Calcification Of Ligament Research Articles

A Contemporary View of the Diagnosis of Osteoporosis in Patients With Axial Spondyloarthritis.

Axial spondyloarthritis (axSpA) is a chronic inflammatory disease that primarily affects the axial joints. Altered bone metabolism associated with chronic inflammation leads to both new bone formation in the spine and increased bone loss. It is known that patients with axSpA have a high prevalence of osteoporosis and fractures. However, there is no consensus on which imaging modality is the most appropriate for diagnosing osteoporosis in axSpA. Bone mineral density measurement using dual-energy X-ray absorptiometry is the primary diagnostic method for osteoporosis, but it has notable limitations in patients with axSpA. This method may lead to the overestimation of bone density in patients with axSpA because they often exhibit abnormal calcification of spinal ligaments or syndesmophytes. Therefore, the method may not provide adequate information about bone microarchitecture. These limitations result in the underdiagnosis of osteoporosis. Recently, new imaging techniques, such as high-resolution peripheral quantitative computed tomography, and trabecular bone score have been introduced for the evaluation of osteoporosis risk in patients with axSpA. In this review, we summarize the current knowledge regarding imaging techniques for diagnosing osteoporosis in patients with axSpA.

AN OBSERVATIONAL STUDY OF ENTHESOPATHY IN DRIED HUMAN SCAPULAE

Objectives: An abnormal ossification process in soft tissues at the attachment site to a bone is called enthesopathy due to biomechanical movements of bone. The present study aimed to observe the calcification of the transverse scapular ligament (TSL) with complete or partial ossification, the presence of the triangular bony growth at the lateral border of scapula and to observe vascular foramen/foramina piercing at the bases of the spine of scapulae.
 Methods: An observational study was conducted on dried human scapulae 140 in number (70 right and 70 left) of unknown sex and age, procured from the Department of Anatomy, People’s College of Medical Science and Research Center, Bhopal, and Government Doon Medical College, Dehradun, India. These scapulae were studied to observe enthesopathic changes in them. Measurements were taken with Vernier calipers.
 Results: In the present study, we observed the presence of completely ossified TSL with formation of complete suprascapular foramina in 8.57% scapulae. The incidence of triangular bony growth at the lateral border of scapula was found in 40% scapulae of the right side and 32.85% of the left. The incidence of vascular foramina piercing at the bases of the spine of scapulae was 17.14% on the right side and 21.42% on the left side scapulae.
 Conclusion: The study provides the descriptive knowledge of enthesopathy in scapulae. The study is of great significance for neurosurgeons and orthosurgeons to carry out various reconstructive surgeries.

Galectin-3 Enhances Osteogenic Differentiation of Precursor Cells From Patients With Diffuse Idiopathic Skeletal Hyperostosis via Wnt/β-Catenin Signaling

Diffuse idiopathic skeletal hyperostosis (DISH) is a noninflammatory skeletal disease characterized by the progressive ectopic ossification and calcification of ligaments and enthuses. However, specific pathogenesis remains unknown. Bone marrow mesenchymal stem cells (BMSCs) are a major source of osteoblasts and play vital roles in bone metabolism and ectopic osteogenesis. However, it is unclear whether BMSCs are involved in ectopic calcification and ossification in DISH. The current study aimed to explore the osteogenic differentiation abilities of BMSCs from DISH patients (DISH-BMSCs). Our results showed that DISH-BMSCs exhibited stronger osteogenic differentiation abilities than normal control (NC)-BMSCs. Human cytokine array kit analysis showed significantly increased secretion of Galectin-3 in DISH-BMSCs. Furthermore, Galectin-3 downregulation inhibited the increased osteogenic differentiation ability of DISH-BMSCs, whereas exogenous Galectin-3 significantly enhanced the osteogenic differentiation ability of NC-BMSCs. Notably, the increased Galectin-3 in DISH-BMSCs enhanced the expression of β-catenin as well as TCF-4, whereas attenuation of Wnt/β-catenin signaling partially alleviated Galectin-3-induced osteogenic differentiation and activity in DISH-BMSCs. In addition, our results noted that Galectin-3 interacted with β-catenin and enhanced its nuclear accumulation. Further in vivo studies showed that exogenous Galectin-3 enhanced ectopic bone formation in the Achilles tendon in trauma-induced rats by activating Wnt/β-catenin signaling. The current study indicated that enhanced osteogenic differentiation of DISH-BMSCs was mainly attributed to the increased secretion of Galectin-3 by DISH-BMSCs, which enhanced β-catenin expression and its nuclear accumulation. Our study helps illuminate the mechanisms of pathological osteogenesis and sheds light on the possible development of potential therapeutic strategies for DISH treatment. © 2022 American Society for Bone and Mineral Research (ASBMR).

An overview of Eagle's syndrome.

Eagle's syndrome is a condition that typically does not present to pain clinics. It consists of an elongated styloid process greater than 25 mm and/or stylohyoid ligament calcification causing an unusual array of symptoms, relating to anatomical involvement. Multiple specialities may be involved with the diagnosis of this rare condition. Three-dimensional reconstructive computed tomographic (CT) scan remains the gold standard for diagnosis. Depending on the presenting symptoms, care should be directed to an appropriate specialist. Pain surrounding Eagle's syndrome does not typically resolve using simple pharmacological methods. Eagle's syndrome should remain a diagnosis to be considered when faced with non-resolving head/facial pain.

Styloidectomy: our experience with intraoral approach

<p><strong>Background:</strong> Eagle’s syndrome is a symptom complex arising due to elongated styloid process or calcification of stylohyoid ligament. Surgical treatment is regarded as the foremost option. The study aims to put forth our experience with intraoral approach to styloidectomy in 17 subjects.</p><p><strong>Methods:</strong> A retrospective study was conducted between January 2017 to December 2019. The study included 17 subjects with a diagnosis of elongated styloid process. All the subjects underwent styloidectomy by intraoral approach and were followed up.</p><p><strong>Results:</strong> In our study, the median age of the study group was 33.76 and out of 17 subjects 13 were female and 4 male. The procedure was done under local anesthesia in 13 subjects and under general anesthesia in 4 subjects. Styloidectomy by intraoral approach was done in all subjects among which 15 were bilateral and 2 unilateral. 88% of the subjects were symptom free by third week.</p><p><strong>Conclusions:</strong> The study suggests that styloidectomy by intraoral approach is minimally invasive and can be done under local anesthesia with an added advantage of quick recovery.<strong></strong></p>

The evaluation of the effect of hypercalcemia in oral pathologies

ObjectiveHypercalcemia is determined as an increase in the serum calcium level (above 10.5 mg/dL or ionized calcium is above 1.5 mmol/L). It was aimed to evaluate the effect of the increased serum calcium levels in dental panoramic radiographs with oral pathologies. Materials & MethodsThe final sample number of the present study was determined as 143. 61 patients with hypercalcemic calcium levels were grouped in Hypercalcemia Group (HPEG) whereas 82 patients were grouped in Normal Group. (NG) Measurements were performed only on the panoramic radiographs. The evaluated parameters were cyst-tumor or granuloma existence, sinus pneumatization, stylohyoid ligament calcifications, lamina dura loss, bone loss existence, etc. Statistical tests were carried out at p < 0.05 significance level. ResultsThe cyst-tumor formation (p = 0.03) and stylohyoid ligament calcification (p = 0.009) and increased radiopacity (p = 0.03) were significantly more common in NG than the HPEG group. Alveolar bone loss (p = 0.001) and periodontal defects (p = 0.01) were significantly more common in HPEG than the NG group. There was no significant relationship between other examined parameters. (p > 0.05) ConclusionThe serum calcium level revealed statistically significant outcomes and a close relationship with the pathologies occurring in the alveolar bone in the oral and maxillofacial region. However, it is highly recommended to include more patients in the newly planned studies and another bone-related biomarker should be evaluated simultaneously.

Development of Enthesopathies and Joint Structural Damage in a Murine Model of X-Linked Hypophosphatemia.

X-linked hypophosphatemia (XLH) is characterized by rickets and osteomalacia, caused by inactivating mutations in the Phosphate-regulating endopeptidase homolog X-linked (PHEX) gene. With aging, adult patients develop paradoxical heterotopic calcifications of tendons and ligaments at their insertion sites (enthesophytes), and joint alterations. Understanding the progression of this structural damage that severely affects patients’ quality of life will help to improve the management of XLH. Here, we characterized the occurrence of enthesophytes and joint alterations through a 12 month in vivo micro-CT follow-up in the Hyp mouse, a murine model of XLH (n = 5 mice per group). Similar to adult patients with XLH, Hyp mice developed calcaneal enthesophytes, hip joint alterations, erosions of the sacroiliac joints and periarticular calcifications. These lesions were already present at month 3 and gradually worsened over time. In sharp contrast, no abnormalities were observed in control mice at early time points. Histological analyses confirmed the presence of bone erosions, calcifications and expansion of mineralizing enthesis fibrocartilage in Hyp mice and their absence in controls and suggested that new bone formation is driven by altered mechanical strain. Interestingly, despite a strong deformation of the curvature, none of the Hyp mice displayed enthesophyte at the spine. Peripheral enthesophytes and joint alterations develop at the early stages of the disease and gradually worsen overtime. Overall, our findings highlight the relevance of this preclinical model to test new therapies aiming to prevent bone and joint complications in XLH.

Combination of Forestier’s disease and laryngeal cancer: a rare clinical case

The objective of the scientific report is to describe a rare clinical case of a combination of Forestier’s disease (diffuse idiopathic skeletal hyperostosis) and laryngeal cancer that have common symptoms. Case report. A 68-year-old male patient presented with hoarseness lasting for a year. Indirect laryngoscopy revealed a vocal fold tumor. Histological examination confirmed well-differentiated keratinizing squamous cell carcinoma of the larynx. A 6-cm tumor was located in the projection of the right vocal fold and had no signs of invasion into the supraglottis, subglottis, and anterior commissure. No other focal disorders were detected. The patient has undergone endolaryngeal laser resection of the larynx and tracheostomy. After probe removal, the patient had swallowing difficulties with esophageal content passing to the trachea mainly due to organic changes in the cervical spine at the СЗ–С4 level, where there was a massive local calcification of the anterior longitudinal ligament. We also noticed severe movement restriction in the cervical spine: the amplitude of movements did not exceed 10°. The formation of the C3–C4 segment was removed via ventrolateral approach. Conclusion. Dysphagia, dysphonia, and dyspnea may indicate both malignant tumor and large osteophyte causing compression of the trachea and esophagus. In this case, no symptom resolution after tumor removal led to the suspicion of a second disease, namely Forestier’s disease.

Eagle’s Syndrome: Transoral Styloidectomy a Technique Modification Case Report

Eagle’s Syndrome is a rare condition with unknown etiology that mainly affects female patients between the third and sixth decade of life. It was first described in 1937 by Dr. Watt W. Eagle, in a study carried out in a group of patients whose main symptom was cervicopharyngeal pain caused by elongation of the styloid process and/or calcification of the stylohyoid ligament [1]. The diagnosis of this pathology is based on the anamnesis and physical examination together with imaging exams of the patients. Cervicofacial pain, palpation of the styloid process in the tonsillar fossa and limitation in neck mobility are the most classic signs and symptoms of this disease [2]. Due to the nonspecific symptoms present in these patients, this disease is usually underdiagnosed and confused with temporomandibular disorders, cervical myalgias, and even being diagnosed as atypical trigeminal neuralgias [3]. For this reason, clinical examination and imaging exams, are indispensable for the correct diagnosis and evaluation of anatomical structures [3]. We present a case of a woman with a history of eagle syndrome which was diagnosed and treated at the Hospital clinico metropolitano El Carmen Santiago, Chile.

Functional characterization of a unique mutant of ALK2, p.K400E, that is associated with a skeletal disorder, diffuse idiopathic skeletal hyperostosis.

Bone morphogenetic protein (BMP) signaling regulates the physiological and pathological development of skeletal tissues. Activin receptor-like kinase 2 (ALK2) is a BMP type I transmembrane serine/threonine kinase receptor. Recently, a p.K400E mutation was found in ALK2 in a patient with diffuse idiopathic skeletal hyperostosis (DISH), which is a disorder characterized by calcification and ossification of spinal ligaments and entheses. We report here the functional characterization of ALK2 p.K400E in vitro. Cells overexpressing ALK2 p.K400E activated BMP signaling in response to osteogenic BMP ligands. However, ALK2 p.K400E was not activated by a nonosteogenic ligand, Activin A. BMP signaling through ALK2 p.K400E was further enhanced by the coexpression of a BMP type II receptor. The type II receptor increased the phosphorylation level of ALK2 p.K400E, suggesting that ALK2 p.K400E is a hypersensitive mutant to the BMP type II receptor kinases. Our findings suggest that pathological calcification and ossification in DISH are caused by overactivated BMP signaling through ALK2 p.K400E enhanced by type II receptors in response to osteogenic BMPs rather than Activin A.

Sonographic assessment of calcium pyrophosphate deposition disease at wrist. A focus on the dorsal scapho-lunate ligament.

To investigate the diagnostic accuracy of ultrasound and conventional radiography in the evaluation of calcium pyrophosphate crystal deposits at wrist level. Consecutive patients with a "definite" diagnosis of calcium pyrophosphate deposition disease and disease-controls were prospectively included in this cross-sectional single-centre study. Scapho-lunate ligament, triangular fibrocartilage complex, and volar recess of the radio-lunate joint were explored using ultrasound, conventional radiography and computed tomography. Sixty one patients and 39 disease controls were enrolled. Two-hundred wrists were evaluated using both conventional radiography and ultrasound and 26 using computed tomography. Ultrasound findings indicative of crystal deposits were found in at least one wrist in 95.1% of patients and in 15.4% of controls (P<0.001). Scapho-lunate ligament calcifications were reported in 83.6% of patients and in 5.1% of controls (P<0.001). On conventional radiography, calcifications were found in at least one wrist in 72.1% of patients and in 0% of controls (P<0.001). Using the Ryan-McCarty criteria as a gold standard, sensitivity, specificity and diagnostic accuracy were 0.72 (0.59-0.83), 1.0 (0.91-1.0) and 0.83 (0.74-0.90) for conventional radiography and 0.95 (0.86-0.99), 0.85 (0.69-0.94) and 0.91 (0.84-0.96) for ultrasound. The agreement between ultrasound and computed tomography was substantial when assessing triangular fibrocartilage complex (kappa=0.70; 0.43-0.97) and scapho-lunate ligament (kappa=0.69; 0.41-0.97), and moderate for radio-lunate joint (kappa=0.46; 0.12-0.80). This study supports the diagnostic accuracy of ultrasound in evaluating wrist involvement in calcium pyrophosphate deposition disease. The inclusion of the scapho-lunate ligament in a disease-oriented scanning protocol could improve the diagnostic performance of ultrasound.

Model of Pathological Collagen Mineralization Based on Spine Ligament Calcification.

The aim of the study was to determine the time of mineral growth in human spine ligaments using a mathematical model. The study was based on our previous research in which the physicochemical analysis and computed microtomography measurements of deposits in ligamenta flava were performed. Hydroxyapatite-like mineral (HAP) constituted the mineral phase in ligament samples, in two samples calcium pyrophosphate dehydrate (CPPD) was confirmed. The micro-damage of collagen fibrils in the soft tissue is the crystallization center. The growth of the mineral nucleus is a result of the calcium ions deposition on the nucleus surface. Considering the calcium ions, the main component of HAP, it is possible to describe the grain growth using a diffusion model. The model calculations showed that the growth time of CPPD grains was ca. a month to 6 years, and for HAP grains >4 years for the young and >5.5 years for the elderly patients. The growth time of minerals with a radius >400 μm was relatively short and impossible to identify by medical imaging techniques. The change of growth rate was the largest for HAP deposits. The mineral growth time can provide valuable information for understanding the calcification mechanism, may be helpful in future experiments, as well as useful in estimating the time of calcification appearance.

Clinical and radiological characteristics of diffuse idiopathic skeletal hyperostosis in two medical centers in Cali, Colombia: Report of 24 cases

IntroductionDiffuse idiopathic skeletal hyperostosis (DISH) is a condition characterized by calcification and progressive ossification of ligaments and entheses. Most patients remain asymptomatic until advanced stages of the disease, where limitation and pain are characteristic. ObjectiveTo describe the demographic, clinical, and radiological characteristics of patients with DISH evaluated in the Centro Médico Imbanaco and Clínica de Artritis Temprana, in Cali, Colombia. Materials and methodsA descriptive, cross-sectional study was conducted by reviewing the records of patients diagnosed with DISH between January 2000 and October 2018. The diagnosis was confirmed according to the Resnick-Niwayama criteria. A total of 24 patients were found, and all were included for the final analysis. Results and discussionThe series included 20 men and 4 women, with a median age at diagnosis of 70.5 years (IQR 61.3–73.8 years), being lower in women (71.5 versus 60 years; p=0.04). The median time of onset of the symptoms was 5 years (IQR 3–10 years), and the duration was shorter in women (5 versus 4 years; p=0.20). It was observed that 54% were overweight and 20% were diabetic. The main symptom was cervical limitation. The most affected vertebral segments due to the ossification of the anterior longitudinal ligament (ALL) were C5-C6, T8-T10 and L1-L3 (cervical C; thoracic T; lumbar L). The peripheral involvement was mainly in the iliac crests. All patients received physiotherapy, and three of them underwent cervical surgery. The degree of functional limitation was assessed in 19 patients using the mHAQ (Modified Health Assessment Questionnaire) and BASFI (Functional Ankylosing Spondylitis Functional (BASFI) questionnaires. The median score of both questionnaires was 2 times higher in women. ConclusionDiffuse idiopathic skeletal hyperostosis was more frequent in men over 65 years of age, and was associated with metabolic conditions such as obesity and diabetes. Although the differences were not significant, the results suggest that women have a more severe phenotype of the disease, explained by the early onset and progressive course of symptoms, as well as greater functional limitation measured by mHAQ and BASFI.

Características clínico-radiológicas de la hiperostosis esquelética idiopática difusa en 2 centros médicos de Cali, Colombia: reporte de 24 casos

IntroductionDiffuse idiopathic skeletal hyperostosis (DISH) is a condition characterised by calcification and progressive ossification of ligaments and entheses. Most patients remain asymptomatic until advanced stages of the disease, where limitation and pain are characteristic. ObjectiveTo describe the demographic, clinical, and radiological characteristics of patients with DISH evaluated in the Centro Médico Imbanaco and Clínica de Artritis Temprana, in Cali, Colombia. Materials and methodsA descriptive, cross-sectional study was conducted by reviewing the records of patients diagnosed with DISH between January 2000 and October 2018. The diagnosis was confirmed according to the Resnick-Niwayama criteria. A total of 24 patients were found, and all were included for the final analysis. Results and discussionThe series included 20 men and 4 women, with a median age at diagnosis of 70.5 years (IQR 61.3-73.8 years), being lower in women (71.5 versus 60 years; P=.04). The median time of onset of the symptoms was 5 years (IQR 3-10 years), and the duration was shorter in women (5 versus 4 years; P=.20). It was observed that 54% were overweight and 20% were diabetic. The main symptom was cervical limitation. The most affected vertebral segments due to the ossification of the anterior longitudinal ligament (ALL) were C5-C6, T8-T10 and L1-L3 (cervical C; thoracic T; lumbar L). The peripheral involvement was mainly in the iliac crests. All patients received physiotherapy, and three of them underwent cervical surgery. The degree of functional limitation was assessed in 19 patients using the mHAQ (Modified Health Assessment Questionnaire) and BASFI (Functional Ankylosing Spondylitis Functional (BASFI) questionnaires. The median score of both questionnaires was 2 times higher in women ConclusionDiffuse idiopathic skeletal hyperostosis was more frequent in men over 65 years of age, and was associated with metabolic conditions such as obesity and diabetes. Although the differences were not significant, the results suggest that women have a more severe phenotype of the disease, explained by the early onset and progressive course of symptoms, as well as greater functional limitation measured by mHAQ and BASFI.

Cervicovertebral anomalies and/or normal variants in patients with congenitally bilateral absent maxillary lateral incisors.

To determine whether there is a relationship between congenitally bilaterally absent maxillary lateral incisors (BAMLIs) and skeletal anomalies and/or normal variants. The records of 86 patients (62 girls, 24 boys; age 12-17 years) with congenitally BAMLIs and 86 patients (55 girls, 34 boys; age 13-18 years) without any dental or skeletal anomalies were collected and evaluated retrospectively. The study was based on the evaluation of lateral cephalometric and orthopantomographic radiographs. Posterior arch deficiency of the atlas bone (PADA); atlanto-occipital ligament calcification, known as "ponticulus posticus" (PP); and interclinoid ligament calcification, known as "sella turcica bridging" were recorded for each participant. Pearson χ2 and Fisher exact tests were used to evaluate and compare skeletal anomalies and/or normal variants between patients with BAMLIs and the control group. The prevalence of cervicovertebral anomalies and/or normal variants seen in the lateral cephalometric radiographs was higher in patients with BAMLI than in the control group. The prevalence of PP was lower and that of PADA was higher in patients with BAMLIs than in the control group (P < .05). The prevalence of PADA was increased and that of PP formation was decreased in patients with BAMLIs. There was a significant relationship between skeletal anomalies and/or normal variants.

Eagle syndrome: toward a clinical delimitation

IntroductionOrofacial and cervical pain are a frequent reason for neurology consultations and may be due to multiple pathological processes. These include Eagle syndrome (ES), a very rare entity whose origin is attributed to calcification of the stylohyoid ligament or elongation of the temporal styloid process. We present a series of five patients diagnosed with ES. MethodsWe describe the demographic and clinical characteristics and response to treatment of 5 patients who attended the headache units of 2 tertiary hospitals for symptoms compatible with Eagle syndrome. ResultsThe patients were 3 men and 2 women aged between 24 and 51, presenting dull, intense pain, predominantly in the inner ear and the ipsilateral tonsillar fossa. All patients had chronic, continuous pain in the temporal region, with exacerbations triggered by swallowing. Four patients had previously consulted several specialists at otorhinolaryngology departments; one had been prescribed antibiotics for suspected Eustachian tube inflammation. In all cases, the palpation of the tonsillar fossa was painful. Computed tomography scans revealed an elongation of the styloid process and/or calcification of the stylohyoid ligament in 3 patients. Four patients improved with neuromodulatory therapy (duloxetine, gabapentin, pregabalin) and only one required surgical excision of the styloid process. ConclusionsEagle syndrome is a rare and possibly underdiagnosed cause of craniofacial pain. We present 5 new cases that exemplify both the symptoms and the potential treatments of this entity.

Imaging of diffuse idiopathic skeletal hyperostosis (DISH)

Diffuse idiopathic skeletal hyperostosis (DISH) is a condition characterised by calcification and ossification of ligaments and entheses. The condition usually affects the axial skeleton, in particular, at the thoracic segment,...

Prevalence of morphological and structural changes in the stylohyoid chain.

BackgroundTotal or partial calcification of the stylohyoid chain, elongation of the stylohyoid process of the temporal bone and/or calcification of the stylohyoid ligament are usually incidental radiographic findings. The purpose of this study was to evaluate the prevalence of morphological and structural changes within the stylohyoid chain in 4413 digital panoramic radiographs. Material and MethodsThe images were evaluated for the presence or absence of changes in the stylohyoid chain by a specialist in dentofacial radiology and the information collected comprised gender, age, side, right and left measurements and classification of the chain side elongated or calcified stylohyoid process, as well as type and pattern of right or left calcification. Results275 (6.2%) subjects presented alterations, mostly bilateral, in the stylohyoid chain, being 186 females (67.6%) and 89 males (32.4%), with a higher proportion elongation. Partial calcification was more prevalent than total calcification. The right side was most affected and the frequency of events increased with age. ConclusionsThe findings of the present study demonstrate that the commonest alterations in the stylohyoid chain are bilateral, mainly elongation, with a clear trend to increased prevalence with increasing age, presenting a low incidence. Noneless, the clinicians must be aware of these alterations in the routinely radiographic examination. Key words:Stylohyoid process, Stylohyoid ligament calcification, Stylohyoid chain, Eagle’s syndrome.

Incidental findings in patients who underwent cone beam computed tomography for implant treatment planning

The aim of this study is to determine the type, frequency, and location of incidental findings in the maxillofacial region in patients undergoing cone beam computed tomography (CBCT) scan for implant treatment.[5]. In this study, 300 patients who underwent CBCT imaging for implant treatment planning were evaluated retrospectively. Patients were evaluated in four different categories, namely, maxillary sinus pathologies, temporomandibular joint (TMJ) findings, dentoalveolar findings, and soft-tissue calcifications. In maxillary sinus pathologies, we categorized patients by mucosal thickening, polypoidal lesion, air-liquid level, total opacification, oroantral fistula, periapical lesion related with maxillary sinus, antrolith, hypoplasia, and foreign body presence. In the TMJ findings category, we evaluated patients for erosion, osteophyte, sclerosis, flattening, and bifid condyle. For dentoalveolar findings, we looked for the residual root and impacted tooth. In soft-tissue calcifications, we examined patients for tonsillolith, sialolith, lymph node calcification, styloid ligament calcification, carotid artery calcifications, and osteoma cutis. Mucosal thickening was mostly seen in maxillary sinus pathology. One hundred and forty-eight (49.3%) of the patients had at least one TMJ incidental finding. We detected at least one impacted tooth in 17 (5.7%) patients' maxilla and 14 (4.7%) patients' mandibles. The most frequently seen calcification was styloid ligament calcification. There was no statistically significant relationship between the age groups and incidental findings (P > 0.05). Oral radiologists should be aware of incidental findings and evaluate the possibilities of underlying diseases in a comprehensive way, and if there is a concern about the finding, they should refer the patient to the relevant specialist.

CALCIFICATION OF THE STYLOHYOID LIGAMENT: A RETROSPECTIVE STUDY OF THE YEAR 2017

This study aims to analyze the incidence of calcification of the stylohyoid ligament through panoramic radiographs, considering its importance in clinical routine. Five hundred digitalized panoramic radiographs taken in 2017 were analyzed considering the incidence of the calcification of the stylohyoid ligament. The material was classified according to age, sex, and the affected side. According to the analysis, it was possible to identify a high frequency of calcifications (88%). It was observed that patients aged between 21 and 30 years old were the most affected ones (32.2%). Despite its probability, no significant difference was observed regarding the presence of calcifications by sex (P = .09, Fisher exact test). As to the affected side, bilateral calcification was more frequent (60%). Regarding the affected side and the sex of the patients, it was not possible to identify a significant difference (P = .20, Fisher exact test). It is possible to conclude that the radiographic findings of the calcification of the stylohyoid ligament are frequent, calling the attention of the professional to this condition, which can bring significant symptomatology for the patient sometimes.