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SOFT TISSUE CALCIFICATION AND OSSIFICATIONUnorganized 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)eg- chondrocalcinosis 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 symmetricallyGENERAL DYSTROPHIC CALCIFICATIONOF 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

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.lymph node chaining

cauliflower-like shapetuberculosis 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 DiagnosisSialolith-smooth outline

Phleboliths- are usually smaller and multiple, with concentric radiopaque and radiolucent rings

bull s-eye or targetCalcification in the TonsilsTonsillar 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 calcified stylohyoid ligament.Differential Diagnosiscalcified granulomatous disease, syphilis, mycosis, or lymphomadense bone island.Arterial Calcifi cationsTwo distinct patterns of arterial calcification can be identified both radiographically and histologicallyMonckebergs medial calcinosisCalcified atherosclerotic plaque

Monckebergs medial calcinosisDefinitionThe 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 (ARTERIOSCLEROSIS) pipe stem or tram-track appearance in Sturge-Weber syndrome

calcification of a facial veinEvaluation 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 PLAQUEmajor 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 themCALCIFIED 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 DiagnosisCalcified triticeous cartilage-uniform size, shape, and location of calcified triticeous cartilage in the laryngeal cartilage

Idiopathic CalcificationSIALOLITH

PHLEBOLITHSPhleboliths are calcified thrombi found in veins, venulae, or the sinusoidal vessels of hemangiomas (especially the cavernous type)

Phleboliths are soft tissue dystrophic calcifications found in veins. They are usually associated with hemangiomas.bull s-eye or target LARYNGEAL CARTILAGE CALCIFICATIONS

A lateral cephalometric film revealing calcification of thethyroid cartilage (arrow).triticeous means grain ofwheat, 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 ligamentSymptoms 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 CUTISOsteoma cutis is a rare soft tissue ossification in the skinresult of acne of long durationThe 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 OSSIFICANS1. Localized (Traumatic) Myositis Ossificans(Posttraumatic myositis ossificans and solitary myositis)2. Progressive Myositis OssificansLocalized (Traumatic) Myositis Ossificans

Soft tissue ossification extending from the coronoid process in a superior direction, following the anatomy of the temporalismuscle (arrow). This condition arose after several attempts were made to provide a submandibular nerve block, leaving the patient unable toopen the mandible.Pseudotrabeculae are characteristic of myositis ossifi cans and strongly imply a diagnosis.Progressive Myositis Ossificans

Myositis ossificans, seen as bilateral linear calcifications (arrows) of the sternohyoidmuscle., An axial CT scan with soft tissue algorithm demonstrating calcifications in the lateral pterygoid muscle