Article Figures & Data
Figures
- Fig 1.
Axial (A), sagittal (B), and coronal (C) CT images of 3 different representative patients demonstrate multiple millimetric scattered facial and scalp hypodermal calcified nodules with varying degrees of severity. A 3D bone window reconstruction of a patient's sinus CT (D) also demonstrates a relatively large, 4- to 5-mm facial calcified nodule within the right premaxillary skin.
- Fig 2.
A scatterplot and linear regression between age and the number of facial calcified nodules among 553 patients with positive facial calcified nodules. No significant linear quantitative relationship was observed.
- Fig 3.
A, The average number of facial calcified nodules in each age group by decade. B, The median number of facial calcified nodules in each age group by decade. The Kruskal-Wallis test revealed a statistically significant difference in the median number of nodules among different age-decade groups. Post hoc analysis between each age group in the overall population, including both males and females, revealed a significantly higher (asterisk indicates P < .05) median number of nodules in the fifth–ninth decades compared with the second and third decades. An additional statistically significant difference was observed between the sixth and seventh decades and the fourth decade.
- Fig 4.
Radiographic examination of cadaveric facial skin specimen (A) reveals multiple calcified nodules. A magnified view of inflated buccal skin on an asymptomatic living patient (B) demonstrates multiple calcified nodules with central lucency. Benign breast skin calcification detected in a routine screening mammogram in a middle-aged female subject (C) demonstrates classic imaging findings of central lucency, which resemble the radiographic appearance of facial calcified nodules in (B). Axial (D) and coronal (E) CT images of the buccal area of a patient demonstrate facial calcified nodules. A magnified axial CT image of a relatively large 5-mm maxillary hypodermal calcified nodule (F) demonstrates a subtle central lucency. A and B, Images adapted from Shigehara et al16 and obtained from Dr Shigehara with permission.
- Fig 5.
A, Pathologic examination of facial calcified nodules from a cadaveric specimen demonstrates mature bone-like characteristics, including a concentric, multilamellated, osteoid cortex and a central adipose medulla. B, A magnified view of a portion of A. C and D, Elemental composition and peak ratios of a cadaveric facial nodule (C) and the clavicle (D) are similar to each other and well-correlated with the composition of hydroxyapatite. Images are adapted from Shigehara et al16 and obtained with permission from Dr Shigehara. MMO indicates multiple miliary osteoma.
Tables
Indications Cases % Chronic sinusitis 823 62.6% Upper respiratory infection/rhinitis 142 10.8% Sinus pain/pressure 76 5.8% Polyposis/mucocele 35 2.7% Fungal infection 11 0.8% Allergy 25 1.9% Asthma 8 0.6% Headache 115 8.8% Obstructive sleep apnea 6 0.5% Mass/cyst 9 0.7% Head and neck cancer 8 0.6% Pituitary mass 6 0.5% Wegener granulomatosis 4 0.3% Epistaxis 12 0.9% CSF leak 6 0.5% Trauma 3 0.2% Facial infection 2 0.2% Facial weakness 3 0.2% Anosmia 5 0.4% Vertigo/hearing loss 8 0.6% Otalgia 1 0.1% Acromegaly 1 0.1% Unspecified 6 0.5% Total 1315 100% ↵a The first 6 indications relate to sinusitis or upper respiratory symptoms, accounting for the majority of indications (1112 cases, 84.6%; 1315 sinus CT cases; male, 599, 45.6%; female, 716, 54.4%).
Nodule Distribution All Male Female None 762 347 415 Frontal 285 126 159 Frontal-maxillary 195 87 108 Maxillary 60 31 29 Temporal 7 3 4 Mandibular/buccal 4 4 0 Orbital 2 1 1 Subtotal 1315 599 716
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