Incidental Findings of Muscle-Origin Calcifications in the Sternocleidomastoid Muscle on an Orthopantomogram: a Case Report

Incidental Findings of Muscle-Origin Calcifications in the Sternocleidomastoid Muscle on an Orthopantomogram: a Case Report | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Incidental Findings of Muscle-Origin Calcifications in the Sternocleidomastoid Muscle on an Orthopantomogram: a Case Report Francesco Valente, Riccardo Riccardi, Roberto Del Rosso, Pierluigi Valente, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5746452/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 03 Mar, 2025 Read the published version in Cureus → Version 1 posted You are reading this latest preprint version Abstract Background: This case report documents incidental findings of bilateral calcifications within the sternocleidomastoid (SCM) muscle observed on a dental panoramic radiograph. The aim is to emphasize the importance of recognizing overlapping anatomical structures in panoramic radiography to prevent misdiagnosis. Methods: During a routine dental examination, a 59-year-old female was found to have multiple small calcifications bilaterally in the mandibular ramus region on an orthopantomogram. Further evaluation with ultrasound confirmed the presence of calcifications within the SCM muscle. A comprehensive differential diagnosis was performed, considering potential causes such as trauma, inflammation, metabolic disorders, and idiopathic conditions. Results: Ultrasound imaging identified multiple small calcified deposits within the SCM muscle bilaterally, with sizes ranging from 2 to 6 mm. The absence of systemic disorders or recent trauma supported a diagnosis of dystrophic calcifications. Conclusions: This case highlights the need to assess anatomical structures beyond the dental region in panoramic imaging. Ultrasound is recommended as an adjunct imaging modality to accurately determine the origin and location of muscle calcifications without additional radiation exposure. Recognizing these incidental findings on dental radiographs is essential for avoiding misinterpretation and unnecessary interventions. Muscle origin calcifications Sternocleidomastoid Ultrasound Dental Orthopantomogram Dental panoramic x-ray Figures Figure 1 Figure 2 Figure 3 Introduction Dental panoramic radiographs are commonly used in dentistry for evaluating dental and bony structures. Occasionally, they reveal incidental findings unrelated to the dental condition being examined. Muscle calcifications are incidental findings in radiological examinations ( 1 , 2 ). While they are generally asymptomatic, their presence may raise concerns for the treating clinician ( 3 ). The sternocleidomastoid (SCM) muscle is a prominent neck muscle that plays a crucial role in head and neck movement. The SCM has two heads. Sternal head, originates from the manubrium of the sternum. Clavicular head, originates from the medial portion of the clavicle. Both heads insert at the mastoid process of the temporal bone and the superior nuchal line of the occipital bone. The SCM muscle is innervated by the accessory nerve (cranial nerve XI) and receives sensory innervation from the cervical plexus (C2 and C3). The SCM muscle is responsible for several key functions, rotation of the head, when one side contracts, it rotates the head to the opposite side, when both sides contract, the neck flexes, bringing the chin closer to the chest. The SCM muscle assists in deep inspiration by elevating the sternum. The cranial part of the SCM muscle is more likely to be visualized on a dental panoramic radiograph. Specifically, the area where the SCM muscle inserts into the mastoid process of the temporal bone may overlap with the mandible, particularly the ramus and angle, and therefore appear on the radiograph. Panoramic radiographs extend their field of view beyond the teeth and mandible to include adjacent soft tissues and skeletal structures in the neck and skull base. Because the mastoid process is anatomically close to the mandible, any calcifications or changes in the cranial SCM may be visualized as overlapping or incidental findings, potentially causing diagnostic confusion ( 19 , 20 ). Radiologists and dental practitioners must be aware of such conditions to prevent misdiagnosis and unnecessary interventions. Clinical Presentation A 59-year-old female underwent a routine dental examination, during which a panoramic radiograph was obtained. The orthopantomography revealed multiple small calcifications bilaterally in the region of the mandibular ramus. Following this finding, the patient underwent ultrasound examination to further investigate the nature of these calcifications. The ultrasound imaging is an important diagnostic tool in determining the localization of soft tissue calcifications ( 12 , 14 ) demonstrated in this case multiple subtle calcific deposits within the muscle belly of the sternocleidomastoid muscle bilaterally. The dimensions of the calcifications varied from 2 to 6 mm in diameter. This case report serves to confirm that these calcifications are likely remnants of an old traumatic injury to the sternocleidomastoid muscle rather than lesions of the mandible region. Discussion Calcifications in the sternocleidomastoid muscle are rarely addressed in dental scientific literature, making this case noteworthy. While a few publications discuss calcifications in the masseter and other masticatory muscles ( 6 , 13 , 15 , 16 , 17 , 18 ), there is a clear gap in the literature concerning calcifications in the sternocleidomastoid muscle. This highlights the importance of recognizing the potential for such findings in dental radiographs, as they can be easily misinterpreted without proper knowledge of overlapping anatomical structures. Previous studies have documented the presence of muscle-origin calcifications resulting from various causes, including trauma, chronic inflammation, or even genetic predispositions ( 4 ). The exact mechanism of calcification formation in skeletal muscle is not entirely understood, but it is thought to be related to tissue injury and the subsequent repair process ( 5 , 13 ). Muscle calcifications can also occur in conditions such as fibrodysplasia ossificans progressiva (FOP), a rare and disabling genetic condition characterized by progressive heterotopic endochondral ossification, leading to significant loss of mobility and functional impairment ( 11 , 20 , 22 ). Muscle-origin calcifications, particularly those within the sternocleidomastoid, are rare findings in routine dental imaging. The etiology of such calcifications can vary. Classically, calcifications are divided into four categories, depending on the mechanism of formation as well as the clinical and biochemical correlation ( 4 ): dystrophic, iatrogenic, metastatic , and idiopathic . However, it is also possible to classify such calcifications by compartment (subcutaneous, neurovascular, fascial, muscle, and periarticular), and that classification can be quite useful in the radiological diagnostic assessment. Dystrophic and iatrogenic calcifications occur in damaged or degenerated tissue and account for 95–98% of all soft-tissue calcifications ( 3 ). Dystrophic and Iatrogenic Calcifications are localized deposits of calcium salts that occur in necrotic or degenerating tissues. These types of calcifications are typically associated with chronic inflammation, trauma, tissue injury, surgical manipulation, or medication infusion. Metastatic Calcifications occur when there is an imbalance in calcium and phosphate metabolism, often due to systemic disorders such as hyperparathyroidism, chronic kidney disease, or other conditions that lead to hypercalcemia. This type of calcification typically affects areas with high blood flow, such as the lungs, kidneys, and blood vessels, but can also appear in soft tissues like muscles. In the present case, the patient had no signs of systemic illness or metabolic disorders, and her blood tests were normal, making metastatic calcification an unlikely diagnosis. Idiopathic calcifications can manifest in tumoral calcinosis, a rare hereditary condition linked to irregular phosphate metabolism regulation. This disorder typically presents in the second decade of life with periarticular calcified masses. On imaging, these masses are similar to metastatic calcifications resulting from imbalances in calcium and phosphorus metabolism and are predominantly found on the extensor (bursal) surfaces of major joints ( 5 ). Muscle calcifications can result not only from traumatic or congenital causes but also from infectious processes. Infectious sources include granulomatous conditions and parasitic infections, such as cysticercosis ( 21 ). Traumatic causes, such as myositis ossificans, lead to heterotopic ossification post-injury or trauma ( 19 ). Despite its name, myositis ossificans lacks inflammation, the process involves heterotopic ossification, but not the inflammatory process that the term myositis suggests. Thus, the condition is primarily characterized by bone formation rather than muscle inflammation ( 6 , 7 ). Other traumatic causes include calcified muscle hematomas and calcific myonecrosis ( 8 ). In dentistry, during routine dental panoramic radiography examinations, the most common radiopaque lesions observed overlapping the ramus of the mandible are tonsilloliths ( 9 ). Tonsilloliths are calcified deposits that form in the crypts of the palatine tonsils and are frequently identified on panoramic radiographs. They often appear as radiopaque masses located in proximity to the ascending ramus of the mandible, which can make differentiation from other calcifications, such as muscle-origin calcifications, challenging ( 10 ). In this case, tonsilloliths were initially considered in the differential diagnosis due to their anatomical location, frequent occurrence in that region, and radiographic resemblance to the observed calcifications; however, the calcifications were not confined to the region of the Tonsillar Fossa, extending beyond the ascending ramus of the mandible. Myositis Ossificans is a condition that must be considered in differential diagnoses when encountering calcifications in skeletal muscles. It is characterized by abnormal bone formation within the muscle tissue following trauma or injury, which may present similarly to muscle-origin calcifications on imaging studies ( 6 , 7 ). Key imaging features of Myositis Ossificans typically include well-defined areas of radiopacity within the muscle belly and may show progressive calcification on serial imaging studies ( 8 ). Core characteristics for the differential diagnosis of the most probable and commonly encountered pathologies in dentistry, such as muscle calcifications, myositis ossificans and tonsilloliths, are delineated by significant distinctions: 1. Location: - tonsilloliths: confined to the region of the palatine tonsils. - muscle calcifications: can occur in various muscle groups and are outside the tonsil area. - myositis ossificans: often localized at a specific injury site, where calcification forms following trauma. 2. Radiographic Appearance: - tonsilloliths: present as well-defined radiopaque small masses. - muscle calcifications: typically appear as multiple, diffuse calcifications. - myositis ossificans: demonstrates a progressive pattern of calcification, often beginning with a hazy or ill-defined area that becomes more defined over time. 3. Clinical Symptoms: - tonsilloliths: patients often experience localized pain, halitosis (bad breath), or difficulty swallowing (dysphagia). - muscle calcifications: generally do not exhibit these symptoms but may be associated with chronic muscle discomfort or stiffness. - myositis ossificans: characterized by pain and swelling at the injury site, which may lead to a restricted range of motion (13). The superimposition of soft tissue calcifications over osseous structures in dental panoramic radiographs frequently results in diagnostic ambiguity. Due to the two-dimensional nature of dental panoramic radiographs, which depict intricate three-dimensional structures, calcifications originating from various anatomical sites may be erroneously interpreted as associated with the jawbones. In this patient, the absence of neck trauma and a lack of history regarding systemic inflammatory conditions further complicate the determination of the calcifications' etiology. Ultrasound provided a critical adjunct imaging modality that helped localize the calcifications to the sternocleidomastoid muscle, and, as the radiologist’s ultrasound report confirmed the findings of benign nature calcifications, a decision was made not to proceed with a biopsy for histological examination, the benign nature of the lesions and absence of clinical symptoms did not warrant further intervention or investigation: dystrophic calcification appears to be the most plausible explanation. In addition to ultrasound, further imaging modalities such as CBCT or MRI can be employed in complex cases where the diagnosis remains unclear. All these imaging techniques can provide detailed views of soft tissue structures and help in the accurate localization of calcifications ( 8 , 9 ). Conclusion This case report points out the importance of thorough clinical and ultrasound evaluation when assessing incidental findings on panoramic radiographs. The calcifications found in this patient were determined to be related to the sternocleidomastoid muscle, demonstrating the necessity of considering the surrounding anatomical structures to avoid misdiagnosis. Recognizing the potential for the superimposition of anatomical structures in dental radiographic imaging is crucial for ensuring an accurate diagnosis. Declarations Compliance with Ethical Standards Conflict of Interest The authors declare that there are no financial or non-financial conflicts of interest. Funding The authors declare that no funds, grants, or other support were received during the preparation of this manuscript. Ethical Approval The need for ethical approval was waived off by the ethical committee/IRB of the University of Perugia, as this study did not involve human participants, animal subjects, or any interventions requiring ethical committee oversight. The research is based solely on imaging data collected from routine diagnostic procedures, with no additional data collection or patient interaction involved. Data Availability Statement The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. Consent for publication The authors declare that written informed consent was obtained from the patient referenced in this article. Authors ’ contributions FV, PV reviewed the literature. FV, RR, RD, PV and AS participated in design, and drafting of the manuscript. All authors read and approved the final manuscript. References Katz JO, Langlais RP, Underhill TE, Kimura K. Localization of paraoral soft tissue calcifications: the known object rule. Oral Surg Oral Med Oral Pathol. 1989 Apr;67(4):459-63. doi: 10.1016/0030-4220(89)90392-7. PMID: 2726207. Monsour PA, Mendoza AR. Panoramic ghost images as an aid in the localization of soft tissue calcifications. Oral Surg Oral Med Oral Pathol. 1990 Jun;69(6):748-56. doi: 10.1016/0030-4220(90)90361-u. PMID: 2356087. Banks KP, Bui-Mansfield LT, Chew FS, Collinson F. A compartmental approach to the radiographic evaluation of soft-tissue calcifications. Semin Roentgenol. 2005 Oct;40(4):391-407. doi: 10.1053/j.ro.2005.01.021. PMID: 16218555. de Faria LL, Babler F, Ferreira LC, de Noronha Junior OA, Marsolla FL, Ferreira DL. Soft tissue calcifications: a pictorial essay. Radiol Bras. 2020 Sep-Oct;53(5):337-344. doi: 10.1590/0100-3984.2019.0100. PMID: 33071378; PMCID: PMC7545731. Olsen KM, Chew FS. Tumoral calcinosis: pearls, polemics, and alternative possibilities. Radiographics. 2006 May-Jun;26(3):871-85. doi: 10.1148/rg.263055099. PMID: 16702460. Steiner M, Gould AR, Kushner GM, Lutchka B, Flint R. Myositis ossificans traumatica of the masseter muscle: review of the literature and report of two additional cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Dec;84(6):703-7. doi: 10.1016/s1079-2104(97)90376-0. PMID: 9431543. Lello GE, Makek M. Traumatic myositis ossificans in masticatory muscles. J Maxillofac Surg. 1986 Aug;14(4):231-7. doi: 10.1016/s0301-0503(86)80295-8. PMID: 3461100. Karaali S, Emekli U. Myositis Ossificans Traumatica of the Medial Pterygoid Muscle After Third Molar Tooth Extraction: A Case Report and Review of Literature. J Oral Maxillofac Surg. 2018 Nov;76(11):2284.e1-2284.e5. doi: 10.1016/j.joms.2018.06.174. Epub 2018 Jul 10. PMID: 30076806. Takahashi A, Sugawara C, Kudoh T, Ohe G, Takamaru N, Tamatani T, Nagai H, Miyamoto Y. Prevalence and imaging characteristics of palatine tonsilloliths evaluated on 2244 pairs of panoramic radiographs and CT images. Clin Oral Investig. 2017 Jan;21(1):85-91. doi: 10.1007/s00784-016-1752-0. Epub 2016 Feb 19. PMID: 26892471. Babu B B, Tejasvi M L A, Avinash CK, B C. Tonsillolith: a panoramic radiograph presentation. J Clin Diagn Res. 2013 Oct;7(10):2378-9. doi: 10.7860/JCDR/2013/5613.3530. Epub 2013 Oct 5. PMID: 24298535; PMCID: PMC3843407. Pignolo RJ, Shore EM, Kaplan FS. Fibrodysplasia ossificans progressiva: diagnosis, management, and therapeutic horizons. Pediatr Endocrinol Rev. 2013 Jun;10 Suppl 2(0 2):437-48. PMID: 23858627; PMCID: PMC3995352. Özkan G, Köse E, Yeşiltepe S. Ultrasonographic Evaluation of Soft Tissue Calcifications in the Head and Neck Region Detected on Panoramic Radiographs. J Ultrasound Med. 2023 May;42(5):1057-1064. doi: 10.1002/jum.16117. Epub 2022 Oct 27. PMID: 36301624. Hanisch M, Hanisch L, Fröhlich LF, Werkmeister R, Bohner L, Kleinheinz J. Myositis ossificans traumatica of the masticatory muscles: etiology, diagnosis and treatment. Head Face Med. 2018 Oct 29;14(1):23. doi: 10.1186/s13005-018-0180-6. PMID: 30373608; PMCID: PMC6206835. Ricci V, Mezian K, Chang KV, Özçakar L. Clinical/Sonographic Assessment and Management of Calcific Tendinopathy of the Shoulder: A Narrative Review. Diagnostics (Basel). 2022 Dec 8;12(12):3097. doi: 10.3390/diagnostics12123097. PMID: 36553104; PMCID: PMC9776939. Sencimen M, Gulses A, Ogretir O, Gunhan O, Ozkaynak O, Okcu KM. Dystrophic calcifications arising in the masseter muscle: a case report. Quintessence Int. 2010 Apr;41(4):295-7. PMID: 20305863. Kim HY, Park JH, Lee JB, Kim SJ. A case of dystrophic calcification in the masseter muscle. Maxillofac Plast Reconstr Surg. 2017 Nov 5;39(1):31. doi: 10.1186/s40902-017-0130-4. PMID: 29159170; PMCID: PMC5671420. Naik CS, Arya AA, Deshmukh SD, Gaopande V. A unique case of dystrophic calcification in masseter: a diagnostic challenge. Indian J Otolaryngol Head Neck Surg. 2012 Sep;64(3):301-4. doi: 10.1007/s12070-011-0398-0. Epub 2011 Dec 2. PMID: 23998041; PMCID: PMC3431515. Mohiuddin SA, Badal S, Doiphode A, Sultana S. Multiple supramassetric dystrophic calcinosis. Ann Maxillofac Surg. 2012 Jan;2(1):74-6. doi: 10.4103/2231-0746.95328. PMID: 23482595; PMCID: PMC3591076. Patel S, Richards A, Trehan R, Railton GT. Post-traumatic myositis ossificans of the sternocleidomastoid following fracture of the clavicle: a case report. Cases J. 2008 Dec 22;1(1):413. doi: 10.1186/1757-1626-1-413. PMID: 19102776; PMCID: PMC2621129. Önal M, Bajin MD, Yılmaz T. Fibrodysplasia ossificans progressiva: a case report. Turk J Pediatr. 2014 Sep-Oct;56(5):561-4. PMID: 26022598. Lal T, Paramasivam S, Jayapal B, Kataria R. Solitary cysticercosis of the sternocleidomastoid muscle. BMJ Case Rep. 2021 Jun 8;14(6):e242322. doi: 10.1136/bcr-2021-242322. PMID: 34103305; PMCID: PMC8189922. Hwang CD, Pagani CA, Nunez JH, Cherief M, Qin Q, Gomez-Salazar M, Kadaikal B, Kang H, Chowdary AR, Patel N, James AW, Levi B. Contemporary perspectives on heterotopic ossification. JCI Insight. 2022 Jul 22;7(14):e158996. doi: 10.1172/jci.insight.158996. PMID: 35866484; PMCID: PMC9431693. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 03 Mar, 2025 Read the published version in Cureus → Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5746452","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":401139168,"identity":"3da3eec4-e56f-4bd4-8ba6-b1787bd77f73","order_by":0,"name":"Francesco Valente","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAsklEQVRIiWNgGAWjYDCCA0D8gYFBhhQtzIyNMxgYeBgYmEnQ0sxDkha+4/3HH9u22fHwS/cffMBQYxNNUIvkmcOMzbltyTyScw4zGzAcS8ttIKTF4EYyY3POGWYeIINNgrHhMJFaLM7U89jfSGb/QbwWhorDPAYSyWwMRGkB+sVwZk/FcR6JG8nGEgnE+IXveOODDz8MquX4ZyQ+/PChxoawFlSQQJryUTAKRsEoGAW4AACJQjw6SiLswwAAAABJRU5ErkJggg==","orcid":"","institution":"DDS, private practice","correspondingAuthor":true,"prefix":"","firstName":"Francesco","middleName":"","lastName":"Valente","suffix":""},{"id":401139169,"identity":"98e6178e-05c1-49a3-81d5-2ffc47d571af","order_by":1,"name":"Riccardo Riccardi","email":"","orcid":"","institution":"DDS, private practice","correspondingAuthor":false,"prefix":"","firstName":"Riccardo","middleName":"","lastName":"Riccardi","suffix":""},{"id":401139170,"identity":"920cc58b-6573-448d-88a5-2bde3ad8437d","order_by":2,"name":"Roberto Del Rosso","email":"","orcid":"","institution":"DDS, private practice","correspondingAuthor":false,"prefix":"","firstName":"Roberto","middleName":"Del","lastName":"Rosso","suffix":""},{"id":401139171,"identity":"9ca5bb66-ca59-429b-bbd7-74739e159fc5","order_by":3,"name":"Pierluigi Valente","email":"","orcid":"","institution":"Vita-Salute San Raffaele University","correspondingAuthor":false,"prefix":"","firstName":"Pierluigi","middleName":"","lastName":"Valente","suffix":""},{"id":401139172,"identity":"8f1e2374-646a-4e48-8fa5-356ed9e1d50e","order_by":4,"name":"Andrea Sbrenna","email":"","orcid":"","institution":"DDS, private practice","correspondingAuthor":false,"prefix":"","firstName":"Andrea","middleName":"","lastName":"Sbrenna","suffix":""}],"badges":[],"createdAt":"2025-01-01 13:53:11","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5746452/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5746452/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.7759/cureus.80016","type":"published","date":"2025-03-04T00:00:00+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":73865326,"identity":"d5650771-808d-4574-9761-7730157b4d2e","added_by":"auto","created_at":"2025-01-15 11:44:33","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":116589,"visible":true,"origin":"","legend":"\u003cp\u003eThe sternocleidomastoid muscle (SCM) and the mastoid process that is anatomically close to the mandible, any calcifications or changes in the cranial SCM may be visualized as overlapping in Orthopantomography.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5746452/v1/654bd68d9e95808f4712634f.png"},{"id":73865972,"identity":"c1c7a382-3c93-45a6-a14c-e992bd7e7525","added_by":"auto","created_at":"2025-01-15 11:52:33","extension":"jpeg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38167,"visible":true,"origin":"","legend":"\u003cp\u003eMultiple small calcific deposits within the soft tissues of the sternocleidomastoid muscle are superimposed over the osseous structures in the region of the mandibular ramus, bilaterally, in a 59-year-old female patient.\u003c/p\u003e","description":"","filename":"floatimage2.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5746452/v1/31f306a6b799ec4af8b8d460.jpeg"},{"id":73865329,"identity":"76bc439f-d520-4af6-9c20-3d18aea8097c","added_by":"auto","created_at":"2025-01-15 11:44:33","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":306201,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasound imaging of multiple small calcified deposits within the muscle belly of the sternocleidomastoid on both sides, with dimensions ranging from 2 to 6 mm in diameter, no hematomas or myofascial discontinuities are observed. The main vascular axes of the neck and the major salivary glands are normal, bilaterally.\u003c/p\u003e","description":"","filename":"floatimage3.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-5746452/v1/b4860c0586f1fd0dd62165ea.jpeg"},{"id":77789545,"identity":"f062d7af-7eb4-4086-a9e9-82b9019338d8","added_by":"auto","created_at":"2025-03-05 14:22:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":819975,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5746452/v1/a5b64dd3-bd87-4b89-a425-a11a2d7e635c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Incidental Findings of Muscle-Origin Calcifications in the Sternocleidomastoid Muscle on an Orthopantomogram: a Case Report","fulltext":[{"header":"Introduction","content":"\u003cp\u003eDental panoramic radiographs are commonly used in dentistry for evaluating dental and bony structures. Occasionally, they reveal incidental findings unrelated to the dental condition being examined. Muscle calcifications are incidental findings in radiological examinations (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). While they are generally asymptomatic, their presence may raise concerns for the treating clinician (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe sternocleidomastoid (SCM) muscle is a prominent neck muscle that plays a crucial role in head and neck movement. The SCM has two heads. Sternal head, originates from the manubrium of the sternum. Clavicular head, originates from the medial portion of the clavicle. Both heads insert at the mastoid process of the temporal bone and the superior nuchal line of the occipital bone. The SCM muscle is innervated by the accessory nerve (cranial nerve XI) and receives sensory innervation from the cervical plexus (C2 and C3). The SCM muscle is responsible for several key functions, rotation of the head, when one side contracts, it rotates the head to the opposite side, when both sides contract, the neck flexes, bringing the chin closer to the chest. The SCM muscle assists in deep inspiration by elevating the sternum. The cranial part of the SCM muscle is more likely to be visualized on a dental panoramic radiograph. Specifically, the area where the SCM muscle inserts into the mastoid process of the temporal bone may overlap with the mandible, particularly the ramus and angle, and therefore appear on the radiograph.\u003c/p\u003e \u003cp\u003ePanoramic radiographs extend their field of view beyond the teeth and mandible to include adjacent soft tissues and skeletal structures in the neck and skull base. Because the mastoid process is anatomically close to the mandible, any calcifications or changes in the cranial SCM may be visualized as overlapping or incidental findings, potentially causing diagnostic confusion (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRadiologists and dental practitioners must be aware of such conditions to prevent misdiagnosis and unnecessary interventions.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Clinical Presentation","content":"\u003cp\u003eA 59-year-old female underwent a routine dental examination, during which a panoramic radiograph was obtained. The orthopantomography revealed multiple small calcifications bilaterally in the region of the mandibular ramus. Following this finding, the patient underwent ultrasound examination to further investigate the nature of these calcifications.\u003c/p\u003e \u003cp\u003eThe ultrasound imaging is an important diagnostic tool in determining the localization of soft tissue calcifications (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e) demonstrated in this case multiple subtle calcific deposits within the muscle belly of the sternocleidomastoid muscle bilaterally. The dimensions of the calcifications varied from 2 to 6 mm in diameter. This case report serves to confirm that these calcifications are likely remnants of an old traumatic injury to the sternocleidomastoid muscle rather than lesions of the mandible region.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eCalcifications in the sternocleidomastoid muscle are rarely addressed in dental scientific literature, making this case noteworthy. While a few publications discuss calcifications in the masseter and other masticatory muscles (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e, \u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), there is a clear gap in the literature concerning calcifications in the sternocleidomastoid muscle. This highlights the importance of recognizing the potential for such findings in dental radiographs, as they can be easily misinterpreted without proper knowledge of overlapping anatomical structures. Previous studies have documented the presence of muscle-origin calcifications resulting from various causes, including trauma, chronic inflammation, or even genetic predispositions (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The exact mechanism of calcification formation in skeletal muscle is not entirely understood, but it is thought to be related to tissue injury and the subsequent repair process (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMuscle calcifications can also occur in conditions such as fibrodysplasia ossificans progressiva (FOP), a rare and disabling genetic condition characterized by progressive heterotopic endochondral ossification, leading to significant loss of mobility and functional impairment (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). Muscle-origin calcifications, particularly those within the sternocleidomastoid, are rare findings in routine dental imaging. The etiology of such calcifications can vary. Classically, calcifications are divided into four categories, depending on the mechanism of formation as well as the clinical and biochemical correlation (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e): \u003cem\u003edystrophic, iatrogenic, metastatic\u003c/em\u003e, and \u003cem\u003eidiopathic\u003c/em\u003e. However, it is also possible to classify such calcifications by compartment (subcutaneous, neurovascular, fascial, muscle, and periarticular), and that classification can be quite useful in the radiological diagnostic assessment.\u003c/p\u003e \u003cp\u003eDystrophic and iatrogenic calcifications occur in damaged or degenerated tissue and account for 95\u0026ndash;98% of all soft-tissue calcifications (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Dystrophic and Iatrogenic Calcifications are localized deposits of calcium salts that occur in necrotic or degenerating tissues. These types of calcifications are typically associated with chronic inflammation, trauma, tissue injury, surgical manipulation, or medication infusion.\u003c/p\u003e \u003cp\u003eMetastatic Calcifications occur when there is an imbalance in calcium and phosphate metabolism, often due to systemic disorders such as hyperparathyroidism, chronic kidney disease, or other conditions that lead to hypercalcemia. This type of calcification typically affects areas with high blood flow, such as the lungs, kidneys, and blood vessels, but can also appear in soft tissues like muscles. In the present case, the patient had no signs of systemic illness or metabolic disorders, and her blood tests were normal, making metastatic calcification an unlikely diagnosis.\u003c/p\u003e \u003cp\u003eIdiopathic calcifications can manifest in tumoral calcinosis, a rare hereditary condition linked to irregular phosphate metabolism regulation. This disorder typically presents in the second decade of life with periarticular calcified masses. On imaging, these masses are similar to metastatic calcifications resulting from imbalances in calcium and phosphorus metabolism and are predominantly found on the extensor (bursal) surfaces of major joints (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMuscle calcifications can result not only from traumatic or congenital causes but also from infectious processes. Infectious sources include granulomatous conditions and parasitic infections, such as cysticercosis (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). Traumatic causes, such as myositis ossificans, lead to heterotopic ossification post-injury or trauma (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Despite its name, myositis ossificans lacks inflammation, the process involves heterotopic ossification, but not the inflammatory process that the term myositis suggests. Thus, the condition is primarily characterized by bone formation rather than muscle inflammation (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Other traumatic causes include calcified muscle hematomas and calcific myonecrosis (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn dentistry, during routine dental panoramic radiography examinations, the most common radiopaque lesions observed overlapping the ramus of the mandible are tonsilloliths (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Tonsilloliths are calcified deposits that form in the crypts of the palatine tonsils and are frequently identified on panoramic radiographs. They often appear as radiopaque masses located in proximity to the ascending ramus of the mandible, which can make differentiation from other calcifications, such as muscle-origin calcifications, challenging (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn this case, tonsilloliths were initially considered in the differential diagnosis due to their anatomical location, frequent occurrence in that region, and radiographic resemblance to the observed calcifications; however, the calcifications were not confined to the region of the Tonsillar Fossa, extending beyond the ascending ramus of the mandible.\u003c/p\u003e \u003cp\u003eMyositis Ossificans is a condition that must be considered in differential diagnoses when encountering calcifications in skeletal muscles. It is characterized by abnormal bone formation within the muscle tissue following trauma or injury, which may present similarly to muscle-origin calcifications on imaging studies (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Key imaging features of Myositis Ossificans typically include well-defined areas of radiopacity within the muscle belly and may show progressive calcification on serial imaging studies (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCore characteristics for the differential diagnosis of the most probable and commonly encountered pathologies in dentistry, such as muscle calcifications, myositis ossificans and tonsilloliths, are delineated by significant distinctions:\u003c/p\u003e \n\u003cp\u003e1. Location:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- tonsilloliths: confined to the region of the palatine tonsils.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- muscle calcifications: can occur in various muscle groups and are\u0026nbsp;outside the tonsil area.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- myositis ossificans: often localized at a specific injury site, where calcification forms following trauma.\u003c/p\u003e\n\u003cp\u003e2. Radiographic Appearance:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- tonsilloliths: present as well-defined radiopaque small\u0026nbsp;masses.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- muscle calcifications: typically appear as multiple, diffuse calcifications.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- myositis ossificans: demonstrates a progressive pattern of calcification, often beginning with a hazy or ill-defined area that becomes more defined over time.\u003c/p\u003e\n\u003cp\u003e3. Clinical Symptoms:\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- tonsilloliths: patients often experience localized pain, halitosis (bad breath), or difficulty swallowing (dysphagia).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- muscle calcifications: generally do not exhibit these symptoms but may be associated with chronic muscle discomfort or stiffness.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp;- myositis ossificans: characterized by pain and swelling at the injury site, which may lead to a restricted range of motion (13).\u003c/p\u003e \u003cp\u003eThe superimposition of soft tissue calcifications over osseous structures in dental panoramic radiographs frequently results in diagnostic ambiguity. Due to the two-dimensional nature of dental panoramic radiographs, which depict intricate three-dimensional structures, calcifications originating from various anatomical sites may be erroneously interpreted as associated with the jawbones. In this patient, the absence of neck trauma and a lack of history regarding systemic inflammatory conditions further complicate the determination of the calcifications' etiology. Ultrasound provided a critical adjunct imaging modality that helped localize the calcifications to the sternocleidomastoid muscle, and, as the radiologist\u0026rsquo;s ultrasound report confirmed the findings of benign nature calcifications, a decision was made not to proceed with a biopsy for histological examination, the benign nature of the lesions and absence of clinical symptoms did not warrant further intervention or investigation: dystrophic calcification appears to be the most plausible explanation. In addition to ultrasound, further imaging modalities such as CBCT or MRI can be employed in complex cases where the diagnosis remains unclear. All these imaging techniques can provide detailed views of soft tissue structures and help in the accurate localization of calcifications (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case report points out the importance of thorough clinical and ultrasound evaluation when assessing incidental findings on panoramic radiographs. The calcifications found in this patient were determined to be related to the sternocleidomastoid muscle, demonstrating the necessity of considering the surrounding anatomical structures to avoid misdiagnosis. Recognizing the potential for the superimposition of anatomical structures in dental radiographic imaging is crucial for ensuring an accurate diagnosis.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eCompliance with Ethical Standards\u003c/p\u003e\n\u003cp\u003eConflict of Interest\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe authors declare that there are no financial or non-financial conflicts of interest.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe authors declare that no funds, grants, or other support were received during the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003eEthical Approval\u003c/p\u003e\n\u003cp\u003eThe need for ethical approval was waived off by the ethical committee/IRB of the University of Perugia, as this study did not involve human participants, animal subjects, or any interventions requiring ethical committee oversight. The research is based solely on imaging data collected from routine diagnostic procedures, with no additional data collection or patient interaction involved.\u003c/p\u003e\n\u003cp\u003eData Availability Statement\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that written informed consent was obtained from the patient referenced in this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u003c/strong\u003e\u003cstrong\u003e\u0026rsquo;\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003econtributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFV, PV reviewed the literature. FV, RR, RD, PV and AS participated in design, and drafting of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eKatz JO, Langlais RP, Underhill TE, Kimura K. Localization of paraoral soft tissue calcifications: the known object rule. Oral Surg Oral Med Oral Pathol. 1989 Apr;67(4):459-63. doi: 10.1016/0030-4220(89)90392-7. PMID: 2726207.\u003c/li\u003e\n\u003cli\u003eMonsour PA, Mendoza AR. Panoramic ghost images as an aid in the localization of soft tissue calcifications. Oral Surg Oral Med Oral Pathol. 1990 Jun;69(6):748-56. doi: 10.1016/0030-4220(90)90361-u. PMID: 2356087.\u003c/li\u003e\n\u003cli\u003eBanks KP, Bui-Mansfield LT, Chew FS, Collinson F. A compartmental approach to the radiographic evaluation of soft-tissue calcifications. Semin Roentgenol. 2005 Oct;40(4):391-407. doi: 10.1053/j.ro.2005.01.021. PMID: 16218555.\u003c/li\u003e\n\u003cli\u003ede Faria LL, Babler F, Ferreira LC, de Noronha Junior OA, Marsolla FL, Ferreira DL. Soft tissue calcifications: a pictorial essay. Radiol Bras. 2020 Sep-Oct;53(5):337-344. doi: 10.1590/0100-3984.2019.0100. PMID: 33071378; PMCID: PMC7545731.\u003c/li\u003e\n\u003cli\u003eOlsen KM, Chew FS. Tumoral calcinosis: pearls, polemics, and alternative possibilities. Radiographics. 2006 May-Jun;26(3):871-85. doi: 10.1148/rg.263055099. PMID: 16702460.\u003c/li\u003e\n\u003cli\u003eSteiner M, Gould AR, Kushner GM, Lutchka B, Flint R. Myositis ossificans traumatica of the masseter muscle: review of the literature and report of two additional cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1997 Dec;84(6):703-7. doi: 10.1016/s1079-2104(97)90376-0. PMID: 9431543.\u003c/li\u003e\n\u003cli\u003eLello GE, Makek M. Traumatic myositis ossificans in masticatory muscles. J Maxillofac Surg. 1986 Aug;14(4):231-7. doi: 10.1016/s0301-0503(86)80295-8. PMID: 3461100.\u003c/li\u003e\n\u003cli\u003eKaraali S, Emekli U. Myositis Ossificans Traumatica of the Medial Pterygoid Muscle After Third Molar Tooth Extraction: A Case Report and Review of Literature. J Oral Maxillofac Surg. 2018 Nov;76(11):2284.e1-2284.e5. doi: 10.1016/j.joms.2018.06.174. Epub 2018 Jul 10. PMID: 30076806.\u003c/li\u003e\n\u003cli\u003eTakahashi A, Sugawara C, Kudoh T, Ohe G, Takamaru N, Tamatani T, Nagai H, Miyamoto Y. Prevalence and imaging characteristics of palatine tonsilloliths evaluated on 2244 pairs of panoramic radiographs and CT images. Clin Oral Investig. 2017 Jan;21(1):85-91. doi: 10.1007/s00784-016-1752-0. Epub 2016 Feb 19. PMID: 26892471.\u003c/li\u003e\n\u003cli\u003eBabu B B, Tejasvi M L A, Avinash CK, B C. Tonsillolith: a panoramic radiograph presentation. J Clin Diagn Res. 2013 Oct;7(10):2378-9. doi: 10.7860/JCDR/2013/5613.3530. Epub 2013 Oct 5. PMID: 24298535; PMCID: PMC3843407.\u003c/li\u003e\n\u003cli\u003ePignolo RJ, Shore EM, Kaplan FS. Fibrodysplasia ossificans progressiva: diagnosis, management, and therapeutic horizons. Pediatr Endocrinol Rev. 2013 Jun;10 Suppl 2(0 2):437-48. PMID: 23858627; PMCID: PMC3995352.\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;zkan G, K\u0026ouml;se E, Yeşiltepe S. Ultrasonographic Evaluation of Soft Tissue Calcifications in the Head and Neck Region Detected on Panoramic Radiographs. J Ultrasound Med. 2023 May;42(5):1057-1064. doi: 10.1002/jum.16117. Epub 2022 Oct 27. PMID: 36301624.\u003c/li\u003e\n\u003cli\u003eHanisch M, Hanisch L, Fr\u0026ouml;hlich LF, Werkmeister R, Bohner L, Kleinheinz J. Myositis ossificans traumatica of the masticatory muscles: etiology, diagnosis and treatment. Head Face Med. 2018 Oct 29;14(1):23. doi: 10.1186/s13005-018-0180-6. PMID: 30373608; PMCID: PMC6206835.\u003c/li\u003e\n\u003cli\u003eRicci V, Mezian K, Chang KV, \u0026Ouml;z\u0026ccedil;akar L. Clinical/Sonographic Assessment and Management of Calcific Tendinopathy of the Shoulder: A Narrative Review. Diagnostics (Basel). 2022 Dec 8;12(12):3097. doi: 10.3390/diagnostics12123097. PMID: 36553104; PMCID: PMC9776939.\u003c/li\u003e\n\u003cli\u003eSencimen M, Gulses A, Ogretir O, Gunhan O, Ozkaynak O, Okcu KM. Dystrophic calcifications arising in the masseter muscle: a case report. Quintessence Int. 2010 Apr;41(4):295-7. PMID: 20305863.\u003c/li\u003e\n\u003cli\u003eKim HY, Park JH, Lee JB, Kim SJ. A case of dystrophic calcification in the masseter muscle. Maxillofac Plast Reconstr Surg. 2017 Nov 5;39(1):31. doi: 10.1186/s40902-017-0130-4. PMID: 29159170; PMCID: PMC5671420.\u003c/li\u003e\n\u003cli\u003eNaik CS, Arya AA, Deshmukh SD, Gaopande V. A unique case of dystrophic calcification in masseter: a diagnostic challenge. Indian J Otolaryngol Head Neck Surg. 2012 Sep;64(3):301-4. doi: 10.1007/s12070-011-0398-0. Epub 2011 Dec 2. PMID: 23998041; PMCID: PMC3431515.\u003c/li\u003e\n\u003cli\u003eMohiuddin SA, Badal S, Doiphode A, Sultana S. Multiple supramassetric dystrophic calcinosis. Ann Maxillofac Surg. 2012 Jan;2(1):74-6. doi: 10.4103/2231-0746.95328. PMID: 23482595; PMCID: PMC3591076.\u003c/li\u003e\n\u003cli\u003ePatel S, Richards A, Trehan R, Railton GT. Post-traumatic myositis ossificans of the sternocleidomastoid following fracture of the clavicle: a case report. Cases J. 2008 Dec 22;1(1):413. doi: 10.1186/1757-1626-1-413. PMID: 19102776; PMCID: PMC2621129.\u003c/li\u003e\n\u003cli\u003e\u0026Ouml;nal M, Bajin MD, Yılmaz T. Fibrodysplasia ossificans progressiva: a case report. Turk J Pediatr. 2014 Sep-Oct;56(5):561-4. PMID: 26022598.\u003c/li\u003e\n\u003cli\u003eLal T, Paramasivam S, Jayapal B, Kataria R. Solitary cysticercosis of the sternocleidomastoid muscle. BMJ Case Rep. 2021 Jun 8;14(6):e242322. doi: 10.1136/bcr-2021-242322. PMID: 34103305; PMCID: PMC8189922.\u003c/li\u003e\n\u003cli\u003eHwang CD, Pagani CA, Nunez JH, Cherief M, Qin Q, Gomez-Salazar M, Kadaikal B, Kang H, Chowdary AR, Patel N, James AW, Levi B. Contemporary perspectives on heterotopic ossification. JCI Insight. 2022 Jul 22;7(14):e158996. doi: 10.1172/jci.insight.158996. PMID: 35866484; PMCID: PMC9431693.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Muscle origin calcifications, Sternocleidomastoid, Ultrasound, Dental Orthopantomogram, Dental panoramic x-ray","lastPublishedDoi":"10.21203/rs.3.rs-5746452/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5746452/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eThis case report documents incidental findings of bilateral calcifications within the sternocleidomastoid (SCM) muscle observed on a dental panoramic radiograph. The aim is to emphasize the importance of recognizing overlapping anatomical structures in panoramic radiography to prevent misdiagnosis.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eDuring a routine dental examination, a 59-year-old female was found to have multiple small calcifications bilaterally in the mandibular ramus region on an orthopantomogram. Further evaluation with ultrasound confirmed the presence of calcifications within the SCM muscle. A comprehensive differential diagnosis was performed, considering potential causes such as trauma, inflammation, metabolic disorders, and idiopathic conditions.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eUltrasound imaging identified multiple small calcified deposits within the SCM muscle bilaterally, with sizes ranging from 2 to 6 mm. The absence of systemic disorders or recent trauma supported a diagnosis of dystrophic calcifications.\u003c/p\u003e\u003ch2\u003eConclusions:\u003c/h2\u003e \u003cp\u003eThis case highlights the need to assess anatomical structures beyond the dental region in panoramic imaging. Ultrasound is recommended as an adjunct imaging modality to accurately determine the origin and location of muscle calcifications without additional radiation exposure. Recognizing these incidental findings on dental radiographs is essential for avoiding misinterpretation and unnecessary interventions.\u003c/p\u003e","manuscriptTitle":"Incidental Findings of Muscle-Origin Calcifications in the Sternocleidomastoid Muscle on an Orthopantomogram: a Case Report","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-01-15 11:44:28","doi":"10.21203/rs.3.rs-5746452/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"937cd26d-a0ab-4c0a-805b-bd6e25ea9637","owner":[],"postedDate":"January 15th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-03-05T14:21:56+00:00","versionOfRecord":{"articleIdentity":"rs-5746452","link":"https://doi.org/10.7759/cureus.80016","journal":{"identity":"cureus","isVorOnly":true,"title":"Cureus"},"publishedOn":"2025-03-04 00:00:00","publishedOnDateReadable":"March 4th, 2025"},"versionCreatedAt":"2025-01-15 11:44:28","video":"","vorDoi":"10.7759/cureus.80016","vorDoiUrl":"https://doi.org/10.7759/cureus.80016","workflowStages":[]},"version":"v1","identity":"rs-5746452","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5746452","identity":"rs-5746452","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}