Abstract
The aim of this retrospective analysis was to assess the incidence of ponticulus posticus and stylohyoid ligament calcification and to evaluate the morphological variations of the sella turcica within the Turkish demographic using CBCT scans. Involving a retrospective review of 460 CBCT scans and utilizing the NewTom 3G system, the study analyzed high-quality CBCT images to investigate ponticulus posticus, stylohyoid ligament calcifications, and sella turcica morphology. The ponticulus posticus was examined for complete or partial formations, while the stylohyoid ligament was classified according to its elongation and calcification patterns. The sella turcica was categorized into six distinct morphological types, enhancing the understanding of structural variations in the context of the Turkish population. The calcification patterns of the styloid processes were examined on both sides of 380 individuals, revealing the highest prevalence in the ‘d’ and ‘e’ categories on the right, and similar findings on the left among 373 individuals. Symmetric calcification patterns were more common, with 68.4% symmetry observed. For the sella turcica, category ‘a’ was the most frequent among 363 individuals. Analysis of ponticulus posticus absence and presence showed a majority lacking this feature on both sides, with complete and partial forms less common. The study highlights the anatomical variability and bilateral symmetry of the styloid processes, sella turcica, and ponticulus posticus, illustrating that these structures do not significantly vary with gender or age. These results hold clinical significance for the diagnosis and treatment of related conditions, prompting further investigation into their impact on patient care.
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Data availability
The data that support the findings of this study are available on request from the corresponding author AK. The data are not publicly available due to their containing information that could compromise the privacy of research participants.
References
Alkofide EA (2007) The shape and size of the ST in skeletal Class I, Class II, and Class III Saudi subjects. Eur J Orthod 29:457–463
Altindag A, Eren H, Kucukkalem MF, Altindag O (2022) Prevalence and pattern of stylohyoid chain complex on panoramic radiographs: a retrospective study. Clin Exp Health Sci 12:906–912
Axelsson S, Storhaug K, Kjaer I (2004) Post-natal size and morphology of the sella turcica in Williams syndrome. Eur J Orthod 26:613–621
Bavbek NC, Dincer M (2014) Dimensions and morphologic variations of sella turcica in type 1 diabetic patients. Am J Orthod Dentofacial Orthop 145:179–187
Bruno G, De Stefani A, Balasso P, Mazzoleni S, Gracco A (2017) Elongated styloid process: an epidemiological study on digital panoramic radiographs. J Clin Exp Dent 9:e1446–e1452
Buyuk SK, Sekerci AE, Benkli YA, Ekizer A (2017) A survey of ponticulus posticus: radiological analysis of atlas in an orthodontic population based on cone-beam computed tomography. Niger J Clin Pract 20(1):106–110
Cakmak O, Gurdal E, Ekinci G, Yildiz E, Cavdar S (2005) Arcuate foramen and its clinical significance. Saudi Med J 26:1409–1413
Chen CH, Chen YK, Wang CK (2015) Prevalence of ponticuli posticus among patients referred for dental examinations by cone-beam CT. Spine J 15:1270–1276
Chitroda PK, Katti G, Baba IA et al (2013) Ponticulus posticus on the posterior arch of atlas, prevalence analysis in symptomatic and asymptomatic patients of gulbarga population. J Clin Diagn Res 7:3044–3047
Giri J, Pokharel PR, Gyawali R (2017) How common is ponticulus posticus on lateral cephalograms? BMC Res Notes 10:172
Go JL, Rajamohan AG (2017) Imaging of the sella and parasellar region. Radiol Clin North Am 55:83–101
Gokce C, Sisman Y, Sipahioglu M (2008a) Styloid process elongation or Eagle’s syndrome: ıs there any role for ectopic calcification? Eur J Dent 2:224–228
Gokce C, Sisman Y, Ertas ET, Akgunlu F, Ozturk A (2008b) Prevalence of styloid process elongation on panoramic radiography in the Turkey population from cappadocia region. Eur J Dent 2:18–22
Iskra T, Stachera B, Możdżeń K, Murawska A, Ostrowski P, Bonczar M, Gregorczyk-Maga I, Walocha J, Koziej M, Wysiadecki G, Balawender K, Żytkowski A (2023) Morphology of the sella turcica: a meta-analysis based on the results of 18,364 patients. Brain Sci 13:1208
Krennmair G, Piehslinger E (2003) Variants of ossification in the stylohyoid chain. Cranio 21:31–37
Krishnamurthy A, Nayak SR, Khan S, Prabhu LV, Ramanathan LA, Ganesh Kumar C, Prasad Sinha A (2007) Arcuate foramen of atlas: incidence, phylogenetic and clinical significance. Rom J Morphol Embryol 48:263–266
MacDonald-Jankowski DS (2001) Calcification of the stylohyoid complex in Londoners and Hong Kong Chinese. Dentomaxillofac Radiol 30:35–39
Magat G, Sener SO (2018) Morphometric analysis of the sella turcica in Turkish individuals with different dentofacial skeletal patterns. Folia Morphol 77:543–550
Monsour PA, Young WG (1986) Variability of the styloid process and stylohyoid ligament in panoramic radiographs. Oral Surg Oral Med Oral Path 61:522–526
Omami G (2018) Calcification of the stylohyoid complex in Libyans. Saudi Dent J 30:151–154
Ortiz PM, Tabbaa S, Flores-Mir C, Al-Jewair T (2018) A CBCT investigation of the association between sella-turcica bridging and maxillary palatal canine impaction. Biomed Res Int 2018:4329050
Öztunç H, Evlice B, Tatli U, Evlice A (2014) Cone-beam computed tomographic evaluation of styloid process: a retrospective study of 208 patients with orofacial pain. Head Face Med 10:5
Pękala PA, Henry BM, Pękala JR et al (2017) Prevalence of foramen arcuale and its clinical significance: a meta-analysis of 55,985 subjects. J Neurosurg Spine 27:276–290
Polat SÖ, Kabakcı AG, Öksüzler FY, Oksüzler M, Yücel AH (2020) Determination of sella turcica types in healthy Turkish population. Cukurova Med J 45:738–745
Putrino A, Leonardi RM, Barbato E, Galluccio G (2018) The association between ponticulus posticus and dental agenesis: a retrospective study. Open Dent J12:510–519
Rao RD, Tang S, Lim C, Yoganandan N (2013) Developmental morphology and ossification patterns of the C1 vertebra. J Bone Jt Surg Am 95:e1241–e1247
Saleh A, Gruber J, Bakhsh W, Rubery PT, Mesfin A (2018) How common ıs the ponticulus posticus?: a computed tomography based analysis of 2917 patients. Spine (phila Pa 1976) 43:E436–E441
Schilling J, Schilling A, Galdames IS (2010) Ponticulus posticus on the posterior arch of atlas, prevalence analysis in asymptomatic patients. Int J Morphol 28:317–322
Sekerci AE, Soylu E, Arikan MP, Aglarci OS (2015) Is there a relationship between the presence of ponticulus posticus and elongated styloid process? Clin Imaging 39:220–224
Shah AM, Bashir U, Ilyas T (2011) The shape and size of the sella turcica in skeletal class I, II & III in patients presenting at Islamic International Dental Hospital, Islamabad. Pakistan Oral & Dental Journal 31:104–110
Shahidi S, Hasani M, Khozaei M (2022) Evaluating the relation between the elongated styloid process and the ponticulus posticus using cone-beam computed tomography. Folia Morphol 81:196–202
Sönmez EI, Polat S, Öksüzler M, Göker P (2024) Evaluation of sella turcica morphology and morphometry based on gender and age in our population using computed tomography. J Craniofac Surg 35:678–681
Stubbs DM (1992) The arcuate foramen. Variability in distribution related to race and sex. Spine (phila Pa 1976) 17:1502–1504
Taitz C, Nathan H (1986) Some observations on the posterior and lateral bridge of the atlas. Acta Anat (basel) 127:212–217
Tassoker M, Kok H, Ozcan S (2017) Investigation of the relationship between" Sella Turcica Bridge" and" Ponticulus Posticus": a lateral cephalometric study. Int J Morphol 35:337–344
Valizadeh S, Shahbeig S, Mohseni S, Azimi F, Bakhshandeh H (2015) Correlation of shape and size of sella turcica with the type of facial skeletal class in an Iranian group. Iran J Radiol 12:e16059
Yalcin ED (2020) Morphometric analysis of sella turcica using cone-beam computed tomography in patients with cleft lip and palate. J Craniofac Surg 31:306–309
Yasa Y, Bayrakdar IS, Ocak A, Duman SB, Dedeoglu N (2017a) Evaluation of sella turcica shape and dimensions in cleft subjects using cone-beam computed tomography. Med Princ Pract 26:280–285
Yasa Y, Ocak A, Bayrakdar IS, Duman SB, Gumussoy I (2017b) Morphometric analysis of sella turcica using cone beam computed tomography. J Craniofac Surg 28:e70–e74
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All authors contributed to the study's conception and design. The preparation of the project was done by Kaan Orhan. Data collection and selecting patient data were done by Seçil Aksoy. Evaluating images, and making measurements were done by Aida Kurbanova, Elif Polat Balkan, Burak İncebeyaz. Writing publications was done by Aida Kurbanova. The final manuscript has been read and approved by all authors. The radiological investigation presented herein is an original contribution and has neither been published previously in any form nor is it concurrently under review by any other scholarly journal.
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The study was approved by the Bioethics Committee of the Faculty of Medicine of Near East University (YDU/2018/64–702).
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All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study.
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Kurbanova, A., Polat Balkan, E., İncebeyaz, B. et al. Retrospective evaluation of ponticulus posticus prevalence, sella turcica types, and stylohyoid complex calcifications in a group of Turkish population. Anat Sci Int (2024). https://doi.org/10.1007/s12565-024-00785-3
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DOI: https://doi.org/10.1007/s12565-024-00785-3