Radiology Forum

Each month this section will bring the reader of Oral Surgery, Oral Medicine, and Oral Pathology information of practical relevance to the art and science of diagnostic imaging and diagnostic images with unusual interpretive features. Practical notes and radiographs will be accompanied by an explanation or inquiry. Please submit 5 by 7 inch glossy black and white prints of your illustrations. All materials for publication should be submitted to Dr. Allan G. Farman, Department of Primary Patient Care, School of Dentistry, University of Louisville, Louisville, Kentucky 40292.

FACIAL PHLEBOLITHS

A 28-year-old woman came to the Oral and Maxillofacial Surgery Clinic for evaluation and treatment of an extensive left facial hemangioma. The arteriovenous malformation extended from the left commissure of the mouth posteriorly into the parotid region and superiorly to the left infraorbital rim, A panoramic radiograph revealed several ovoid opacities over an edentulous region of the left maxil- lary posterior alveolar ridge. Palpation of the buccal tissue overlying the ridge revealed the opacities to be phleboliths in the hemangioma. The patient had subtotal resection of the lesion, not including the region of the phleboliths, and has done well postop- eratively.

James R. Hupp, DMD, MD Department of Oral and Maxillofacial Surgery

University of Connecticut School of Dental Medicine

Farmington, CT 06032

STEEL COILS

A 20-year-old man with Down’s Syndrome and Eisenmenger’s complex was referred to the oral maxillofacial surgery service for evaluation of a slowly enlarging left maxillary mass. The patient was prepared for incisional biopsy but before beginning an aspiration was attempted. This was positive for a vascular process so, instead of incisional biopsy, a needle biopsy was performed. This revealed the lesion to be a large arteriovenous malformation. An arteriogram was performed; this confirmed the diag- nosis and revealed that the left internal maxillary and facial arteries were feeding the mass. These arteries were occluded with the use of gelatin emboli and stainless steel coils. The mass was partially excised and the remaining tumor sclerosed. Fig. 1 reveals the appearance of the four stainless steel coils in the left internal maxillary artery and one coil in the facial artery. The patient has done well since the embolization and surgery. (Movement visible on the

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March 1989

film is due to the patient’s unwillingness to cease movement during imaging.)

James R. Hupp, DMD, MD Department of Oral and

Maxillofacial Surgery University of Connecticut

School of Dental Medicine Farmington, CT 06032

DYSTROPHIC CALCIFICATION OF THE SUBMANDIBULAR GLAND

T he following case involved a mass occupying the region of the right submandibular gland.

CASEREPORT

A 62-year-old white man was referred by his dentist for evaluation of a right submandibular swelling. Oral exami- nation revealed an edentulous maxilla and six remaining anterior mandibular teeth. The swelling of the right submandibular triangle was rock hard, mobile, and non- tender to palpation. The patient stated that he had had several painful swellings in this area over approximately a 5-year period 15 years before our evaluation. He had been treated with antibiotics for an “infected gland” each time, and the swellings eventually resolved. The present hard swelling had been present for “many years” and had not enlarged.

A panoramic radiograph (Fig. 1) was obtained; it revealed a large radiopaque mass occupying the entire region of the right submandibular gland. A clinical diag- nosis of dystrophic calcification of the right submandibular gland was made. The patient declined treatment or biopsy of the lesion because of its asymptomatic and apparently static nature.

DISCUSSION

Dystrophic calcification of the tissues usually results from calcium deposition in areas of long- standing tissue necrosis. An underlying history of deranged calcium metabolism such as hyperparathy- roidism, chronic renal disease, or milk alkali syn- drome is not necessarily present.

Whether the present case represents a progressive enlargement of a solitary sialolith or multicentric calcification throughout the entire gland after repeated infections is impossible to ascertain.

James B. Murphy, DMD. MS ChieA Oral and Maxillofacial Surgery

Veterans Administration Medical Center

Philadelphia, PA 19104

REFERENCE

I. Robbins SL, Cotran RS, Kumar, V. Pathologic basis of disease. 3rd ed. Philadelphia: WB Saunders Co, 1984:35.

Fig. 1.