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Case Report

Investigation and differential diagnosis of

Stafne bone cavities with cone beam computed
tomography and magnetic resonance imaging:
Report of two cases
Elif Tarim Ertas, Meral Yırcalı Atıcı, Fahrettin Kalabalik, Ozlem Ince1
Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, İzmir Katip Çelebi University, 1Department of Radiology, Sifa University
Research and Training Hospital, İzmir, Turkey

A B S T R A C T

Stafne bone cavity (SBC), commonly known as Stafne bone cyst or defect is mostly asymptomatic, appearing as a unilateral, round
or ovoid, radiolucent defect with thick and corticated border. Defects that are referred as pseudocysts generally occur in mandibular
molar region, below the mandibular canal at the lingual side of the mandible and may grow slowly in time. They have been also located
lingually in the anterior mandible above the mylohyoid muscle, and on the ascending ramus just inferior to mandibular condyle or very
rarely buccal region of the ascending ramus. The aim of this case report is to present two unusual cases of SBC detected incidentally
during radiographic examination with cone beam computed tomography and magnetic resonance imaging findings. In the first case,
significant enlargement caused vestibular resorption of the buccal cortex, which is a rare finding with SBCs and in the second case
the large bone resorption reached up to the mental foramen.

Key words: Cone beam computed tomography, magnetic resonance imaging, panoramic radiography, salivary gland depression,
Stafne bone cavity

Introduction Radiographically, they are unilocular, round or ovoid

Stafne bone cavity (SBC), is an asymptomatic bone depression
which is referred as pseudocyst without epithelial lining.[1] In
general, they occur in the mandibular molar region, related to
the submandibular gland below the mandibular canal. Rarely,
they appear apical region of the premolars and canines of the
anterior mandible, associated with the sublingual glands above
the mylohyoid muscle.[2] Etiology of SBC is unknown, but
the surrounding tissue or facial artery mechanical pressures
can be origin of this developmental anomaly.[3]
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DOI:
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radiolucent cyst like defects with well-defined, thick and
corticated border and their diameter size varies 1-3 cm.[2]
Nevertheless they can be seen multilocular with irregular
borders.[4]
The differential diagnosis of mandibular depressions
includes several pathologic entities, such as, odontogenic
cyst, simple bone cyst, ameloblastoma, hemangioma,
myxoma, central giant cell lesion, fibro-osseous lesions,
multiple myeloma, eosinophilic granuloma, benign salivary
gland tumors, neurogenic tumors, and metastatic disease.[1,5-7]
If SBC have well-defined, thick and corticated borders and
oval shape under the mandibular canal in contact with the
base of the mandible, differential diagnosis can be easy.
However, if they are noticed higher or above the mandibular
canal and have no connection with the mandibular base
with irregular borders, can cause misdiagnose. Computed
tomography (CT) or magnetic resonance imaging (MRI)

Address for correspondence: Dr. Elif Tarim Ertas, Aydınlık Evler Mahallesi, Cemil Meriç Caddesi, 6780 Sokak. No. 48, 35640-Çiğli, İzmir,
Turkey. E-mail: dt.eliftarim@yahoo.com

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Ertas, et al.: Investigation of Stafne bone cavities
should be useful for differential diagnose.[3] In this case
report, two unusual cases of posterior and anterior Stafne
bone cysts are presented with three-dimensional cone-beam
CT (CBCT) and MRI findings.
Case Reports
Case 1
A 51-year-old male patient was referred to our clinic for
routine dental examination and periodontal treatment. The
radiolucent area, which was located at the posterior right
molar region of the mandible below the inferior dental
canal, had been identified on a panoramic radiograph
[Figure 1]. The patient had no complaints concerning this
region, and his medical history was ordinary and he had no
trauma or surgery history of the jaws. At the right posterior
region of the mandible and submandibular region, there
was no swelling or abnormality. He had no pain during
palpation. Along the distribution of the inferior alveolar
and mental nerves, revealed intact sensation.
Stafne bone cavity was considered for the radiolucent area
located under the mandibular canal but because of the
Figure 1: The radiolucent area, which was located at the posterior right
molar region of the mandible below the inferior dental canal on panoramic
radiography
Figure 3: Three-dimensional cone beam computed tomography volume
rendering reconstructed images of the patient showed lingual bone defect field
Journal of Oral and Maxillofacial Radiology / September-December 2015 / Vol 3 | Issue 3
largeness of the lesion and to view its dimensions and borders,
CBCT (NewTom 5G; QR, Verona, Italy) was performed
[Figure 2]. Examination of the axial images of the CBCT
scan showed a mandibular lingual wall defect at the molar
region with vestibular extension, which causes resorption
of the vestibular cortex [Figure 2a]. The cross-sectional
images presented the invagination of the lingual cortex up
to the buccal cortex [Figure 2b]. Figure 3 shows the three-
dimensional (3D) CBCT volume rendering reconstructed
images of the patient showed lingual bone defect field.
In the literature vestibular cortical resorption is an unusual
finding so to learn the content of the cavity, MRI was
performed. In the defective cavity located in the alveolar
arcus two components with different signal intensities were
detected. In the T1 fat-saturated, T2 fat saturated, and T1
fat saturated contrasted MRI images, the posterior part of
the bone cavity is filled with anteriosuperior part of the
submandibular gland. In T1 and T2 sequences, anterior
part of the cavity showed hiperintens signals, which is
compatible with proteinaceous content in this area. No
fatty content was detected in fat saturated sequences in
the anterior part [Figure 4].
Figure 2: (a) The cross-sectional images presented the invagination of the
lingual cortex up to the buccal cortex. (b) The axial images of the cone beam
computed tomography scan showed a mandibular lingual wall defect at the
molar region with vestibular extension
a b c
Figure 4: (a) Coronal short tau inversion recovery, (b and c) postcontrast
axial T1 FSE, images shows that the posterior part of mandibular defect is
filled with soft tissue that is continuous and identical in signal with that of
submandibular gland, and the anterior part is filled with proteinaceous soft
tissue
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Ertas, et al.: Investigation of Stafne bone cavities

Final diagnose of the lesion was made as a posterior variant any connection with the apex of premolars [Figure 6b]. 3D
of SBC and the patient was informed about the lesion and CBCT volume rendering reconstructed images revealed a
scheduled follow-up appointments for every 6 months. bone defect at the anterior mandible [Figure 7].

Case 2 Successively, to learn the content of the cavity since

A 38-year-old male patient was referred to our clinic for this location is not as common as a posterior variant of
routine dental examination and prosthetic management. A SBC, MRI was performed. In the T1 fat-saturated, T2 fat
panoramic radiograph of the patient revealed a radiolucent saturated, and T1 fat saturated contrasted MRI images, the
area at the right first and second premolar region of the bone cavity is filled with soft tissue that is, continuous and
mandible below the root of the premolars [Figure 5]. The identical in signal with that of the mylohyoid muscle. This
patient’s medical and dental history was not contributory. is clearly seen in all types of sequences in various plains
There was no pain and no symptoms such as expansion in in Figure 8.
this region. Along the distribution of the inferior alveolar
and mental nerves, revealed intact sensation. In order to Final diagnose of the lesion was made as an anterior variant
eliminate the diagnosis of the radicular cyst, vitality test of SBC and the patient was informed about the lesion and
was performed, and teeth were vital. recommended follow-up appointments for every 6 months.
We performed CBCT (NewTom 5G; QR, Verona, Italy) scan
to the definite, exact location of the lesion and to confirm
the diagnosis of the entity [Figure 6]. Two-dimensional
multiplanar reconstructed CBCT axial images revealed
that the radiolucent area located on the anterior region of
the mandible lingually with mental foramen relationship
[Figure 6a]. The cross-sectional images showed depression
of the lingual cortex below the premolar region without

Figure 6: (a) The cross-sectional images showed depression of the lingual

cortex below the premolar region without any connection with apex of
premolars. (b) cone beam computed tomography axial images revealed
that the cavity located on the anterior region of the mandible with mental
foramen relationship

Figure 5: A panoramic radiograph of the patient revealed a radiolucent area

below the root of the premolars

Figure 8: (a) Sag T1 FSE, (b) coronal short tau inversion recovery, (c) contrast
Figure 7: Three-dimensional cone beam computed tomography volume COR T1 FSE (d) contrast axial T1 FSE, images shows that the mandibular
rendering reconstructed images revealed a bone defect at the anterior defect is filled with tissue that is continuous and identical in signal with that
mandible of mylohyoid muscle

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Ertas, et al.: Investigation of Stafne bone cavities
Discussion
Stafne bone cavities are asymptomatic, ovoid-shaped,
homogeneous, well-defined radiolucent lingual bone
defects, which are usually detected incidentally on routine
radiographic examinations.[2] There are variances in the
location of SBC. The most common location of SBC is
submandibular gland fossa close to the inferior border of
the mandible, beneath the inferior dental canal, which is
termed posterior variant of SBC. In our first case, SBC
is located at the posterior mandibular region close to
the inferior border of the mandible. The lingual anterior
variant of SBC is 7 times less frequent than the posterior
variant, which is located near the apical region of the
premolars, associated with the sublingual glands such as
our second case. Lingual and especially buccal bone cavities
of ascending ramus are very rare findings such as in our
previously reported case.[8,9]
Several hypotheses have been offered for the etiology
of SBC, and the cause is still controversial. According
to Stafne,[8] bone cavities are developmental failures in
the ossification process in the region that is occupied
by cartilage. Philipsen et al.[1] declared that hyperplastic
or hypertrophic salivary glands pressure on the bone
surface can cause the formation of SBCs. Minowa et al.[10]
hypothesized that SBC is the result of erosion caused by
an acquired vascular lesion or lipoma.
Stafne bone defects (SBDs) can include generally salivary
glands in accordance with their placement but can also
include fat, connective tissue, lymphoid tissue, muscle and
blood vessels and even SBCs can be empty.[11] Shimizu
et al.[3] reported that SBDs which have a connection with
the base of the mandible generally include soft tissues. In
accordance with Shimizu et al.,[3] our first case, the posterior
part of the bone cavity was filled with submandibular gland,
but anterior part of the cavity was filled with proteinaceous
content. No fatty content was detected. In the literature,
anterior SBCs commonly contained normal or inflamed
salivary sublingual salivary gland tissue.[12] In our second
case, the content of the cavity was mylohyoid muscle, which
is a rare finding in the literature.
Generally, no surgical treatment is necessary for SBCs,
which are anatomic rather than pathologic. Clinical and
radiographical examinations are adequate to confirm the
static nature of cavities.[13,14] Surgical management and
biopsy can be performed when the diagnosis is unclear[1,3]
or to reduce the risk of the fractures when the defect
has a critical size or has an alteration in size during the
Journal of Oral and Maxillofacial Radiology / September-December 2015 / Vol 3 | Issue 3
follow-up periods.[15,16] Prechtl et al.[15] presented a SBC case
with significant enlargement during 17 years period. Kao
et al.[16] presented a mandibular fracture related to Stafne
bone defect. Consequently, imaging techniques and follow-
up radiographs are important to diagnose these cavities.
Panoramic radiographs may ensure knowledge concerning
the diagnosis of SBC. Since CBCT provides examination
the suspicious radiolucent lesions in all sections with lower
radiation exposure and higher speed, it might be used for
diagnosis of SBC cases instead of CT imaging.[17] Moreover,
to identify the contents of the cavity, MRI with superior
soft tissue characterization and differentiation and without
ionizing radiation should be preferred.[18]
Conclusion
Differential diagnose of SBCs from other possible
pathologies that may require treatment and imaging
technique selection according to case is significant. CBCT
and MRI might be serious for a definitive diagnosis.
Moreover, especially in cases with critical size to monitor
the alterations in size to reduce the risk of fractures follow-
ups are very important and the patients should be informed
and warned about the condition.
Acknowledgments
This case report reported on in a poster presentation at The
European Society of Head and Neck Radiology (ESHNR)
Congress, İzmir, Turkey, October 03-05, 2013.
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Cite this article as: Ertas ET, Atici MY, Kalabalik F, Ince O. Investigation
and differential diagnosis of Stafne bone cavities with cone beam computed
tomography and magnetic resonance imaging: Report of two cases. J Oral
Maxillofac Radiol 2015;3:92-6.
Source of Support: Nil. Conflicts of interest: None declared.

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