A 72-Year-Old Male with Chronic Untreated Pain and Incidental Radiographic Findings

Abstract

Abstract

A 72-year-old hypertensive male presented with four-month history of right upper back tooth pain and bilateral neck pain. Initially self-medicating with analgesics, worsening symptoms restricting head movement and mastication prompted consultation. Clinical examination revealed multiple decayed teeth and bilateral head rotation pain. Digital panoramic radiography unexpectedly demonstrated bilateral elongated styloid processes extending beyond normal limits with multiple radiopaque calcifications in vascular regions. Cone-beam computed tomography confirmed bilateral elongation measuring 64.09mm (right) and 45.98mm (left), exceeding normal range of 20-25mm. Three-dimensional reconstruction revealed close proximity to internal carotid arteries with calcifications at C3-C5 levels. Stylocarotid syndrome was diagnosed. Given advanced age, hypertension, bilateral involvement, and atherosclerotic calcifications, the patient was categorized as extremely high-risk for cerebrovascular events. Immediate interdisciplinary consultation with vascular surgery, neurology, and cardiology was arranged. This case demonstrates how routine dental imaging can reveal potentially fatal systemic pathology, highlighting the importance of diagnostic vigilance when chronic untreated pain masks underlying vascular etiology.

Keywords: Incidental findings, dental imaging, chronic pain, vascular pathology, interdisciplinary care