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SOFT TISSUE

CALCIFICATION AND
OSSIFICATION

Unorganized fashion of soft tissue calcification is


referred to as heterotopic calcification.
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)egchondrocalcinosis 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 CALCIFICATION


OF 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
calcifi cation (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.

cauliflower-like
shape

tuberculosis was (scrofula or cervical tuberculous


adenitis).
bacille Calmette-Gu 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 Tonsils


Tonsillar 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

Differential Diagnosis
calcified granulomatous disease,
syphilis, mycosis, or lymphoma
dense bone island.

Arterial Calcifi cations


Two distinct patterns of arterial calcification can be
identified both radiographically and histologically
Monckebergs medial calcinosis
Calcified atherosclerotic plaque
Monckebergs 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
(ARTERIOSCLERO
SIS)
pipe stem or tramtrack 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 calcifi cation 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 triticeous cartilage-uniform
size, shape, and location of calcified
triticeous cartilage in the laryngeal
cartilage

Idiopathic Calcification
SIALOLITH

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
(osteoma mucosae 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 miliary
osteoma cutis.
The differential diagnosis
should include myositis
ossificans, calcinosis cutis, and
osteoma mucosae

MYOSITIS OSSIFICANS
1. Localized (Traumatic) Myositis
Ossificans
(Posttraumatic myositis ossificans and
solitary myositis)
2. Progressive Myositis Ossificans

Localized (Traumatic) Myositis


Ossificans

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
Pseudotrabeculae
are
open the mandible.
characteristic
of myositis ossifi
cans and strongly imply a
diagnosis.

Progressive Myositis
Ossificans

Myositis ossificans, 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