Diagnostic accuracy of panoramic radiography in detecting styloid process elongation: a cone-beam computed tomography...

This study aims to evaluate the reliability of panoramic imaging in assessing styloid process (SP), using cone beam computed tomography (CBCT) as the reference standard. CBCT is preferred for assessing SP as it displays the dimensions and morphology of the SP without superimpositions.

SP elongation, calcification type (type 1: elongated, type 2: pseudoarticulated, type 3: segmented, and type 4: distant), and calcification pattern (calcified outline, partially calcified, nodular, and completely calcified) were evaluated on both panoramic and CBCT images of the same 407 patients. All measurements were recorded for the left and right sides independently. The efficacy of panoramic imaging in assessing SP was analysed through sensitivity, specificity, positive predictive value, and negative predictive value, accompanied by their 95% confidence intervals, with a significance threshold of about 0.05 for all studies.

There were 113 (27.8%) male and 294 (72.2%) female, for a total of 407 patients with a median age of 43 years (18-69). The prevalence of elongated SP was 43.5% in panoramic images, whereas in CBCT images, it was 52.6%. When compared to CBCT imaging, panoramic imaging exhibited good specificity, with values of 81.2% on the right side and 83.7% on the left side, but demonstrated low sensitivity, recording 67.3% on the right side and 64.4% on the left side.

Almost one-third of the elongated SP cases were detected as false negative in panoramic images. Considering these findings, it is advisable to assess the region using CBCT in situations where SP examination is critical.