Radiological findings of soft tissue calcification in mandible through panoramic radiography: a literature review
DOI:
https://doi.org/10.32793/jrdi.v10i1.1461Keywords:
Soft tissue calcifications, panoramic radiography, mandibleAbstract
Objectives: This review aims to analyze the role of digital panoramic radiography in identifying soft tissue calcifications in the mandibular region, summarize the prevalence and distribution of these calcifications based on recent literature (2018–2023), and critically evaluate the diagnostic necessity and relevance of complementary imaging modalities (CBCT, CT, MRI, and ultrasonography) for definitive characterization in each specific type of calcification.
Review: Soft tissue calcifications in the maxillofacial region are frequently detected as incidental findings on panoramic radiographs performed for routine dental evaluations. Although panoramic radiography is not the first-line modality for soft tissue assessment due to the superimposition of anatomical structures and reduced contrast resolution, its wide coverage enables visualization of a variety of calcified entities. Based on the reviewed studies, the most frequently detected calcifications include sialoliths, carotid artery calcifications, tonsilloliths, stylohyoid ligament calcification, phleboliths, and calcified lymph nodes. Prevalence varies widely between populations (5.4–46.9%) and increases significantly with age, particularly in individuals over 40 years old. Gender association remains inconsistent across studies. Panoramic radiography demonstrates value in identifying potentially clinically significant findings, such as carotid artery atheroma, which may indicate increased systemic vascular risk. However, localization and characterization accuracy remain limited, and advanced imaging modalities such as CBCT and MRI demonstrate superior capability in differentiating tissue origin and defining lesion morphology.
Conclusion: The most common soft tissue calcifications include sialoliths in the ramus or angle of the mandible, followed by calcifications of the carotid artery, stylohyoid ligament, phleboliths, tonsilloliths, and antroliths. The highest distribution is observed in the submandibular gland, followed by the parotid gland. Soft tissue calcifications are more prevalent in the middle-aged population, followed by young adults, and are more frequently found in women.
References
1. Moreira-Souza L, Michels M, Lagos de Melo LP, Oliveira ML, Asprino L, Freitas DQ. Brightness and contrast adjustments influence the radiographic detection of soft tissue calcification. Oral Dis. 2019;25(7):1809–14.
2. ALTINDA? A, CORA AH. Evaluation of Maxillofacial Soft Tissue Calcifications in Edentulous Patients on Panoramic Radiographs. Geriatr Bilim Derg. 2023;6(2):103–13.
3. Garay I, Netto HD, Olate S. Soft tissue calcification in the mandibular angle area observed by means of panoramic radiography. Int J Clin Exp Med. 2014;7(1):51–6.
4. KUR?UN ÇAKMAK E?, BAYRAK S, ATAKAN C. Prevalence and Characteristics of Soft Tissue Calcifications in CBCT Images of Mandibular Region. Clin Exp Heal Sci. 2020;10(1):68–71.
5. TURK E, AYYILDIZ VA, GÖRMEZ Ö. The Evaluation of Incidentally Detected Head and Neck Region Soft Tissue Calcifications and Ossifications on Computed Tomography Images. Süleyman Demirel Universitesi Sa?l?k Bilim Derg. 2022;13(3):393–401.
6. G O. Soft Tissue Calcification in Oral and Maxillofacial Imaging: A Pictorial Review. Int J Dent Oral Sci. 2016;3(3):219–24
7. Schreiner-Tiefenbacher B, Forster V, Pauli K, Sutter W, Meier M, Roland H, et al. Evaluation of mandibular calcification on 3D volume images. Heliyon. 2019;5(5):0–5.
8. Siber S, Hat J, Brakus I, Bio?i? J, Brajdi? D, Zajc I, et al. Tonsillolithiasis and orofacial pain. Gerodontology. 2012;29(2):e1157–60
9. Song Y Bin, Jeong HG, Kim C, Kim D, Kim J, Kim HJ, et al. Comparison of detection performance of soft tissue calcifications using artificial intelligence in panoramic radiography. Sci Rep [Internet]. 2022;12(1):1–10. Available from: https://doi.org/10.1038/s41598-022-22595-1
10. Preethy M, Elangovan S, Lakshmi SJ, Kumar S. Incidental findings of soft tissue radiopacities on digital panoramic radiographs: A cross-sectional study. J Indian Acad Oral Med Radiol. 2022;34(2):193–7.
11. Abdal K, Yari A, Bonyadi M, Shafiei E. Predictive Role of Ectopic Calcifications on Digital Panoramic Radiographs in the West of Iran. J Res Dent Maxillofac Sci. 2024;9(1):43–8.
12. Darwin D, Castelino RL, Babu GS, Asan MF. Prevalence of soft tissue calcifications in the maxillofacial region – a radiographic study. Braz J Oral Sci. 2023;22(e230009):1–14.
13. Kohinata K, Ishioka Y, Yamada S, Sugino N, Kuroiwa H, Yoshinari N, et al. Study on the carotid artery calcification appearing on the panoramic radiography and computed tomography. J Hard Tissue Biol. 2019;28(1):93–6.
14. Kose TE, Demirtas N, Karabas HC, Ozcan I. Evaluation of dental panoramic radiographic findings in edentulous jaws: A retrospective study of 743 patients. “Radiographic features in edentulous jaws.” J Adv Prosthodontist. 2015;7(5):380–5.
15. Pohankar P. Prevalence of soft tissue calcifications on digital panoramic radiographs in Marathwada population: A retrospective study. Int J Dent Health Sci. 2018; 5(1): 110-118.
16. Mohan N, Rizwana A, Ravikumar PT, Karthik R, Mathew S. Digital Panoramic Radiograph-A Screening Aid in Detection of Soft Tissue Calcifications: A Retrospective Study. J Adv Med Dent Sci Res. 2019;7(6):14–8.
17. Rajkumar M, Siva B, Sudharshan R, Srinivas H, Vishalini A. Prevalence of Soft Tissue Calcification in Orthopantamograph. Journal of Contemporary Issues in Business and Government. 2021;4(1):20–8.
18. Haghighat ASJ, Nikbin A, Sajedikia S. Prevalence of Soft Tissue Calcifications in Panoramic Radiographs of Patients Referred to Guilan School of Dentistry Within 1 Year and Its Relationship With Systemic Diseases. Avicenna J Dent Res. 2019;11(1):15–20.
19. Nasseh I, Sokhn S, Noujeim M, Aoun G. Considerations in Detecting Soft Tissue Calcifications on Panoramic Radiography. J Int Oral Heal. 2016;8(6):742–6.
20. da Silva Berticelli R. Calcifications in Soft Tissues Observed in Panoramic Radiographs. EC Dent Sci. 2018;17(12):2012–8.
21. Çitir M, Gündüz K. Panorama radyografide yumu?ak doku kalsifikasyon/ossifikasyonlar?n?n görülme s?kl???. Selcuk Dent J. 2020;7(2):226-232.
22. Patil SR, Alam MK, Moriyama K, Matsuda S, Shoumura M, Osuga N. 3D CBCT assessment of soft tissue calcifications. J Hard Tissue Biol. 2017;26(3):297-300.
23. Khojastepour L, Haghnegahdar A, Sayar H. Prevalence of soft tissue calcification in CBCT images of the mandibular region. J Dent (Shiraz). 2017;18(2):88-94.
24. Ye?ilova E, Bayrakdar ??. Radiological evaluation of maxillofacial soft tissue calcifications with cone beam computerized tomography and panoramic radiography. Int J Clin Pract. 2021;75(5):e14086
25. Yalcin ED, Ararat E. Prevalence of soft tissue calcification in the head and neck region: A cone-beam computed tomography study. Niger J Clin Pract. 2020;23(6):759-763.
26. Bayramov N, Üsdat A, Yalc?nkaya ?E. KIBT Görüntülerinde Rastlant? Bulgusu Olarak Görülen Yumu?ak Doku Kalsifikasyonlar?. Selcuk Dental Journal. 2019;6(4):228-233.
27. Garay I, Netto HD, Olate S. Soft tissue calcification in the mandibular angle region was observed by panoramic radiography. Int J Clin Exp Med. 2014;7(1):51-56.
28. Sezer B, Tugsel Z, Bilgen C. An unusual tonsillolith. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95(4):471-473.
29. Lo RH, Chang KP, Chu ST. Upper airway obstruction caused by bilateral giant tonsilloliths. J Chin Med Assoc. 2011;74(7):329-331
30. White C, Pharaoh MJ. Oral Radiology, Principles and Interpretation. 7th edition. St. Louis: Mosby Elsevier; 2014. p. 526 39
31. Khojastepour L, Haghnegahdar A, Sayar H. Prevalence of Soft Tissue Calcification in CBCT Images of Mandibular Region. J Dent (Shiraz). 2017;18(2):88-94.
32. Garay I, Netto HD, Olate S. Soft tissue calcification in the mandibular angle area observed by means of panoramic radiography. Int J Clin Exp Med. 2014;7(1):51–6
33. Kur?un Çakmak E?, Bayrak S, Atakan C. Prevalence and Characteristics of Soft Tissue Calcifications in CBCT Images of Mandibular Region. Clin Exp Heal Sci. 2020;10(1):68–71.
34. Kose TE, Demirtas N, Karabas HC, Ozcan I. Evaluation of dental panoramic radiographic findings in edentulous jaws: A retrospective study of 743 patients. J Adv Prosthodont. 2015;7(5):380-385.
35. ?ahin SC, Özdede M. Analysis of digital panoramic imaging findings in edentulous patients seeking prosthetic treatment. Ann Med Res 2020;27(9):2285-91
36. Ha?tar E, Y?lmaz H, Orhan H. Findings from panoramic radiography in edentulous elderly patients. SDU Sa?l?k Bil Ens Derg. 2010;1(2):82-7
37. Vengalath J, Puttabudi JH, Rajkumar B, Shivakumar GC. Prevalence of soft tissue calcifications on digital panoramic radiography: A retrospective study. J Radiol Med Oral Acad India. 2014;26(4):385
38. Garay I, Netto HD, Olate S. Soft tissue calcification in the mandibular angle region observed by panoramic radiography. Int J Clin Exp Med. 2014;7(1):51-6.
39. Sutter W, Roland H, et al. Evaluation of mandibular calcification on 3D volume images. Heliyon. 2019;5(5):1–5
40. Haghighat ASJ, Nikbin A, Sajedikia S. Prevalence of Soft Tissue Calcifications on Panoramic Radiographs of Patients Referred to Guilan Dental School Within 1 Year and Its Relationship to Systemic Diseases. Avicenna J Dent Res. 2019;11(1):15-20
41. Icoz D, Akgunlu F. Prevalence of soft tissue calcifications detected on digital panoramic radiography. SRM J Res Dent Sci. 2019;10(1):21.
42. Ohba T, Karasawa J, Watanabe R, Seki S, Shinozaki Y. Prevalence of carotid artery calcification on panoramic radiographs. Dentomaxillofacial Radiology. 2003;32(6):380-4.
43. Ohba T, Takata Y, Ansai T, Morimoto Y, Tanaka T, Kito S, et al. Evaluation of calcified carotid artery atheroma detected by panoramic radiography in an 80-year-old. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;96(5):647-50.
44. Bayer S, Hekimoglu S, Aras MH, Erbagci H. Prevalence of carotid artery calcifications on digital panoramic radiographs in the Gaziantep population. Journal of International Medical Research. 2012;40(1):335-42
45. Lincot J, et al. Tonsillolithiasis. Diagnostic and Interventional Imaging. 2016;97:279—282.
46. Boffano P, Zavattero E, Roccia F, Gallesio C. Myositis ossificans of the left temporal muscle: a case report. 2011;25(3):149–51.
47. Sarkari AD, Kumar A. Retropharyngeal calcific tendinitis: A rare cause of acute neck pain. J Clin Diagn Res. 2017;11(8):RD01-RD02.
48. Suresh K, Rajamani S, Arumugam S. Phleboliths in the maxillofacial region: A rare incidental finding on panoramic radiograph. J Indian Acad Oral Med Radiol. 2015;27(3):471-473.
49. Mupparapu M, Kantiro?lu A. Prevalence of soft tissue calcifications on digital panoramic radiographs. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(2):225-230.
50. Ahmad M, Madden R, Perez L. Triticeous cartilage: Prevalence on panoramic radiographs and diagnostic criteria. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2005;99(2):225-230.
51. Sezer B, Tugsel Z, Bilgen C. An unusual tonsillolith. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2003;95(4):471-473.
52. Lo RH, Chang KP, Chu ST. Upper airway obstruction caused by bilateral giant tonsilloliths. J Chin Med Assoc 2011;74: 329—31.
53. Mody RN, Srivastava S. Bilateral multiple tonsilloliths. Oral Radiol. 2009;25(1):67–70.
54. Mandel L. Multiple bilateral tonsilloliths: case report. J Oral Maxillofac Surg. 2008;66(1):148–50.
55. Lincot J, et al. Tonsillolithiasis. Diagnostic and Interventional Imaging. 2016; 97: 279—282.
56. Chuang CC, Lin HC, Huang CW. Submandibular cavernous hemangiomas with multiple phleboliths masquerading as sialolithiasis. J Chin Med Assoc 2005;68(9):441–3.
57. Mandel L, Perrino MA. Phleboliths and the vascular maxillofacial lesion. J Oral Maxillofac Surg 2010;68(8):1973–6.
58. Garry S, dkk. Calcium phosphate and calcium carbonate represent the main components of vascular phleboliths. Journal of Oral and Maxillofacial Surgery. 2010;68(8):1973–1976.
59. Zengin AZ, Celenk P, Sumer AP. Intramuscular hemangioma presenting with multiple phleboliths: a case report. Oral surgery, oral med, oral pathology and oral radiol 2013;115(1):e32–6.
60. Moreira-Souza L, Michels M, Lagos de Melo LP, Oliveira ML, Asprino L, Freitas DQ. Brightness and contrast adjustments influence the radiographic detection of soft tissue calcification. Oral Dis. 2019;25(7):1809–14.
61. Kamburo?lu K, et al. Cone beam computed tomography versus panoramic radiography in edentulous jaws: diagnostic yield comparison. Dentomaxillofac Radiol. 2021;50(5):20200184.
62. Schimmel M, Srinivasan M, McKenna G, Müller F. Effect of edentulism on oral and general health. Int J Environ Res Public Health. 2021;18(9):4986.
63. Rushton VE, Horner K. The use of panoramic radiology in dental practice. J Dent. 2020;98:103–110.
64. Carter LC, Haller AD. Soft tissue calcifications of the head and neck region. Oral Maxillofac Clin North Am. 2019;31(1):45–63.
65. Köse TE, et al. Prevalence of soft tissue calcifications in panoramic radiographs: a retrospective study. BMC Oral Health. 2021;21(1):1–8.
66. Patil S, et al. Prevalence of soft tissue calcifications on digital panoramic radiographs: a cross-sectional study. J Clin Exp Dent. 2022;14(3):e256–e262.
67. Sutter W, Bornstein MM, Buser D. Soft tissue calcifications in panoramic radiographs: prevalence and diagnostic considerations. Clin Oral Investig. 2019;23(6):2807–2815
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