Radiographic manifestations of Mönckeberg arteriosclerosis in the head and neck region

Abstract

Mönckeberg sclerosis is a disease of unknown etiology, characterized by dystrophic calcification within the arterial tunica media of the lower extremities leading to reduced arterial compliance. Medial calcinosis does not obstruct the lumina of the arteries, and therefore does not lead to symptoms or signs of limb or organ ischemia. Mönckeberg sclerosis most commonly occurs in aged and diabetic individuals and in patients on dialysis. Mönckeberg arteriosclerosis is frequently observed in the visceral arteries, and it can occur in the head and neck region as well. This report describes a remarkable case of Mönckeberg arteriosclerosis in the head and neck region as detected on dental imaging studies. To the best of our knowledge, this is the first case that has been reported in which this condition presented in the facial vasculature. The aim of this report was to define the radiographic characteristics of Mönckeberg arteriosclerosis in an effort to assist health care providers in diagnosing and managing this condition.

Arteriosclerosis in Dental Radiographs: Two Case Reports

“…Cases of facial artery medial calcification detected on intraoral radiographs were first published in 1942 by Ennis and 1966 by Hays [16,18]. Tahmasbi-Arashlow reported a case of 65year old male with diabetes mellitus and end-stage renal disease on hemodialysis with panoramic and intraoral radiographic evidence of facial artery and lingual artery medial calcification [17]. From a review of 2,422 panoramic radiographs taken on Veterans Administration patients, 6 cases of facial artery calcification were found (0.25% occurrence) by Miles with 4 of the 6 veterans having chronic renal failure, 2 of the 6 being on hemodialysis, and the age range of the 6 patients being 58-66 years [19].…”

“…Medial artery calcification is related to age and structural changes from metabolic disease, such as diabetes and chronic kidney disease, and is independent of hypercholesterolemia [14,15]. Medial artery sclerosis most often occurs in the extremities, but can also occur in the abdomen and head and neck areas [16,17]. Dentists can assist in the detection of this type of vascular calcification, as arteriosclerosis of the facial artery can present in routine dental radiographs [16,[18][19][20].…”

Calcificación vascular arterial detectada en radiografía panorámica digital

“…La primera es parte de la aterosclerosis, que está determinada por la acumulación de placas calcificadas dentro de la luz del vaso sanguíneo. En cuanto a la calcificación de la túnica media o también conocida como arteriosclerosis de Monckeberg, es una enfermedad degenerativa y no inflamatoria que está caracterizada por la calcificación distrófica y el endurecimiento progresivo de las fibras musculares, por lo que el vaso pierde su elasticidad sin obstruir o estrechar su luz [1][2][3] .…”

“…Al examen clínico generalmente se presenta de manera asintomática, pero en cuanto al examen radiográfico se observa como una imagen radiopaca proyectada en tejidos blandos que puede tener un curso recto o un camino tortuoso dando un patrón muy parecido a las vías del ferrocarril 1,6 (Figura).…”

Imaging Features of Soft-Tissue Calcifications and Related Diseases: A Systematic Approach

“…Currently, the exact etiology of this type of atherosclerosis remains unclear; they are primarily incidental findings that appear as a “railroad track” pattern ( Fig. 5 ) ( 10 ).…”