soft tissue calcifications

Question 1

tonsillolits (MUST KNOW)
- clinical features
- radiographic features
- management

Answer 1

clinical features
- small: asymphtomatic
- large: pain, swelling, dysphagia (swallowing difficulties), halitosis
- large - rare features: ulceration and extrusions

radiographic
- small
- ill defined
- mandibular ramus area (soft palate area = palatine tonsils or tongue area = lingual tonsils)
- single/clustered

management
- nth or surgery if large

Question 2

sialoliths
- 2 types
- clinical features
-radiographic features
-management

Answer 2

2 types - parotid gland sialoliths (rare) or submandibular gland sialoliths

differentiating clinical feature from tonsiloliths:
- meal time symptoms: discomfort when saliva stimulated
- can be asymp

radiographic features:
- parotid gland sialoliths: single/multiple
- submandibular gland sialoliths: smooth outline, single but can be multiple, near angle of mandible

management
- none
- small stones milk out
- large: lithotripsy (break up stones)
- sialoendoscope (basket removal)
- surgery (last resort)

Question 3

what radiograph to take for sialoliths?

Answer 3

• parotid gland sialoliths - buccal PA
• submand gland sialoliths - mand occlusal radiograph –> standard or lateral oblique, no longer use vertex

Question 4

triticeal cartilage calcification
- no clinical features
- radiographic features
- management
- dont confuse w calcified atheromatous plaque

Answer 4

radiographic features
- between hyoid bone and superior horn of thyroid cartilage
- small, round, smooth, well defined

management:
- none

Question 5

calcified atheromatous plaque (MUST KNOW)
- radiographic features
- management

Answer 5

–> plaque at carotid artery

radiographic features:
- c3/c4 level
- vertical linear distribution
- irregular shaped radiopacities

management:
- if high bp –> refer pt
- if normal bp –> ask pt if previously screened before –> nope –> refer for medical attention
- if normal bp –> pt has dr treating –> inform medical provider of finding

Question 6

calcified lymph node
- clinical features
-radiographic features
-management

Answer 6

clinical features
- hard/lumpy when palpate

radiographic features
- differentiate from sub mand sialoliths
–> calc lymph node is cauliflower shaped, irregular VS sialoliths is smooth
–> sialoliths have meal time symptoms
- near submand region

management:
- none

Question 7

calcified lymph node related disease

Answer 7

• tb
• bcg vaccine
• fungal infections
• cat scratch disease
• rheumatoid arthritis
• sarcoidosis
• systemic sclerosis
• lymphoma
• metastatic thyroid carcinoma

Question 8

phleboliths
- calcification of thrombi
- clinical features
- radiographic features
- management

Answer 8

clinical
- overlying soft tissue swollen, throbbing, discolored
- blanching when apply pressure
- associated w hemangioma/venous malformations

radiograph:
- bulls eye
- round

management:
evaluate for vascular lesion

Question 9

anthroliths (max sinus)
- what is it?

Answer 9

–> usually root tip/bone fragment/ectopic tooth

Question 10

rhinoliths (nasal cavity)
- what is it?

Answer 10

–> usually foreign body

Question 11

anthroliths and rhinoliths
- clinical features
- management

Answer 11

clinical:
- small = asyp
- large: nose bleeds, sinusitis, pain, nasal obstruction, headache, fever, odours

management: none or ENT

Question 12

osteoma cutis
- soft tissue ossifications in cheeks
- clinical features
- radiographic feature

Answer 12

clinical
- might be able to palpate if large

radiograph
- smooth, round small
- donut shape
- BW/PA
- usually multiple

Question 13

eagle syndrome/ossified stylohyoid ligament
- long styloid
- eagle syndrome affect what nerve
- clinical features
-radiograph
- management

Answer 13

clinical:
- might be able to palpate over tonsillar fossa
- incidental finding
- lenght dont correlate to severity

eagle syndrome affect nerves: CN 5,7,9,10,12

radiograph
- joint like
- long
- bone like density

management
- none or LA injections or stylohyoidectomy (cut off)