I thought it would be helpful to elaborate on the diagnosis and management of patients who have chance findings on panoramic and CBCT radiographs which are suggestive of calcification of the Carotid arteries. In adult patients who do not have chronic renal disease the chance of seeing an irregular shaped and variable density opacity at the level of C3- C4 in the parapharyngeal regions is about 4-5% of radiographs. If the patient is a smoker with a known history of cardiovascular disease then chances increase of finding a calcification.
Patients with Chronic Renal disease have a 50% prevalence of carotid artery calcification on radiographs. In the average general practice of about 1,500 people with 50% being adults then about 30 people are likely to have carotid artery calcifications so you should definitely see this condition in your office population.
In this CBCT image of a 71 year old male with known problems of cardiovascular disease and hypertension, a 4 mm opacity appeared with 2 distinct white lines which are compatible with calcification of the walls of the carotid artery. The carotid artery bifurcation is about 6 mm in diameter.
A letter was sent to the patient’s MD regarding the need for further evaluation and the possible complications for the planned tooth extractions. A Doppler ultrasound examination was performed and calcification of the Internal Carotid artery was found bilaterally. The Internal carotid artery is smaller than the Common Carotid which explains why the calcification measured 4 mm.
– Dr. Douglas K Benn