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CASE REPORT
Year : 2015  |  Volume : 3  |  Issue : 1  |  Page : 28-30

An unusual case of large, destructive stafne bone cavity with computed tomography findings


1 Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
2 Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Ondokuz Mayis University, Samsun, Turkey
3 Department of Pathology, Gulhane Military Medicine Academy, Ankara, Turkey

Date of Web Publication18-Feb-2015

Correspondence Address:
Prof. Dr. Mahmut Sumer
Ondokuz Mayis Universitesi, Dis Hekimligi Fakultesi, Agiz Dis Ve Cene Cerrahisi Anabilim Dali, 55139 Kurupelit, Samsun
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2321-3841.151647

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  Abstract 

Stafne bone cavity (SBC) is an asymptomatic lingual bone depression that usually described as a small oval homogenous radiolucency in the posterior mandibular region. The radiographic appearance and location of the SBC are characteristic and easily identified. The diagnosis can be confirmed by computed tomography (CT) scans, magnetic resonance (MR) imaging or sialography. This report describes a case of SBC in a 61-year-old male asymptomatic patient, presenting as a radiolucency in the left mandibular body with loss of buccal and lingual cortical plates on three-dimensional CT scan.

Keywords: Computed tomography, mandible, salivary glands, stafne bone cavity


How to cite this article:
Sumer M, Acikgoz A, Uzun C, Gunhan O. An unusual case of large, destructive stafne bone cavity with computed tomography findings. J Oral Maxillofac Radiol 2015;3:28-30

How to cite this URL:
Sumer M, Acikgoz A, Uzun C, Gunhan O. An unusual case of large, destructive stafne bone cavity with computed tomography findings. J Oral Maxillofac Radiol [serial online] 2015 [cited 2019 Sep 17];3:28-30. Available from: http://www.joomr.org/text.asp?2015/3/1/28/151647


  Introduction Top


Stafne bone cavity (SBC) is an asymptomatic lingual bone depression of the lower jaw that usually diagnosed during routine radiographic examination. It is observed as a round or an ovoid-shaped well-defined homogenous radiolucent area that ranges in diameter from 1 to 3 cm on radiographs and most commonly located in the angle of the mandible below the inferior alveolar canal. [1] Rare examples are located in the anterior mandible and are related to the sublingual fossa. [1],[2],[3],[4],[5] More cases have been reported in men than in women [3],[4],[5],[6],[7],[8],[9],[10],[11] and in middle-aged and older adults with children rarely affected. [4],[5],[6],[7],[8],[12]

Stafne bone cavity contains ectopic salivary gland tissue, however a few of these defects have been reported to contain muscle, fibrous connective tissue, blood vessels, fat, or lymphoid tissue. [2] The radiographic appearance and location of SBC are characteristic and easily identified. The diagnosis can be confirmed by computed tomography (CT) scans, magnetic resonance (MR) imaging or sialography. [3],[4],[6],[7],[9],[12] No treatment is required but sometimes biopsy may be necessary to rule out other pathologic lesions. [2] In this study a case of SBC showing a complete destruction of lingual plate and a perforation of buccal cortex on three-dimensional CT scan in a 61-year-old male patient is presented. Generally the depression area is lined with an intact outer cortex [1] and a large, destructive SBC with buccal expansion represents a rare clinical course of this pseudocyst.


  Case Report Top


A 61-year-old man was referred to dentomaxillofacial radiology clinic with an asymptomatic lesion in the mandible discovered incidentally on a panoramic radiograph done for routine dental treatment by his dentist. The patient's medical history was unremarkable. He had a history about a jaw trauma with a steel stick when he was a child. There was no history of swelling, pain or sensory disturbance about the lesion.

Panoramic and periapical radiographs revealed a well-defined radiolucent area with a corticated smooth at the level of the second to third molar on the left mandible [[Figure 1]a and b]. CT was found appropriate for further evaluation. CT images revealed the presence of a lingual bony defect involved the mandibular body. Axial images showed a radiolucent area of cystic aspect and irregular cortical outline with a little buccal cortical resorption in the posterior left mandible. The buccal cortex expanded and possibly perforated. Three-dimensional reconstruction of the lesion indicated a hole-like defect extending from lingual to vestibule plate. This lithic area located under the lower left second and third molar, was anterior to the mandibular angle [[Figure 2]a and b].
Figure 1: Panoramic (a) and periapical (b) radiographs revealed a well-defined corticated radiolucency in the left mandible


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Figure 2: Axial section (a) and three-dimensional computed tomography view (b) of the stafne bone cavity in the left mandible


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Within the wide range of possible pathologies and at the request of the patient, it was decided to take a biopsy [Figure 3]. Histopathologic examination showed the absence of any cystic lesion but rather than the presence of a salivary gland tissue with a reactive trabecular bone in a small area confirming the SBC diagnosis [Figure 4].
Figure 3: Intraoral appearence of stafne bone cavity during surgery


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Figure 4: Histopathologic examination of the excised sample from the bone cavity revealed normal salivary gland tissue (H and E, ×100)


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  Discussion Top


The aetiology of SBC has been unclear. The most widely accepted concept is local pressure of sublingual and submandibular gland to the bone induces the development of the defect. [3],[9] Generally, the submandibular gland is directly related with the posterior lingual variant of the lesion while the sublingual gland causes the anterior lingual variant. [4],[5] The parotid gland is described in association with the ascending ramus variant. [13],[14]

The diagnosis of the SBC has usually based on panoramic radiography used for routine dental examination. [7] Improved imaging techniques such as CT, [3],[4],[6],[7],[14] MR imaging [12] and also sialography of the submandibular gland [9] can provide sufficient information to make a diagnosis. CT is noninvasive and effective in the evaluation of bone borders and the size and extent of the lesion can be visualized with CT using both soft tissue and bone window settings. [3],[4],[6],[7],[15] Recently, cone beam CT is being used with high resolution and low-dose radiation in dentomaxillofacial radiology and also diagnosis of SBC. [8],[9],[10],[16]

Magnetic resonance imaging should be considered a primary diagnostic technique in cases where SBC is suspected. [12] Segev et al. [12] establish a definitive and solid diagnosis of SBC merely on MR imaging and in his case MR imaging demonstrated a bony cavity that was filled with soft tissue that is continuous and identical in signal with that of the submandibular salivary gland.

Sialography is able to depict salivary tissue in the bony cavity and have been used to confirm the diagnosis of SBC. A combination of cone beam CT with sialography was a promising approach that provided detailed information about the content of the cavity and allowed diagnosis of SBC. [9]


  Conclusion Top


A case of large and destructive SBC with loss of buccal and lingual cortical plates has been presented. Beside a panoramic radiograph CT shows fine details of SBC lesions in mandible. Generally, the surgical treatment of SBC is not considered, however, a long-term follow-up is required. [9],[10],[11] Rarely, biopsy could be performed in exceptional cases for concomitant other jaw pathologies.

 
  References Top

1.
White SC, Pharoah MJ. Oral Radiology Principles and Interpretation. 5 th ed. St. Louis, Missouri: Mosby; 2004.  Back to cited text no. 1
    
2.
Neville BW, Damm DD, Allen CM, Bouquot JE. Oral and Maxillofacial Pathology. 3 rd ed. St. Louis: Elsevier; 2009.  Back to cited text no. 2
    
3.
Dereci O, Duran S. Intraorally exposed anterior Stafne bone defect: A case report. Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:e1-3.  Back to cited text no. 3
    
4.
Turkoglu K, Orhan K. Stafne bone cavity in the anterior mandible. J Craniofac Surg 2010;21:1769-75.  Back to cited text no. 4
    
5.
de Courten A, Küffer R, Samson J, Lombardi T. Anterior lingual mandibular salivary gland defect (Stafne defect) presenting as a residual cyst. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2002;94:460-4.  Back to cited text no. 5
    
6.
Etöz M, Etöz OA, Sahman H, Sekerci AE, Polat HB. An unusual case of multilocular Stafne bone cavity. Dentomaxillofac Radiol 2012;41:75-8.  Back to cited text no. 6
    
7.
Kao YH, Huang IY, Chen CM, Wu CW, Hsu KJ, Chen CM. Late mandibular fracture after lower third molar extraction in a patient with Stafne bone cavity: A case report. J Oral Maxillofac Surg 2010;68:1698-700.  Back to cited text no. 7
    
8.
Boffano P, Gallesio C, Daniele D, Roccia F. An unusual trilobate Stafne bone cavity. Surg Radiol Anat 2013;35:351-3.  Back to cited text no. 8
    
9.
Li B, Long X, Cheng Y, Wang S. Cone beam CT sialography of Stafne bone cavity. Dentomaxillofac Radiol 2011;40:519-23.  Back to cited text no. 9
    
10.
Münevveroglu AP, Aydin KC. Stafne bone defect: Report of two cases. Case Rep Dent 2012;2012:654839.  Back to cited text no. 10
    
11.
Sisman Y, Miloglu O, Sekerci AE, Yilmaz AB, Demirtas O, Tokmak TT. Radiographic evaluation on prevalence of Stafne bone defect: A study from two centres in Turkey. Dentomaxillofac Radiol 2012;41:152-8.  Back to cited text no. 11
    
12.
Segev Y, Puterman M, Bodner L. Stafne bone cavity - Magnetic resonance imaging. Med Oral Patol Oral Cir Bucal 2006;11:E345-7.  Back to cited text no. 12
    
13.
Philipsen HP, Takata T, Reichart PA, Sato S, Suei Y. Lingual and buccal mandibular bone depressions: A review based on 583 cases from a world-wide literature survey, including 69 new cases from Japan. Dentomaxillofac Radiol 2002;31:281-90.  Back to cited text no. 13
    
14.
Barker GR. A radiolucency of the ascending ramus of the mandible associated with invested parotid salivary gland material and analogous with a Stafne bone cavity. Br J Oral Maxillofac Surg 1988;26:81-4.  Back to cited text no. 14
    
15.
Sisman Y, Etöz OA, Mavili E, Sahman H, Tarim Ertas E. Anterior Stafne bone defect mimicking a residual cyst: A case report. Dentomaxillofac Radiol 2010;39:124-6.  Back to cited text no. 15
    
16.
Kopp S, Ihde S, Bienengraber V. Differential diagnosis of stafne idiopathic bone cyst with Digital Volume Tomography (DVT). J Maxillofac Oral Surg 2010;9:80-1.  Back to cited text no. 16
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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