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Stafne bone defect SBD is a bone cavity in the lingual surface of the mandible normally filled by salivary gland tissue.
In conventional radiographs, SBD typically resembles a radiolucent unilocular lesion with welldefined margins, localized under the inferior alveolar canal. The diagnosis of SBD is often incidental due to the asymptomatic nature.
The aim of this study was to investigate the prevalence of SBDs in a Brazilian population and to describe the radiographic features of the cases reported.
This retrospective study evaluated 17, digital panoramic radiographs of patients with an indication of radiography for dental treatment seen at three centers located in the three Brazilian states. In each center, two researchers evaluated the images for establishment of the consensual diagnosis of SBD. In the case of disagreement, a third researcher was consulted to reach a final consensus. To assess the prevalence of SBDs, sex and age of patients were considered, and SBDs were classified according to their form and location.
Data were submitted to descriptive analysis. Among the The age range of the patients with SDB was years mean: Fourteen cases were located in the posterior region of the mandibular body and one case in the ascending ramus. Stafne bone defect is a rare developmental anomaly that more commonly affects middle-aged men. The condition has a typical radiographic appearance and panoramic radiography is a valuable tool for its diagnosis.
Entre los Stafne bone defects SBDs were described for the first time by Stafne in , who reported 35 asymptomatic unilateral radiolucent cavities in the mandibular posterior region Stafne, These bone cavities generally measure 1 to 3 cm in diameter and are located on the lingual surface of the posterior mandible between the mandibular angle and third molar, below the mandibular canal and above the mandibular base.
The prevalence of SBDs at this posterior site ranges from 0. The posterior variant is mainly diagnosed in men between 50 and 70 years of age Asaaf et al. The anterior variant is often located in the region between the incisors and premolars, and its prevalence is generally seven times lower than that of the posterior variant Asaaf et al. Many different terms have been used to describe this condition, including ectopic salivary glands, static bone cyst, lingual mandibular bone defect, Stafne bone cavity, idiopathic bone cavity, or lingual mandibular bone depression Philipsen et al.
As most of the terms clarify, SBD is not a pathology but seems to be related to the pressure exerted by the submandibular gland, or by the sublingual gland in the case of the anterior variant, which causes bone resorption in the region Philipsen et al. Since SBDs are usually asymptomatic, they are discovered accidentally in imaging tests.
In view of the similarity of SBD with some lesions, it is important for the professional to be able to identify the condition. The differential diagnosis should include bone cysts and cyst-like lesions such as solitary bone cysts, aneurysmal bone cysts and traumatic-hemorrhagic bone cysts Asaaf et al. The objective of this study was to describe the clinical and radiographic characteristics of SBDs diagnosed at three referral centers for Oral and Maxillofacial Radiology in Brazil, to estimate their frequency in the Brazilian population, and to compare the results with literature data.
Protocol 1,, - CAAE: Were included panoramic radiographs which exhibited no positioning errors or jaw bone lesions. Six calibrated oral radiologists with at least 4 years experience in the interpretation of imaging tests examined the images for establishment of the consensual diagnosis of SBD.
Two in each center evaluated the panoramic radiograph in a silent room without artificial or natural lighting. In the case of disagreement between the evaluators, a third researcher oral radiology specialist was consulted to reach a final consensus. The criteria proposed by Schneider et al. The age, sex, laterality, location, and shape of the SBD cases were recorded.
The results were entered into Excel spreadsheets and analyzed descriptively. A total of 17, radiographs met the inclusion criteria and were examined.
Fifteen 0. The age of the patients diagnosed as SBD ranged from 30 to 69 years, with a mean of Regarding location, 5 cases involved the left side and 10 cases, the right side. The anterior and bilateral presentations were not observed. Table I shows the distribution of the cases according to patient age and sex, as well as the location and shape of the SBDs found. Figure 1 shows the images of the 15 cases diagnosed as SBD. Case 2 was located in the ascending ramus and the remaining cases in the posterior region of the mandibular body.
In general, SBD is an incidental finding during the interpretation of imaging tests, especially panoramic radiographs and cone beam computed tomography scans, where it appears as an oval or round, uni- or bilateral, generally corticated, radiolucent image located near the mandibular angle, below the inferior alveolar canal. It mainly affects the posterior region of the mandible and is rarely found in the anterior region Avsever et al.
The description of the bone lesion as latent, stable or static is due to the fact that it persists unchanged over long periods Asaaf et al. Several theories try to explain the etiopathology of SBD Sisman et al. One theory suggests a congenital or embryonic origin of the condition.
According to this theory, SBD is the result of mandibular hypoplasia during growth and development Stafne. The main objection to this theory is that these defects are more frequently diagnosed in adults than in children, suggesting that they develop after ossification of the mandible.
The youngest patient with SBD reported in the literature was 11 years old Hansson, In this respect, the findings of the present study support the objection to this theory since the youngest patient diagnosed with SBD was 30 years. Another theory suggests that SBD is caused by the constant pressure from the salivary gland tissue Sisman et al. According to this theory, the submandibular gland is related to posterior defects, while the sublingual gland is related to anterior defects Philipsen et al.
Some authors defend acquired vascular lesions to be a possible cause of bone depression Minowa et al. Further studies are needed to clarify the true etiology of this condition. According to a literature review, SBDs are commonly diagnosed in men between 50 and 70 years of age Sisman et al. This trend of a higher prevalence in male patients was observed in the present study male-to-female ratio of , in agreement with previous studies that found ratios of , 1.
Stafne bone defects are generally diagnosed in patients older than 20 years, most of them in the fifth and sixth decades of life Sisman et al. Similarly, the 15 cases of SBD included in the present study were patients aged 30 to 69 years mean The low prevalence of SBDs ranging from 0.
Table II was confirmed in the present study, in which the prevalence was 0. The same rate was reported in other studies investigating different populations Sisman et al. The anterior variant is even lower prevalence, 0. This fact may explain why this variant was not found in the present study. In most cases, SBDs are unilateral but bilateral defects are observed occasionally.
No bilateral defects were found in the present study. To our knowledge, there are only 9 cases of bilateral anterior SBDs reported in the literature Queiroz et al. Generally, SBDs are located in the posterior region of the mandibular body or in the mandibular angle, below the mandibular canal. These defects are rare in the ramus, coronoid process, or anterior mandible.
In the present study, 14 cases were located in the posterior region of the mandibular body and only one case in the left mandibular ramus. Hisatomi et al. Since SBDs are asymptomatic, most cases are discovered accidentally during imaging examinations. However, in some case reports the patients reported pain at the site of the SBD Bornstein et al. In this retrospective analysis of previous anamnesis, none of the patients had pain, swelling or infection and all cases were discovered by evaluation of panoramic radiographs.
The correct identification of SBD is important because the posterior mandible is prone to develop pathological lesions. Thus, the differential diagnosis of SBD should include pathologies such as odontogenic cystic lesions, vascular malformations, unicystic ameloblastoma, giant cell granuloma, odontogenic keratocyst, aneurysmal bone cyst, benign salivary gland tumors, and neurogenic tumors Sisman et al.
One important feature to distinguish between SBD and other conditions is the location of the former below the mandibular canal. In most cases, the diagnosis of SBD is easy, because of its specific appearance on radiographs.
The defects are usually detected on conventional or digital panoramic radiographs. These imaging methods generally provide sufficient information for the diagnosis of SBDs and were therefore used in the present study. Panoramic radiography is widely used in dentistry because of its broad availability and the low radiation dose. More advanced imaging techniques such as computed tomography, magnetic resonance imaging and even sialography should be restricted to atypical lesions, when the final diagnosis cannot be made by panoramic radiography Avsever et al.
Treatment of the posterior or anterior variants of SDB is not necessary since these mandibular bone depressions were found to be a change in the anatomical condition and are not pathological.
A conservative approach consisting of clinical and imaging follow-up is generally recommended. Surgical procedures or biopsies should only be performed in atypical cases or if notable changes are observed during radiographic follow-up Sisman et al.
Assaf, A. Prevalence of Stafne's bone cavity-retrospective analysis of 14, panoramic views. In Vivo, 28 6 , Avsever, H. Stafne bone cavity: A retrospective panoramic evaluation on prevalence in Turkish subpopulation.
Bornstein, M. Anterior Stafne's bone cavity mimicking a periapical lesion of endodontic origin: report of two cases. Chen, C. An analysis of radiological findings of Stafne's idiopathic bone cavity. Correll, R. Lingual cortical mandibular defects: a radiographic incidence study. Oral Surg. Oral Med. Oral Pathol.
2018, Number 4
Skip to search form Skip to main content You are currently offline. Some features of the site may not work correctly. DOI: Diagnosis of this lesion is essential because of its similarity with other odontogenic pathologies. We present three cases of SBC which was firstly diagnosed with plain radiographs that were confirmed with dental computerized tomography.
The Stafne defect also termed Stafne's idiopathic bone cavity , Stafne bone cavity , Stafne bone cyst misnomer , lingual mandibular salivary gland depression , lingual mandibular cortical defect , latent bone cyst , or static bone cyst is a depression of the mandible on the lingual surface the side nearest the tongue. The Stafne defect is thought to be a normal anatomical variant, as the depression is created by ectopic salivary gland tissue associated with the submandibular gland and does not represent a pathologic lesion as such. It is a classed as a pseudocyst ,  since there is no epithelial lining or fluid content. This defect is usually considered with other cysts of the jaws , since it can be mistaken for such on a radiograph. There are no symptoms,  and no signs can be elicited on examination.