Is Diagonal Ear Lobe Crease Associated With Cartoid Calcifications on Panoramic Radiograph or Cone Beam Computed Tomography?

 

Atherosclerosis and coronary artery disease is associated with significant morbidity and mortality. It also poses risk for the oral and maxillofacial surgery (OMS) patient undergoing anesthesia and surgery. It is known that diagonal ear lobe creases (DELC) are associated with atherosclerosis. Additionally, atheromas of the carotid arteries have been identified on panoramic radiography of dental patients. Furthermore, with more routine use of cone beam computed tomography(CBCT) in the dental and OMS settings, it is prudent to use this technology as an adjunct to identify atheromas in the carotid arteries whenever present. The purpose of this investigation was to determine the correlation between DELC and atheromas identified on panoramic radiographs and CBCT.

This is a retrospective cohort study of two groups of subjects evaluated from June 2015 to March 2016 at the Columbia University College of Dental Medicine: 1) a study group composed of subjects with carotid calcifications identified on either panoramic radiograph or CBCT and 2) a control group composed of unaffected individuals not found to have such radiographic findings. The outcome variable was presence of a diagonal ear lobe crease. The study sample included 20 subjects: 10 with atheromas identified on panoramic radiographs or CBCT and 10 unaffected individuals without such findings. Each patient was then examined and the presence or absence of unilateral or bilateral ear lobe crease was noted.

The mean age of the study group was 54.5 years (range, 27-68; median, 58 years). The mean age of the control group was 43 years (range, 35-60; median, 41 years). Six patients with atheromas identified on panoramic radiograph or CBCT had DELC: five patients with bilateral creases, one patient with a unilateral crease. None of the ten patients in the control group had DELC.

The study results suggest that DELC is associated with atheromas seen on panoramic radiograph or CBCT. This association is clinically useful as Oral and Maxillofacial Surgeons may want to include inspection for DELC as part of the routine examination. This may be useful for the evaluation of a patient’s medical risk assessment prior to procedures or to the use of anesthesia. The clinician may be able to identify patients at risk of coronary artery disease that may otherwise be missed.

References:

1) Evrengul H, et. al: Bilateral diagonal ear lobe crease and coronary artery disease: A significant association. Dermatology 209:271, 2004.

2) Friedlander AH and Scully C: Diagonal ear lobe crease and atherosclerosis: A review of the medical literature and oral and maxillofacial implications. Journal of Oral and Maxillofacial Surgery 68:3043-3050, 2010.