A Comparative Study Evaluating Tonsillolith and Stylohyoid Ligament Ossification on Cone Beam Computed Tomography and Panoramic Radiography: A Retrospective Study
Öz
Aim: Dentists frequently encounter soft tissue calcifications in their routine practice. Stylohyoid ligament calcification or ossification (SHLO) is a common incidental finding on radiographs. Tonsillolith is a calcified structure formed as a result of chronic and recurrent inflammation in the crypts of the tonsils. The purpose of this study was to compare the prevalence of tonsillolith and SHLO and mean length oh SHL obtained using cone beam computed tomography (CBCT) and panoramic radiography (PR) images.
Material and Method: In this study, CBCT and PR images of a total of 289 patients (mean age 41.87 years), including 157 females and 132 males, were evaluated. The prevalence of tonsilloliths and SHLO was recorded as present/absent, and SHL lengths were measured as the linear distance between the base and the apex of the stylohyoid process on CBCT and PR images. The SHL lengths greater than 30 mm were labeled as SHLO and used in the prevalence statistics. Wilcoxon test used for the relationship between SHL/SHLO lengths obtained by two different imaging methods and McNemar test for the prevalence of tonsillolith obtained by two different imaging methods.
Results: The prevalence of tonsillolith was found to be 7.4% with PR and 23.5% with CBCT, the prevalence of SHLO was 34.78% with PR and 43.25% with CBCT, and the mean SHL length was 28.67 mm with PR and 30.88 mm with CBCT. The prevalence of SHLO and tonsillolith was found to be higher in CBCT than in PR, and the measured mean SHL length was greater. This difference was statistically significant. No statistically significant differences were observed between genders with respect to SHL length and SHLO prevalence. The prevalence of tonsillolith in males was found to be statistically significantly higher than in females.
Conclusion: In cases where the length of the SHL is of critical importance for SHLO or when there is a suspicion of Eagle syndrome, CBCT is more suitable imaging technique instead of PR. This is also the case for tonsillolith evaluations, as the CBCT eliminates superimpositions.
Anahtar Kelimeler
Cone-beam computed tomography heterotopic ossification palatine tonsil panoramic radiography
Etik Beyan
The research protocol was approved by Kütahya Health Sciences University Non-Interventional Clinical Research Ethics Committee (decision date and approval number: 22.04.2024, 2024/05-14). All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration. Since our research is a retrospective study, the informed consent form has not been taken.
Destekleyen Kurum
The authors declared that this study has received no financial support.
Proje Numarası
Decision date and approval number: 22.04.2024, 2024/05-14
Teşekkür
N/A
Kaynakça
- Syed AZ. Soft tissue calcifications in the head and neck region. Dent Clin North Am. 2024;68:375-91.
- Yalcin ED, Ararat E. Prevalence of soft tissue calcifications in the head and neck region: a cone-beam computed tomography study. Niger J Clin Pract. 2020;23:759-63.
- Scarfe WC, Farman A. Soft tissue calcifications in the neck: Maxillofacial CBCT presentation and significance. AADMRT Currents. 2010;2.2:3-15.
- de Oliveira Cde N, Amaral TM, Abdo EN, Mesquita RA. Bilateral tonsilloliths and calcified carotid atheromas: case report and literature review. J Craniomaxillofac Surg. 2013;41:179-82.
- Buyuk C, Gunduz K, Avsever H. Morphological assessment of the stylohyoid complex variations with cone beam computed tomography in a Turkish population. Folia Morphol (Warsz). 2018;77:79-89.
- Hettiarachchi PVKS, Jayasinghe RM, Fonseka MC, et al. Evaluation of the styloid process in a Sri Lankan population using digital panoramic radiographs. J Oral Biol Craniofac Res. 2019;9:73-6.
- Al-Amad SH, Al Bayatti S, Alshamsi HA. Stylohyoid ligament calcification and its association with dental diseases. Int Dent J. 2023;73:151-6.
- Akçiçek G, Kara D, Uysal S, Zengin HY. Comparison of elongation and calcification patterns of styloid process on panoramic and cone beam computed tomography images. European Annals of Dental Sciences. 2023;50:S1-5.
- Saati S, Foroozandeh M, Alafchi B. Radiographic characteristics of soft tissue calcification on digital panoramic images. Pesquisa Brasileira em Odontopediatria e Clínica Integrada. 2020;20:e5053.
- Dey A, Mukherji S. Eagle's syndrome: a diagnostic challenge and surgical dilemma. J Maxillofac Oral Surg. 2022;21:692-6.
- Badhey A, Jategaonkar A, Anglin Kovacs AJ et al. Eagle syndrome: a comprehensive review. Clin Neurol Neurosurg. 2017;159:34-8.
- Çitir M, Gündüz K. The prevelance of soft tissue calcification/ossification on panoramic radiography. Selcuk Dent J. 2020;7:226-32.
- de Moura MD, Madureira DF, Noman-Ferreira LC, et al. Tonsillolith: a report of three clinical cases. Med Oral Patol Oral Cir Bucal. 2007;12:E130-3.
- Babu BB, Tejasvi MLA, Avinash CK, B C. Tonsillolith: a panoramic radiograph presentation. J Clin Diagn Res. 2013;7:2378-9.
- Carter LC. Yumuşak doku kalsifikasyon ve ossifikasyonları. In: White SC, Pharoah MJ, eds. Oral radyoloji ilkeler ve yorumlama. 7 edition. Ankara: Palme Yayınevi; 2018;524-41.
- Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice. J Can Dent Assoc. 2006;72:75-80.
- Mısırlıoglu M, Nalcaci R, Adisen MZ, Yardımcı S. Bilateral and pseudobilateral tonsilloliths: three dimensional imaging with cone-beam computed tomography. Imaging Sci Dent. 2013;43:163-9.
- Duran MH, Coşgun Baybars S. Evaluation of soft tissue calcifications in the head and neck region on panoramic radiography of edentulous patients. NEU Dent J. 2024;6:208-15.
- Avsever H, Orhan K. Çene kemiği ve çevre dokuları etkileyen kalsifikasyonlar. Turkiye Klinikleri J Oral Maxillofac Radiol-Special Topics. 2018;4:43-52.
- Centurion BS, Imada TS, Pagin O, et al. How to assess tonsilloliths and styloid chain ossifications on cone beam computed tomography images. Oral Dis. 2013;19:473-8.
- Gayathri G, Elavenil P, Sasikala B, et al. 'Stylo-mandibular complex' fracture from a maxillofacial surgeon's perspective--review of the literature and proposal of a management algorithm. Int J Oral Maxillofac Surg. 2016;45:297-303.
- Ghabanchi J, Haghnegahdar A, Khojastehpour L, Ebrahimi A. Frequency of tonsilloliths in panoramic views of a selected population in southern iran. J Dent (Shiraz). 2015;16:75-80.
- Icoz D, Akgunlu F. Prevalence of detected soft tissue calcifications on digital panoramic radiographs. SRM Journal of Research in Dental Sciences. 2019;10:21-5.
- Takahashi A, Sugawara C, Kudoh T et al. Prevalence and imaging characteristics of palatine tonsilloliths evaluated on 2244 pairs of panoramic radiographs and CT images. Clin Oral Investig. 2017;21:85-91.
- Acikgoz A, Akkemik O. Prevalence and radiographic features of head and neck soft tissue calcifications on digital panoramic radiographs: a retrospective study. Cureus. 2023;15:e46025.
- Maia PRL, Tomaz AFG, Maia EFT, et al. Prevalence of soft tissue calcifications in panoramic radiographs of the maxillofacial region of older adults. Gerodontology. 2022;39:266-72.
- Lopes IA, Tucunduva RM, Handem RH, Capelozza AL. Study of the frequency and location of incidental findings of the maxillofacial region in different fields of view in CBCT scans. Dentomaxillofac Radiol. 2017;46:20160215.
- Missias EM, Nascimento E, Pontual M et al. Prevalence of soft tissue calcifications in the maxillofacial region detected by cone beam CT. Oral Dis. 2018;24:628-37.
- Pette GA, Norkin FJ, Ganeles J et al. Incidental findings from a retrospective study of 318 cone beam computed tomography consultation reports. Int J Oral Maxillofac Implants. 2012;27:595-603.
- Diniz V, Corrêa ECDCB, Gonçalves BC et al. Prevalence of soft tissue calcifications in cone beam computed tomography images in the region of head and neck. Brazilian Dental Science. 2020;23:6-p.
- Ozdede M, Akay G, Karadag O, Peker I. Comparison of panoramic radiography and cone-beam computed tomography for the detection of tonsilloliths. Med Princ Pract. 2020;29:279-84.
- Oda M, Kito S, Tanaka T et al. Prevalence and imaging characteristics of detectable tonsilloliths on 482 pairs of consecutive CT and panoramic radiographs. BMC Oral Health. 2013;13:54.
- More CB, Asrani MK. Evaluation of the styloid process on digital panoramic radiographs. Indian J Radiol Imaging. 2010;20:261-5.
- Zokaris N, Siska I, Natsis K et al. Investigation of the styloid process length in a Greek population. Folia Morphol (Warsz). 2019;78:378-88.
- Guimarães AC, Pozza DH, Guimarães AS. Prevalence of morphological and structural changes in the stylohyoid chain. J Clin Exp Dent. 2020;12:e1027-32.
- Togan B, Gander T, Lanzer M, et al. Incidence and frequency of nondental incidental findings on cone-beam computed tomography. J Craniomaxillofac Surg. 2016;44:1373-80.
- Okabe S, Morimoto Y, Ansai T, et al. Clinical significance and variation of the advanced calcified stylohyoid complex detected by panoramic radiographs among 80-year-old subjects. Dentomaxillofac Radiol. 2006;35:191-9.
- Andrei F, Motoc AG, Didilescu AC, Rusu MC. A 3D cone beam computed tomography study of the styloid process of the temporal bone. Folia Morphol (Warsz). 2013;72:29-35.
- Ilgüy D, Ilgüy M, Fişekçioğlu E, Dölekoğlu S. Assessment of the stylohyoid complex with cone beam computed tomography. Iran J Radiol. 2012;10:21-6.
- Alpoz E, Akar GC, Celik S, et al. Prevalence and pattern of stylohyoid chain complex patterns detected by panoramic radiographs among Turkish population. Surg Radiol Anat. 2014;36:39-46.
Öz
Proje Numarası
Decision date and approval number: 22.04.2024, 2024/05-14
Kaynakça
- Syed AZ. Soft tissue calcifications in the head and neck region. Dent Clin North Am. 2024;68:375-91.
- Yalcin ED, Ararat E. Prevalence of soft tissue calcifications in the head and neck region: a cone-beam computed tomography study. Niger J Clin Pract. 2020;23:759-63.
- Scarfe WC, Farman A. Soft tissue calcifications in the neck: Maxillofacial CBCT presentation and significance. AADMRT Currents. 2010;2.2:3-15.
- de Oliveira Cde N, Amaral TM, Abdo EN, Mesquita RA. Bilateral tonsilloliths and calcified carotid atheromas: case report and literature review. J Craniomaxillofac Surg. 2013;41:179-82.
- Buyuk C, Gunduz K, Avsever H. Morphological assessment of the stylohyoid complex variations with cone beam computed tomography in a Turkish population. Folia Morphol (Warsz). 2018;77:79-89.
- Hettiarachchi PVKS, Jayasinghe RM, Fonseka MC, et al. Evaluation of the styloid process in a Sri Lankan population using digital panoramic radiographs. J Oral Biol Craniofac Res. 2019;9:73-6.
- Al-Amad SH, Al Bayatti S, Alshamsi HA. Stylohyoid ligament calcification and its association with dental diseases. Int Dent J. 2023;73:151-6.
- Akçiçek G, Kara D, Uysal S, Zengin HY. Comparison of elongation and calcification patterns of styloid process on panoramic and cone beam computed tomography images. European Annals of Dental Sciences. 2023;50:S1-5.
- Saati S, Foroozandeh M, Alafchi B. Radiographic characteristics of soft tissue calcification on digital panoramic images. Pesquisa Brasileira em Odontopediatria e Clínica Integrada. 2020;20:e5053.
- Dey A, Mukherji S. Eagle's syndrome: a diagnostic challenge and surgical dilemma. J Maxillofac Oral Surg. 2022;21:692-6.
- Badhey A, Jategaonkar A, Anglin Kovacs AJ et al. Eagle syndrome: a comprehensive review. Clin Neurol Neurosurg. 2017;159:34-8.
- Çitir M, Gündüz K. The prevelance of soft tissue calcification/ossification on panoramic radiography. Selcuk Dent J. 2020;7:226-32.
- de Moura MD, Madureira DF, Noman-Ferreira LC, et al. Tonsillolith: a report of three clinical cases. Med Oral Patol Oral Cir Bucal. 2007;12:E130-3.
- Babu BB, Tejasvi MLA, Avinash CK, B C. Tonsillolith: a panoramic radiograph presentation. J Clin Diagn Res. 2013;7:2378-9.
- Carter LC. Yumuşak doku kalsifikasyon ve ossifikasyonları. In: White SC, Pharoah MJ, eds. Oral radyoloji ilkeler ve yorumlama. 7 edition. Ankara: Palme Yayınevi; 2018;524-41.
- Scarfe WC, Farman AG, Sukovic P. Clinical applications of cone-beam computed tomography in dental practice. J Can Dent Assoc. 2006;72:75-80.
- Mısırlıoglu M, Nalcaci R, Adisen MZ, Yardımcı S. Bilateral and pseudobilateral tonsilloliths: three dimensional imaging with cone-beam computed tomography. Imaging Sci Dent. 2013;43:163-9.
- Duran MH, Coşgun Baybars S. Evaluation of soft tissue calcifications in the head and neck region on panoramic radiography of edentulous patients. NEU Dent J. 2024;6:208-15.
- Avsever H, Orhan K. Çene kemiği ve çevre dokuları etkileyen kalsifikasyonlar. Turkiye Klinikleri J Oral Maxillofac Radiol-Special Topics. 2018;4:43-52.
- Centurion BS, Imada TS, Pagin O, et al. How to assess tonsilloliths and styloid chain ossifications on cone beam computed tomography images. Oral Dis. 2013;19:473-8.
- Gayathri G, Elavenil P, Sasikala B, et al. 'Stylo-mandibular complex' fracture from a maxillofacial surgeon's perspective--review of the literature and proposal of a management algorithm. Int J Oral Maxillofac Surg. 2016;45:297-303.
- Ghabanchi J, Haghnegahdar A, Khojastehpour L, Ebrahimi A. Frequency of tonsilloliths in panoramic views of a selected population in southern iran. J Dent (Shiraz). 2015;16:75-80.
- Icoz D, Akgunlu F. Prevalence of detected soft tissue calcifications on digital panoramic radiographs. SRM Journal of Research in Dental Sciences. 2019;10:21-5.
- Takahashi A, Sugawara C, Kudoh T et al. Prevalence and imaging characteristics of palatine tonsilloliths evaluated on 2244 pairs of panoramic radiographs and CT images. Clin Oral Investig. 2017;21:85-91.
- Acikgoz A, Akkemik O. Prevalence and radiographic features of head and neck soft tissue calcifications on digital panoramic radiographs: a retrospective study. Cureus. 2023;15:e46025.
- Maia PRL, Tomaz AFG, Maia EFT, et al. Prevalence of soft tissue calcifications in panoramic radiographs of the maxillofacial region of older adults. Gerodontology. 2022;39:266-72.
- Lopes IA, Tucunduva RM, Handem RH, Capelozza AL. Study of the frequency and location of incidental findings of the maxillofacial region in different fields of view in CBCT scans. Dentomaxillofac Radiol. 2017;46:20160215.
- Missias EM, Nascimento E, Pontual M et al. Prevalence of soft tissue calcifications in the maxillofacial region detected by cone beam CT. Oral Dis. 2018;24:628-37.
- Pette GA, Norkin FJ, Ganeles J et al. Incidental findings from a retrospective study of 318 cone beam computed tomography consultation reports. Int J Oral Maxillofac Implants. 2012;27:595-603.
- Diniz V, Corrêa ECDCB, Gonçalves BC et al. Prevalence of soft tissue calcifications in cone beam computed tomography images in the region of head and neck. Brazilian Dental Science. 2020;23:6-p.
- Ozdede M, Akay G, Karadag O, Peker I. Comparison of panoramic radiography and cone-beam computed tomography for the detection of tonsilloliths. Med Princ Pract. 2020;29:279-84.
- Oda M, Kito S, Tanaka T et al. Prevalence and imaging characteristics of detectable tonsilloliths on 482 pairs of consecutive CT and panoramic radiographs. BMC Oral Health. 2013;13:54.
- More CB, Asrani MK. Evaluation of the styloid process on digital panoramic radiographs. Indian J Radiol Imaging. 2010;20:261-5.
- Zokaris N, Siska I, Natsis K et al. Investigation of the styloid process length in a Greek population. Folia Morphol (Warsz). 2019;78:378-88.
- Guimarães AC, Pozza DH, Guimarães AS. Prevalence of morphological and structural changes in the stylohyoid chain. J Clin Exp Dent. 2020;12:e1027-32.
- Togan B, Gander T, Lanzer M, et al. Incidence and frequency of nondental incidental findings on cone-beam computed tomography. J Craniomaxillofac Surg. 2016;44:1373-80.
- Okabe S, Morimoto Y, Ansai T, et al. Clinical significance and variation of the advanced calcified stylohyoid complex detected by panoramic radiographs among 80-year-old subjects. Dentomaxillofac Radiol. 2006;35:191-9.
- Andrei F, Motoc AG, Didilescu AC, Rusu MC. A 3D cone beam computed tomography study of the styloid process of the temporal bone. Folia Morphol (Warsz). 2013;72:29-35.
- Ilgüy D, Ilgüy M, Fişekçioğlu E, Dölekoğlu S. Assessment of the stylohyoid complex with cone beam computed tomography. Iran J Radiol. 2012;10:21-6.
- Alpoz E, Akar GC, Celik S, et al. Prevalence and pattern of stylohyoid chain complex patterns detected by panoramic radiographs among Turkish population. Surg Radiol Anat. 2014;36:39-46.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Ağız, Diş ve Çene Radyolojisi |
| Bölüm | Özgün Makaleler |
| Yazarlar | |
| Proje Numarası | Decision date and approval number: 22.04.2024, 2024/05-14 |
| Yayımlanma Tarihi | 9 Mayıs 2025 |
| Gönderilme Tarihi | 1 Şubat 2025 |
| Kabul Tarihi | 3 Mart 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 7 Sayı: 2 |
Chief Editors
Assoc. Prof. Zülal Öner
İzmir Bakırçay University, Department of Anatomy, İzmir, Türkiye
Assoc. Prof. Deniz Şenol
Düzce University, Department of Anatomy, Düzce, Türkiye
Editors
Assoc. Prof. Serkan Öner
İzmir Bakırçay University, Department of Radiology, İzmir, Türkiye
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