The search for bilateral asymmetry in CBCT images cannot be over stressed. In the three images below a 30 year old male has an incidental finding of a soft tissue opacity 11 x 8 mm in the right external auditory canal.

The adjacent bone does not appear to be eroded or expanded so it could be a benign mass and an ENT referral is needed.

- Dr Douglas K Benn DDS, PhD, Dipl. Dental Radiology (Royal College of Radiologists, England)
Oral and Maxillofacial Radiologist

3610 Leavenworth Court
Omaha, NE 68105-1200 USA
Tel: (402)-953-6264
Fax: (866)-420-4903
www.ReadCTs.com

Just anterior to the epiglottis at the base of the tongue are two bilateral spaces, the Valleculae. These should be symmetrical spaces which are clearly seen on axial sections. However, in the section below there is a soft tissue nodule 8 x 10 mm in the right space.

In the images below, there are two nodules on the left side of the base of the tongue.

The differential diagnosis includes lymphoid hyperplasia (the lingual tonsils are in this region), benign and occasionally malignant tumors. The patient should have an examination by an ENT specialist.

-Dr. Douglas K Benn DDS, PhD
Oral and Maxillofacial Radiologist

In CBCTs which include the cavernous sinuses, just medial and posterior to the back of the orbit lie the internal carotid arteries.

The cavernous part of the artery has a tortuous path which causes turbulance and is more likely to calcify than the straighter portions.

​The calcified walls of the artery may be single white lines or parallel lines if both walls are calcified as in this sagittal image.

In coronal images the arteries can appear as opaque circles.

Calcification of the carotid artery walls is a sign of advanced atherosclerotic disease and likely affects other vessels such as coronary arteries.

If you find calcifications, you should advise your patient to consult with their doctor and send a brief letter to the physician.

-Dr Douglas K Benn DDS, PhD, Dipl. Dental Radiology (Royal College of Radiologists, England)
Oral and Maxillofacial Radiologist
www.ReadCTs.com

It is common for the IANC to be close or even touching the apices of unerupted third molars. However, it is rare for the IANC to actually pass between or through the roots.

In the images below, the IANC passes between two mesial roots of #32.

- By Dr. Douglas K Benn DDS, PhD, Dipl. Dental Radiology (Royal College of Radiologists, England)
Oral and Maxillofacial Radiologist
www.ReadCTs.com

Although I have in the past shown some images I wanted to provide some clinical relevance regarding the prevalence of CACNs and the role of dentists.

In adults with a negative history for cardiovascular disease, diabetes, hypertension and chronic kidney disease about 5-7% of adults over the age of 40 years may have CACNs seen of pans or CBCTs. In patients with diseases listed, the prevalence will approach 50%.

To put this in context, a dentist with an average sized dental office population may see 3-5 oral cancers in their practicing life time.

However, the number of CACNs will probably be in the 100s of patients. For those patients who do not know they have hypertension, diabetes or kidney disease, the first indication of their cardiovascular disease may be a fatal heart attack or stroke.

If a dentist sees a CACN in a patient with a normal medical history and refers them to their MD to further evaluate, they will probably save many lives.

By Dr. Douglas K Benn DDS, PhD, Dipl. Dental Radiology (Royal College of Radiologists, England)
Oral and Maxillofacial Radiologist

3610 Leavenworth Court
Omaha, NE 68105-1200 USA
Tel: (402)-953-6264
Fax: (866)-420-4903
www.ReadCTs.com

A 65-year-old male with chance finding of vascular calcification inside the left cheek region from the lower border of the mandible running upwards adjacent to #18-19 region.

This is probably the facial artery.

The 3D reconstruction shows a posterior transverse branch rising towards the parotid region.
The patient is being treated for high cholesterol and hypertension.

Vascular calcification is a late change in atherosclerosis and similar changes are likely in the carotid and coronary arteries. The patient should be informed of the calcification and advised to consult their physician. A letter should be sent to the physician.

- By Dr. Douglas K Benn DDS PhD, Diploma in Dental Radiology (Royal College of Radiologists, England)
Oral and Maxillofacial Radiologist

Chance finding of large 11 x 6 mm well defined multilocular lucency in the midline upper pharynx posterior adenoidal region in M 20 years of age. Developmental unilocular Tornwald mucous cysts are uncommon in this region seen in 0.06% of CTs and MRIs of this region.

However, they are unilocular and this lesion is multilocular and so the differential diagnosis includes

• nasopharyngeal carcinoma (NPC)
• up to 12% NPC’s are midline
• minor salivary gland tumours
• neurenteric cysts
• meningocoele

The patient and their MD should be informed for an ENT follow up examination.

By Dr Douglas K Benn DDS PhD
Oral and Maxillofacial Radiologist
ReadCTs.com

Incidental finding in a 34 year-old male of the Right Zygomatic bone moderately well defined opacity 8 x 15 x 27 mm. The bone is sclerotic with a small oblong central low density region and is continuous with surrounding bone.

The zygomatico-temporal and zygomatico-maxillary sutures are visible. The bone density varies slightly and is not uniform.

There is an increase in size compared to the left zygomatic bone. Differential diagnosis includes 1) fibrous dysplasia, 2) trauma, 3) osteoma.

In the absence of signs or symptoms no further investigation recommended.

Dr Douglas K Benn DDS PhD
Dipl. Dental Radiology (Royal College of Radiologists, England)
Maxillofacial Radiologist
www.ReadCTs.com

Here is a 44-year-old male asymptomatic with a chance finding of a well defined round opacity 9 mm in diameter.

It has a circular layered appearance and is located probably at the posterior edge of the mylohyoid muscle where the submandibular duct curls around the muscle.

The differential diagnosis could include a lymph node (but which are often lobulated) and a phlebolith (which usually has a more lucent central vessel lumen).