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 Table of Contents  
CASE REPORT
Year : 2016  |  Volume : 28  |  Issue : 3  |  Page : 314-316

Stafne cyst: Report of two unusual cases with review


Department of Oral Medicine and Radiology, Tamil Nadu Government Dental College and Hospital, Chennai, Tamil Nadu, India

Date of Submission13-Sep-2015
Date of Acceptance02-Dec-2016
Date of Web Publication13-Dec-2016

Correspondence Address:
Dr. Vidhya Kalanjiam
No. 4, Elango Street, J. B. Nagar, R.C.C., Avadi, Chennai - 600 109, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-1363.195654

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   Abstract 

Stafne cyst, named after Edward Stafne, was first described in 1942 when he noticed asymptomatic radiolucent cavities in intraoral radiographs of 35 different patients. It is usually a well-defined, round, ovoid or occasionally lobulated radiolucency of size 1–3 cm typically located in the submandibular gland fossa. In this paper, we present two cases of Stafne cyst, one with an unusual presentation having trapezoid-shaped radiolucency with scalloped margin involving the inferior border of the mandible and another with the usual presentation. In both the cases, diagnosis was based on clinical and radiological features alone without any surgical exploration. With the condition remaining static throughout the follow-up period, it is proven that noninvasive diagnostic radiography such as computed tomography scan with three-dimensional reconstruction and cone beam computed tomography can be very helpful for the definite diagnosis of Stafne cyst, rather than invasive procedures.

Keywords: Idiopathic bone cavity, static bone cyst, Stafne cyst


How to cite this article:
Murali Gopika MG, Kalanjiam V. Stafne cyst: Report of two unusual cases with review. J Indian Acad Oral Med Radiol 2016;28:314-6

How to cite this URL:
Murali Gopika MG, Kalanjiam V. Stafne cyst: Report of two unusual cases with review. J Indian Acad Oral Med Radiol [serial online] 2016 [cited 2022 Dec 2];28:314-6. Available from: http://www.jiaomr.in/text.asp?2016/28/3/314/195654


   Introduction Top


Stafne cyst is also known as lingual salivary gland depression, lingual mandibular bone depression, developmental salivary gland defect, Stafne bone cavity, static bone cavity, idiopathic bone cavity, latent bone cyst, lingual cortical mandibular bone defect, lingual mandibular bone defect, aberrant salivary gland defect and mandibular embryonic defect.[1] It was first described by Edward Stafne in 1942 when he noticed asymptomatic radiolucent cavities near the angle of the mandible as an incidental finding in intraoral radiographs of 35 patients.[2] Various explanations exist regarding the pathogenesis of Stafne cyst such as localized pressure atrophy of the lingual surface of mandible from the adjacent salivary gland, failure of normal bone deposition in the region previously occupied by Meckel's cartilage and development of mandible around entrapped submandibular salivary gland during the embryonic life, making the etiology of this condition not well defined.[3]

Lingual salivary gland depression is usually a well-defined, round, ovoid or occasionally lobulated radiolucency of size 1–3 cm, with well-defined dense sclerotic margins of variable width, usually located in the posterior region, i.e., submandibular salivary gland fossa of the mandible.[4] Variations such as lingual anterior variant, the medial ramus variant, bilateral presentation and bilocular defect,[5] multilocular defect,[6] or perforation of buccal cortical plate [7] have been reported occasionally.


   Case Reports Top


Case 1

A 47-year-old male patient reported with the chief complaint of pain in his right preauricular region of 2 months duration. His past medical, surgical and dental history were found to be noncontributory. On local extraoral examination, tenderness was present in the right temporomandibular joint region. Radiological evaluation using orthopantomogram (OPG) revealed altered condylar morphology on the right and left side and a trapezoid-shaped radiolucency involving the inferior border of the inferior alveolar canal superiorly and the lower border of the mandible inferiorly with corticated borders. The posterior margin was not clearly defined; it extended from the apices of lower right second and third molar [Figure 1] on the right side. Intraorally, the lesion was asymptomatic. All the teeth were vital on electric pulp testing. Computed tomography (CT) scan in axial, sagittal and coronal sections with three-dimensional reconstruction was employed for definite diagnosis, which revealed an open concavity with scalloped margin on the posterior lingual surface of the mandible with the base of the concavity reaching the buccal cortical plate without expansion or distortion of the plate. Within the defect, homogeneous soft tissue density continuous from the adjacent submandibular gland [Figure 1] was evident. The patient also had OPG and CT scan taken 10 years ago elsewhere, which also showed the same lesion with features evident in the current OPG and CT scan [Figure 2]. Comparing the current CT scan with the one taken 10 years ago, the lesion did not show any remarkable change in shape and size. Based on these evidences, the case was clinically and radiographically diagnosed as Stafne cyst.
Figure 1: Current orthopantomograph and computed tomography scan with three-dimensional reconstruction of the first patient

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Figure 2: Orthopantomograph and computed tomography scan of the first patient from 10 years ago

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Case 2

A 46-year-old male patient reported with the chief complaint of pain in his lower left back tooth region of 1 week duration. His medical and dental history were noncontributory. On clinical examination, extraorally and intraorally, no obvious changes were seen in the region of pain. His OPG revealed root stumps in relation to 25 and a well-defined ovoid radiolucency with sclerotic margin below the inferior alveolar canal and above the lower border of the mandible below the apices of lower second and third molar on the left side was found [Figure 3]. For further evaluation cone beam computed tomography (CBCT) was taken, which revealed an open mandibular concavity involving the lingual wall, with the base of the concavity reaching the buccal cortical plate without expansion of the plate [Figure 3]. Based on the clinical and radiological features, the case was diagnosed as Stafne cyst.
Figure 3: Orthopantomograph and cone beam computed tomography with three-dimensional reconstruction of the second patient

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   Discussion Top


As per the review of literature, Stafne cyst is a rare entity (0.10–0.48%), and the incidence is 4 in 1000 adults.[8] Lingual mandibular bone depression predominantly affects males than females. Ariji et al. divided Stafne cyst into different types based on the mandibular concavity, its relation with the buccal cortical plate and based on the CT findings.[9] Shigematsu et al. reported a radiological classification of Stafne bone cavity from a radiological investigation of the condition in 24 patients using OPG.[10]

The typical radiological features described in literature for a definite diagnosis is missing in the first case. Our first case had trapezoid-shaped radiolucency when compared to the ovoid shape normally reported in Stafne cyst. It extended inferiorly and involved the lower border of the mandible, whereas it is commonly seen in between the lower border of the mandible and the inferior alveolar nerve. The margins were found to be scalloped in the CT scan, a variation when compared to the routine well-defined margins. The case was also diagnosed at age 37 with a 10 year follow-up, which is much earlier than the generally reported age of between 50 and 70 years.

Both the cases fall under Type II category considering the concavity, because the base of the concavity reached the buccal cortical plate, without any expansion or distortion of the plate and were asymptomatic. Another critical point was that the CT scans taken 10 years ago and now did not show remarkable changes in the size and shape of the lesion.

Because we had radiographs and CT scan taken 10 years back and at present, we were able to compare the size of the lesion 10 years back and at present. If such a periodical review of the case is available, it is possible to diagnose Stafne cyst without surgical intervention. This paper mainly emphasizes on the importance of regular examination and follow-up for such cases to avoid surgical intervention in Stafne cyst.


   Conclusion Top


Diagnosis for Stafne cyst can be arrived at based on the clinical and radiological features alone with regular clinical examination and follow-up. Dental surgeons must keep in mind that it may present with many variations in shape, size, margins and extensions such as trapezoid shape with margins that may be scalloped and/or may involve the inferior border of the mandible.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Lello GE, Makek M. Stafne's mandibular lingual cortical defect: Discussion of aetiology. J Maxillofac Surg 1985;13:172-6.  Back to cited text no. 1
    
2.
Stafne EC. Bone cavities situated near the angle of the mandible. J Am Dent Assoc 1942;29:1969-72.  Back to cited text no. 2
    
3.
Philipsen HP, Takata T, Reichart PA, Sato S, Suei Y. Lingual and buccal mandibular bone depressions: A review based on 583 cases from a world-wide literature survey, including 69 new cases from Japan. Dentomaxillofac Radiol 2002;31:281-90.  Back to cited text no. 3
    
4.
White SC, Pharoah MJ. Cranofacial Anomalies. In: Jha AK, editor. Oral Radiology Principles and Interpretation. 1st ed. Gurgaon, India: Reed Elsevier India Private Limited; 2014. p. 625.  Back to cited text no. 4
    
5.
Imanimoghaddam M, Darijani M, Keshavarzi M. Bilocular Stafne bone defect above and below the inferior alveolar canal assessed by cone beam computed tomography: A case report. JDMT 2015;4;127-32.  Back to cited text no. 5
    
6.
Etöz M, Etöz OA, Sahman H, Sekerci AE, Polat HB. An unusual case of multilocular Stafne bone cavity. Dentomaxillofac Radiol 2012;41:75-8.  Back to cited text no. 6
    
7.
Herranz-Aparicio J, Figueiredo R, Gay-Escoda C. Stafne's bone cavity: An unusual case with involvement of the buccal and lingual mandibular plates. J Clin Exp Dent 2014;6:96-9.  Back to cited text no. 7
    
8.
Correll RW, Jensen JL, Rhyne RR. Lingual cortical mandibular defects: A radiographic incidence study. Oral Surg Oral Med Oral Pathol 1980;50:287-91.  Back to cited text no. 8
    
9.
Ariji E, Fujiwara N, Tabata O, Nakayama E, Kanda S, Shiratsuchi Y et al. Stafne's bone cavity. Classification based on outline and content determined by computed tomography. Oral Surg Oral Med Oral Pathol 1993;76:375-80.  Back to cited text no. 9
    
10.
Shigematsu H, Suzuki S, Osuga T, Okumura Y, Fujita K. A radiographical classification of Stafne's bone cavity. Oral Radiol 1993;2:13-8.  Back to cited text no. 10
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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