-CLS-E, Tacoma, WA 98431, United States.
| | - Bryan J Liming
- Madigan Army Medical Center, Otolaryngology-Head and Neck Surgery, 9040 Jackson Ave., ATTN: MCHJ-CLS-E, Tacoma, WA 98431, United States
| | - Derek J Rogers
- Madigan Army Medical Center, Otolaryngology-Head and Neck Surgery, 9040 Jackson Ave., ATTN: MCHJ-CLS-E, Tacoma, WA 98431, United States
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