A unique case of calcifications of torus tubarius in cone beam computed tomography (CBCT)

Abstract

Clinical Presentation

A 97-year-old female patient was presented to a private dental clinic for evaluation and treatment due to pain in her lower jaw. The patient had ill-fitting complete and partial dentures and severe bone loss and mobility of the remaining teeth. The patient was on multiple medications. A cone beam computed tomography (CT) was recommended as part of the treatment plan. Along with common clinical findings, the cone beam CT exposed significant degenerative changes with the C-spine and atherosclerotic calcifications in the internal carotids. A rare finding consisting of bilateral calcifications was noted with cartilaginous parts of Eustachian tubes. The calcifications appear as tear drop structures.

Differential Diagnosis

The various lesions considered for reasonable diagnostic possibilities include calcifications of the torus tubarius, tubal tonsils, and other dystrophic calcifications of soft tissues in the region.

Diagnosis and Management

The bilateral, teardrop structures were diagnosed as rare calcifications of the torus tubarius, which are mucosal elevations of the cartilaginous portions of the Eustachian tubes. As no clinical significance has yet been established, no further treatment is warranted.

Conclusion

Torus tubarius calcifications are rare; however, they increase in occurrence with aging. One study noted 0.6% prevalence in a 1571-patient dataset. The first report of these calcifications on a CT was presented by Mafee et al. in 2011. A case report of a 67-year-old woman with a medical history of hyperthyroidism, presented by Syed et al, reported similar ossifications of the Eustachian tube. Even though no clinical significance is established, loss of elasticity of the cartilages due to calcification leading to Eustachian tube dysfunction for elderly people, including otitis media, is proposed by Mafee et al. Torus tubarius calcifications can easily be confused with calcifications of tubal tonsils, as they are very close to each other.