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Stafne Bone Defect in the Ramus of the Mandible: a Case Report

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Stafne Bone Defect in the Ramus of the Mandible: a Case Report Stafne bone defect in the ramus of the mandible: a case report Abstract Case Report Introdouction: Parotid Stafne bone defect is a very rare and in- Najme Anbiaee1, Saeede Ebrahimi2, Hamed frequent variant, which is located on the buccal Ebrahimnejad3, Maryam Mohammadzade Rezaie3, or lingual surface of the mandibular ascending Zoha Sahebnasagh2 ramus. In this paper, a case of parotid Stafne defect, which was incidentally discovered dur- ing dental radiographic examination, is report- 1 Associate Professor, Oral and maxillofacial radiolo- ed. This bone defect was observed as a lucent gist, Department of Oral and Maxillofacial Radiology, oval-shaped defect on the lingual aspect of the Maxillofacial Diseases Research Center, School of right mandibular ramus. Parotid Stafne bone de- Dentistry, Mashhad University of Medical Sciences, fect is a rare entity that should not be misinter- Mashhad, Iran. preted by radiologists. 2Oral and Maxillofacial Radiology Resident,Depart- ment of Oral and Maxillofacial Radiology, Maxillofa- cial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran. 3Oral and Maxillofacial Radiologist,Department of Oral and Maxillofacial Radiology, Maxillofacial Diseases Research Center, School of Dentistry, Mashhad University of Medical Sciences, Mashhad, Iran. Received:Mar 3, 2016 Key words: Accepted: May 28,2016 •Cone-Beam Computed Tomography • Parotid Gland• Mandible Corresponding Author: Saeede Ebrahimi Address: Oral and Maxillofacial Radiology Department, Faculty of Dentistry, Mashhad University of Medical Sciences, Mashhad 91735-984, Iran. Telephone: +98-51-38829501 Email: [email protected] Fax: +98-51-38829500 Journal of Dentomaxillofacial Radiology, Pathology and Surgery Vol 5, No 1, Spring 2016 Parotid Stafne bone defect Case Report In the panoramic radiograph, a well-defined unilocular radiolucent area in the posterior and A 55-year-old man was referred by his physi- upper one-third of the mandibular ascending ra- cian to the Oral and Maxillofacial Radiology mus under the condylar neck was observed. The Department of Mashhad Dental College for lesion did not have any effect on the inferior al- parotid Stafne defect. His past history revealed veolar canal. No expansion was noticed on the that he was referred to an oral and maxillofacial dimensions of the mandibular ascending ramus radiology center for dental implant planning 2 (Figure 1).In comparison with the appearance of years ago. The radiologist had informed him the lesion 2 years ago, the shape and size of the about the presence of a lesion in his right man- lesion now did not show any perceptible change. dibular ramus with a presumptive diagnosis of CBCT assessment revealed a well-defined uni- parotid Stafne defect. locular, oval-shaped radiolucent area on the On extraoral and intraoral examinations, no lingual aspect of the ascending ramus with an swelling or discoloration was observed in the approximate size of 8.64 × 3.20 mm. The depres- mucosa and the patient did not complain of sion had involved almost the full thickness of the pain or any other symptoms. His medical and ramus in some sections (Figures 2, 3). familial histories were unremarkable. According to the radiologic and clinical exam- In order to rule out benign tumors and achieve inations, the diagnosis of parotid Stafne defect definitive diagnosis, the patient underwent was confirmed. No additional treatments except panoramic and Cone-Beam Computed Tomog- scheduled follow-up appointments were per- raphy (CBCT) examinations. formed. Figure 1. A panoramic radiograph shows a well-defined unilocular radiolucent lesion in the posterior and upper one-third of the mandibular ramus under the condylar neck. Figure 2. Cone-Beam Computed Tomography axial (A) and coronal (B) views show a well-defined bone defect on the- 38 lingual - side of right mandible ramus. N. Anbiaee, S. Ebrahimi, H. Ebrahimnejad, et al. Figure 3. Three-dimensional view shows the bone defect on the lingual surface of the In 1942, Edward C Stafne described Stafnemandibular bone cal ramus. surface of mandibular ascending ramus (LR defect (SBD) for the first time.(1) He reported 35 and BR, respectively) are very rare. The rarest radiolucent, asymptomatic cavities, located uni- type of defect was located on the buccal aspect laterally in the posterior region of mandible, be- of the mandibular ascending ramus, which was low the inferior alveolar canal and slightly above described by Shields during a study of 7,686 dry the mandibular inferior cortex. Since then, this mandibles.(6, 7) entity has been given numerous names, such as Although posterior variants of SBDs with Static bone cyst, lingual mandibular bone defect, well-defined unilocular presentation are usually Stafne bone cavity, idiopathic bone cavity, lin- diagnosed with panoramic radiographs, SBDs gual mandibular bone depression, aberrant or with unusual presentations are often misdiag- ectopic salivary gland defect, latent bone cyst, nosed with benign odontogenic inflammatory developmental bone defect, and embryonic man- or cystic lesions and need to be identified with dible defect.(2, 3) advanced imaging techniques; such as Comput- Salivary gland bone defects are rare and general- ed Tomography (CT) or MRI.(8) Radiological ly asymptomatic, which are found in routine ra- artifacts and superimposition of anatomic struc- diographic examinations. If pain is present, other tures (such as soft palate) can also mimic the oral pathologies, such as chronic sialadenitis or SBDs appearance or mask structures in the area. pleomorphic adenoma, are considered.(2, 4) Other Among three-dimensional advanced imaging lesions that can be considered for differential di- modalities, cone-beam CT (CBCT) is preferred agnosis are ameloblastoma, keratocystic odonto- to the multi-slice CT (MSCT) because it has a genic tumor, solitary bone cyst, aneurysmal bone higher spatial resolution and a lower cost and ra- cyst, eosinophilic granuloma, central giant cell diation dose.(9) Although the diagnosis of lingual granuloma, and metastatic tumors.(5) plate defect with CBCT is valid and safe, MRI Although four variants of this defect have been has the advantage of showing the soft tissue pro- described, when the term “Stafne bone cavity” is lapsed into the bony defect without exposing the used in literature, it usually refers to the poste- patient to radiation.(10, 11) Smith et al reported that rior lingual variant (LP) that is located between MRI is the most useful diagnostic tool to discov- the angle of mandible and the first permanent er the content and extent of SBD.(12) Sialography molar, below the inferior alveolar canal.(3) The can also be used to determine the presence of anterior lingual variant (LA), seven times less glandular tissue within the cavity. However, this frequent than the posterior, is usually located procedure is invasive and can be distressful for between the incisor and the mandibular premo- patients. lar areas, superior to the insertion of mylohyoid Parotid Stafne defect is an infrequent finding, muscle. Variants located on the lingual or buc- which has two LR and BR variants. The LR type - 39 - Parotid Stafne bone defect is located posterior to the mandibular foramen inflammatory infiltrations leading to fibrosis, hy- and below the neck of the condyle. Its radio- pertrophy and hyperplasia of varying degrees.(13) graphic appearance is often more circular than These processes will gradually change the soft the LA and LP variants. The LR variant is usual- consistency of the gland to a fibrous tissue mass. ly smaller than the other types.(6) In early and middle age, pressure by fibrosis lobe The incidence of LP varies between 0.10 and of gland on the mandibular cortex may have suf- 0.48%, and the incidence of LA variant is about ficient force to cause local bone resorption. It is 0.009%.(9) Philipsen et al stated that until the necessary to consider that the connective tissue year 2002 only 13 cases of LR Stafne defect that connects the parotid gland to the posterior were reported.(6) The present case was reported border of the ascending ramus allows glandular due to the scarce abundance of LR Stafne var- tissue to slide on the bone surface during man- iant, which can mislead a clinician in making a dibular movements. This would prevent any cer- correct diagnosis. tain pressure on the posterior border of the man- The age range is quite wide, with the highest dibular ramus that could form cavities.(6) incidence in the fifth and sixth decades.(3) The Some tumors like calcified parotid gland adeno- higher prevalence in men is documented in dif- ma can also create a notch or depression on the ferent studies.(6) posterior border of the mandibular ascending ra- Since the pathological processes are not involved mus.(6) in the pathogenesis of SBD, it may take several Since the size of the SBDs rarely change, they years until the defect is visible radiographical- are considered static lesions and a non-invasive ly. This is consistent with the fact that SBDs are method based on periodic control examinations rarely diagnosed before the age of 40 years.(6) is the proposed process. However, in unusual Etiology and pathogenesis of SBD is not clearly cases or when there is doubt in the diagnosis, known. It is anatomically related to the salivary surgical intervention and histopathological eval- glands and may contain adipose tissue, pleomor- uation may be necessary.(2) phic adenoma, connective tissue, lymphoid tis- sue, skeletal muscle or blood vessels. In some Conclusion (2, 4) cases, the cavity is completely empty. It is The purpose of presenting this case is to intro- assumed that SBDs may have a common source duce a rare parotid Stafne defect that was inci- (Glandular Theory): the pressure by hyperplas- dentally discovered in a 55-year-old man. The tic/hypertrophic salivary glands tissues on the radiologist must be aware of these bone defects (13, 14) bone surface. With age, the major salivary in order not to misinterpret them.
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