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Case report: Calcification of genioglossus: A painful radiographic finding
Clinical Radiology(1992) 46, 137 138
Case Report: Calcification of Genioglossus: A Painful Radiographic Finding S. P. R. M A C L E O D a n d D. R. M A C I N T Y R E
Department of Oral Surgery, Raigmore Hospital, Inverness Resorption of the edentulous mandible can lead to the genial tubercles taking up a relatively superficial position. A case is presented where resorption was accompanied by calcification of the insertion of genioglossus resulting in the development of a painful mass in the floor of the mouth, whose nature could only be determined radiographically. MacLeod, S.P.R. & M a c i n t y r e , D.R. (1992). Clinical Radiology 46, 137-138. Case Report: Calcification of Genioglossus: A Painful R a d i o g r a p h i c F i n d i n g
CASE REPORT A 56-year-old woman was referred for an opinion on a painful swelling which had arisen beneath her lower denture. The patient had been wearing dentures successfullyand without symptoms for 30 years. On examination a swelling 3 cm in diameter, was present in the midline of the floor of the mouth, behind the alveolar ridge. The lower alveolar ridge was atrophic and the overlyingmucosa ulcerated (Fig. 1). The lower denture rested on this swelling. Intraoral radiography was non-contributory. However a lateral X-ray of the mandible demonstrated the gross resorption of the alveolar ridge and the dramatic calcificationof the genial tubercles extendingup into the insertion of the genioglossus muscle (Fig. 2). The swelling was excised under general anaesthesia. The patient declined the offer of reconstructive preprosthetic surgery.
m e n t a l f o r a m i n a and genial tubercles occupying more superficial positions. These changes can be used in the classification of e d e n t u l o u s jaws [2]. C h r o n i c irritation by poorly fitting dentures can also lead to dystrophic calcification of the t e n d i n o u s insertion o f the genioglossus muscle. F r a c t u r e of the genial tubercle region following this has been d o c u m e n t e d [3]. In our p a t i e n t resorption a n d dystrophic calcification occurred c o n c u r r e n t l y to p r o d u c e the p a i n f u l swelling in the floor o f her m o u t h . The true n a t u r e of the swelling could only be d e m o n strated radiographically.
DISCUSSION F o l l o w i n g tooth extraction resorption of the alveolar process occurs to a variable extent. The factors c o n t r i b u t ing to this have recently been reviewed [1]. They c a n be divided into local factors such as occlusal t r a u m a from poorly fitting dentures or systemic factors such as p o s t m e n o p a u s a l osteoporosis. This resorption can lead to changes in the form o f the jaws, with structures such as the
Fig. 1 Intraoral viewshowing swellingof the floor of mouth lingual to resorbed mandibular ridge. Correspondence to: Stephen P. R. MacLeod, 19 Ctunie Street, Banff AB45 1HY.
Fig. 2-Lateral X-ray of the mandible taken using a Cephalostat, showing marked mandibular resorption and calcification of the genioglossus insertion.
138
CLINICAL RADIOLOGY
Small genial tubercles m a y b e r e c o g n i z e d as a n o r m a l r a d i o g r a p h i c finding. H o w e v e r , large g e n i a l t u b e r c l e s are u n c o m m o n , as is calcification o f the g e n i o g l o s s u s . T h i s p a t t e r n o f calcification s h o u l d b e r e c o g n i z e d as a p o t e n t i a l l y significant r a d i o g r a p h i c f i n d i n g w h e n i n t e r p r e t i n g r a d i o g r a p h s o f the e d e n t u l o u s m a n d i b l e . Acknowledgements. We would like to thank Dr D.M. Nichols, Consu!tant Radiologist, for his helpful comments and the Department of Medical Illustration, Raigmore Hospital, for their assistance in preparing the illustrations.
REFERENCES
1 Devlin H, Ferguson MWJ. Alveolar ridge resorption and mandibular atrophy. A review of the role of local and systemic factors. British Dental Journal 1991;170:101-104. 2 Cawood JI, Howell RA. A classification of the edentulous jaws. International Journal of Oral and Maxillofacial Surgery 1988;l 7:232 236. 3 Carroll MJ. Spontaneous fracture of the genial tubercles. British Dental Journal 1983;154:47.
Case Report: Calcification of Genioglossus: A Painful Radiographic Finding S. P. R. M A C L E O D a n d D. R. M A C I N T Y R E
Department of Oral Surgery, Raigmore Hospital, Inverness Resorption of the edentulous mandible can lead to the genial tubercles taking up a relatively superficial position. A case is presented where resorption was accompanied by calcification of the insertion of genioglossus resulting in the development of a painful mass in the floor of the mouth, whose nature could only be determined radiographically. MacLeod, S.P.R. & M a c i n t y r e , D.R. (1992). Clinical Radiology 46, 137-138. Case Report: Calcification of Genioglossus: A Painful R a d i o g r a p h i c F i n d i n g
CASE REPORT A 56-year-old woman was referred for an opinion on a painful swelling which had arisen beneath her lower denture. The patient had been wearing dentures successfullyand without symptoms for 30 years. On examination a swelling 3 cm in diameter, was present in the midline of the floor of the mouth, behind the alveolar ridge. The lower alveolar ridge was atrophic and the overlyingmucosa ulcerated (Fig. 1). The lower denture rested on this swelling. Intraoral radiography was non-contributory. However a lateral X-ray of the mandible demonstrated the gross resorption of the alveolar ridge and the dramatic calcificationof the genial tubercles extendingup into the insertion of the genioglossus muscle (Fig. 2). The swelling was excised under general anaesthesia. The patient declined the offer of reconstructive preprosthetic surgery.
m e n t a l f o r a m i n a and genial tubercles occupying more superficial positions. These changes can be used in the classification of e d e n t u l o u s jaws [2]. C h r o n i c irritation by poorly fitting dentures can also lead to dystrophic calcification of the t e n d i n o u s insertion o f the genioglossus muscle. F r a c t u r e of the genial tubercle region following this has been d o c u m e n t e d [3]. In our p a t i e n t resorption a n d dystrophic calcification occurred c o n c u r r e n t l y to p r o d u c e the p a i n f u l swelling in the floor o f her m o u t h . The true n a t u r e of the swelling could only be d e m o n strated radiographically.
DISCUSSION F o l l o w i n g tooth extraction resorption of the alveolar process occurs to a variable extent. The factors c o n t r i b u t ing to this have recently been reviewed [1]. They c a n be divided into local factors such as occlusal t r a u m a from poorly fitting dentures or systemic factors such as p o s t m e n o p a u s a l osteoporosis. This resorption can lead to changes in the form o f the jaws, with structures such as the
Fig. 1 Intraoral viewshowing swellingof the floor of mouth lingual to resorbed mandibular ridge. Correspondence to: Stephen P. R. MacLeod, 19 Ctunie Street, Banff AB45 1HY.
Fig. 2-Lateral X-ray of the mandible taken using a Cephalostat, showing marked mandibular resorption and calcification of the genioglossus insertion.
138
CLINICAL RADIOLOGY
Small genial tubercles m a y b e r e c o g n i z e d as a n o r m a l r a d i o g r a p h i c finding. H o w e v e r , large g e n i a l t u b e r c l e s are u n c o m m o n , as is calcification o f the g e n i o g l o s s u s . T h i s p a t t e r n o f calcification s h o u l d b e r e c o g n i z e d as a p o t e n t i a l l y significant r a d i o g r a p h i c f i n d i n g w h e n i n t e r p r e t i n g r a d i o g r a p h s o f the e d e n t u l o u s m a n d i b l e . Acknowledgements. We would like to thank Dr D.M. Nichols, Consu!tant Radiologist, for his helpful comments and the Department of Medical Illustration, Raigmore Hospital, for their assistance in preparing the illustrations.
REFERENCES
1 Devlin H, Ferguson MWJ. Alveolar ridge resorption and mandibular atrophy. A review of the role of local and systemic factors. British Dental Journal 1991;170:101-104. 2 Cawood JI, Howell RA. A classification of the edentulous jaws. International Journal of Oral and Maxillofacial Surgery 1988;l 7:232 236. 3 Carroll MJ. Spontaneous fracture of the genial tubercles. British Dental Journal 1983;154:47.