Unorganized fashion of soft tissue calcification is referred to as heterotopiccalcification. Divided into three categories: • Dystrophic calcification(degenerating,diseased, and dead tissue) eg-blunt trauma, inflammation, injections, the presence of parasites, soft tissue changes arising from disease • Idiopathic calcification or calcinosis(deposition of calcium in normal tissue)eg- chondrocalcinosis and phleboliths. • Metastatic calcification (deposition in normal tissue as a result of higher than normal serum levels of calcium) hyperparathyroidism, hypercalcemia, of malignancy) or phosphate (e.g., chronic renal failure). usually occurs bilaterally and symmetrically
GENERAL DYSTROPHIC CALCIFICATIONOF THE ORAL REGIONS A large residual cyst with ill-defined calcifications seen in a panoramic image (arrows). coronal computed tomographic image with bone algorithm of the same case, which demonstrates the dystrophic calcification within the cyst (arrow).
A periapical film showing the soft tissue mass, inflammatory fibrous hyperplasia, emanating from the edentulous ridge. • This soft tissue mass contains a dystrophic calcification(arrow)
CALCIFIED LYMPH NODES lymph node “ chaining ” Examples of dystrophic calcification in the lymph nodes. behind the ramus with a cauliflower-like shape and two smaller examples in a more superior position (arrows). Several smaller examples positioned below the lower border of the mandible.
tuberculosis was (scrofula or cervical tuberculous adenitis). • bacille Calmette-Gu é rin vaccination, • sarcoidosis, • cat-scratch disease, • rheumatoid arthritis • Systemic sclerosis, • lymphoma previously treated with radiation therapy, • Fungal infections, and • metastases from distant calcifying neoplasms, most metastatic thyroid carcinoma.
Differential Diagnosis • Sialolith-smooth outline • Phleboliths- are usually smaller and multiple, with concentric radiopaque and radiolucent rings bull ’ s-eye or “ target
Calcification in the TonsilsTonsillar calculi, tonsil concretions, and tonsilloliths Dystrophic calcification of the tonsils. These two examples show positions anterior to the ramus (A) and overlapping the posterior aspect of the ramus (B) (arrows). Note the calcified stylohyoidligament.
Differential Diagnosis • calcified granulomatous disease, syphilis, mycosis, or lymphoma • dense bone island.
Arterial Calcifications Two distinct patterns of arterial calcification can be identified both radiographically and histologically • Monckeberg’s medial calcinosis • Calcified atherosclerotic plaque Monckeberg’s medial calcinosis Definition • The hallmark of arteriosclerosis is the fragmentation, degeneration, and eventual loss of elastic fibers followed by the deposition of calcium within the medial coat of the vessel.
MONCKEBERG ’ S MEDIAL CALCINOSIS (ARTERIOSCLEROSIS) • “ pipe stem ” or “ tram-track ” appearance in Sturge-Weber syndrome calcification of a facial vein
Evaluation of the patient for occlusive arterial disease and peripheral vascular disease may be appropriate. • In addition, hyperparathyroidism may be considered because medial calcinosis frequently develops as a metastatic calcification in patients with this condition.
CALCIFIED ATHEROSCLEROTIC PLAQUE • major contributing source of cerebrovascular embolic and occlusive disease. • Dystrophic calcification can occur in the evolution of plaque within the intima of the involved vessel. • Location. Atherosclerosis first develops at arterial bifurcations
Panoramic image with bilateral examples of calcifications associated with the carotid arteries In OPG- It can be seen Superior or inferior to the greater corn of the hyoid bone (where the common carotid artery splits into the external and internal carotid arteries) and adjacent to the cervical vertebrae C3, C4, or the intervertebral space between them
CALCIFIED ATHEROSCLEROTIC PLAQUE Axial CT image of the same case showing bilateral calcification with the walls of the carotid arteries (arrows), Coronal and sagittal CT images of the same case demonstrating the carotid calcifications (arrows) .
Differential Diagnosis • Calcified triticeouscartilage-uniform size, shape, and location of calcified triticeouscartilage in the laryngeal cartilage
PHLEBOLITHS Phleboliths are calcified thrombi found in veins, venulae, or the sinusoidal vessels of hemangiomas (especially the cavernous type) bull ’ s-eye or “ target ” Phleboliths are soft tissue dystrophic calcifications found in veins. They are usually associated with hemangiomas.
LARYNGEAL CARTILAGE CALCIFICATIONS A lateral cephalometric film revealing calcification of the thyroid cartilage (arrow). triticeous means “ grain of wheat, ”
RHINOLITH/ANTROLITH Lateral occlusal film shows a rhinolith(arrow) positioned above the floor of the nose. Posteroanterior skull film of the same case demonstrating that the rhinolith is positioned within the nasal fossa(arrow).
OSSIFICATION OF THE STYLOHYOID LIGAMENT Examples of prominent ossification of the stylohyoid ligament
Symptoms related to this ossified ligament are termed Eagle syndrome, which is expressed as one of two subtypes: • Classic Eagle syndrome resulting from cranial nerve impingement, • The carotid artery syndrome, resulting from impingement on the carotid vessels.
OSTEOMA CUTIS • Osteoma cutis is a rare soft tissue ossification in the skin • result of acne of long duration • The tongue is the most common intraoral site (osteomamucosae or osseous choristoma) • Some patients have numerous (dozens to hundreds) of lesions, usually on the face in females and on the scalp or chest in males. This form is known as multiple miliaryosteoma cutis. • The differential diagnosis should include myositisossificans, calcinosis cutis, and osteomamucosae
MYOSITIS OSSIFICANS 1. Localized (Traumatic) MyositisOssificans (Posttraumatic myositisossificans and solitary myositis) 2. Progressive MyositisOssificans
Localized (Traumatic) MyositisOssificans Soft tissue ossification extending from the coronoid process in a superior direction, following the anatomy of the temporalis muscle (arrow). This condition arose after several attempts were made to provide a submandibular nerve block, leaving the patient unable to open the mandible. Pseudotrabeculae are characteristic of myositisossifi cans and strongly imply a diagnosis.
Progressive MyositisOssificans Myositisossificans, seen as bilateral linear calcifications (arrows) of the sternohyoid muscle., An axial CT scan with soft tissue algorithm demonstrating calcifications in the lateral pterygoid muscle