Mandible & maxilla
Giant cell lesions & pseudocystic bone lesions
Stafne defect
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Deputy Editor-in-Chief: Kelly Magliocca, D.D.S., M.P.H.
Last author update: 10 April 2025
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PubMed Search: Stafne defect
Table of Contents
Definition / general | Essential features | Terminology | ICD coding | Epidemiology | Sites | Etiology | Clinical features | Diagnosis | Radiology description | Radiology images | Prognostic factors | Case reports | Treatment | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Sample pathology report | Differential diagnosis | Practice question #1 | Practice answer #1Cite this page: Goldfaden JS, Vargo RJ. Stafne defect. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/oralcavitystafnedefect.html. Accessed April 29th, 2025.
Definition / general
- Rare, asymptomatic bone lesion that radiographically appears as a well circumscribed, ovoid shaped radiolucent lesion with sclerotic borders and most often occurs on the lingual aspect of the posterior mandible, below the inferior alveolar nerve canal
- These defects typically contain ectopic salivary gland tissue and do not require treatment (Dentomaxillofac Radiol 2014;43:20140075)
Essential features
- Stafne defects frequently appear as well defined, unilocular, oval shaped radiolucencies with thick sclerotic borders that encompass the entire contour of the defect
- ~94% of Stafne defects occur on the lingual aspect of the posterior mandible (particularly in the area of the third molar) and are below the inferior alveolar nerve canal, typically near the angle of the mandible (Med Oral Patol Oral Cir Bucal 2023;28:e264)
- Stafne defects are commonly observed in 50 - 70 year old individuals with a male predilection (Ann Transl Med 2019;7:399)
Terminology
- In 1942, Dr. Edward C. Stafne published a series of 35 bone cavities situated near the angle of the mandible in 34 patients (J Am Dent Assoc 1942;29:1969)
- As Stafne was the first to identify this phenomenon, these gnathic anomalies have been given the following eponyms: Stafne defects, Stafne bone cavities or Stafne bone cysts (J Dent Sci 2019;14:435, Dentomaxillofac Radiol 2020;49:20190475)
- These lesions have also been referred to as static bone defects, mandibular lingual bone depressions, mandibular salivary gland inclusions and latent bone cysts (Oral Surg Oral Med Oral Pathol 1963;16:703, J Oral Surg Anesth Hosp Dent Serv 1960;18:16, Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:e1, Gen Dent 2006;54:336, Oral Surg Oral Med Oral Pathol 1955;8:963)
ICD coding
Epidemiology
- Stafne defects are commonly observed in 50 - 70 year old individuals with a male predilection (Ann Transl Med 2019;7:399)
- Youngest patient reported to have a Stafne defect was an 11 year old boy (Oral Surg Oral Med Oral Pathol 1980;49:376)
Sites
- ~94% of Stafne defects occur on the lingual aspect of the posterior mandible (particularly in the area of the third molar) and are below the inferior alveolar nerve canal, typically near the angle of the mandible; in contrast, ~6% of cases involve the lingual aspect of the anterior mandible (Med Oral Patol Oral Cir Bucal 2023;28:e264)
- Stafne defects are seldom bilateral and exhibit no laterality predilection (Dentomaxillofac Radiol 2020;49:20190475)
- Rare cases of Stafne defects involving the parotid gland have been reported (Imaging Sci Dent 2017;47:269, Braz J Otorhinolaryngol 2018;84:669)
Etiology
- Exact cause of Stafne defects is unknown; however, both congenital and developmental origins have been postulated
- Stafne conjectured that the observed mandibular bone defects are congenital in nature and are the result of a failure of fusion in areas previously occupied by Meckel cartilage (J Am Dent Assoc 1942;29:1969)
- Others who also support a congenital origin have suggested that Stafne defects arise from portions of salivary gland tissue that became entrapped during mandibular development (J Craniofac Surg 2010;21:1769)
- Those who support a developmental origin hypothesize that the defect is the result of a hyperplastic, hypertrophic or aberrant lobe of the parotid, sublingual or submandibular gland, which exerts pressure on the lingual cortex of the mandible, ultimately leading to resorption of the bone (Dentomaxillofac Radiol 2002;31:281)
- This proposition is referred to as the glandular hypothesis (J Dent Sci 2019;14:378)
- Evidence supporting a developmental etiology is the reported average age range of 50 - 70 years, during which this entity is often first noted (Ann Transl Med 2019;7:399)
- Stafne conjectured that the observed mandibular bone defects are congenital in nature and are the result of a failure of fusion in areas previously occupied by Meckel cartilage (J Am Dent Assoc 1942;29:1969)
Clinical features
- Patients typically present with no abnormal clinical symptoms or evident oral manifestations (Ann Transl Med 2019;7:399)
Diagnosis
- Stafne defects are usually incidental findings on routine radiographic examination (Dentomaxillofac Radiol 2020;49:20190475)
Radiology description
- Stafne defects frequently appear as well defined, unilocular, oval shaped radiolucencies with thick sclerotic borders that encompass the entire contour of the defect
- These lesions are continuous with the base of the mandible and are found below the inferior alveolar nerve canal, near the angle of the mandible; a majority of Stafne defects are present in the third molar region (Med Oral Patol Oral Cir Bucal 2019;24:e12)
- Cone beam computed tomography (CBCT) can demonstrate the concave architecture of the lesion, while magnetic resonance imaging (MRI) highlights soft tissue plunging into the defect (Br J Oral Maxillofac Surg 2014;52:369)
- Pertaining to MRI, both T1 and T2 weighted multiplanar imaging demonstrate the presence of salivary tissue, filling the depression of the defect (Med Oral Patol Oral Cir Bucal 2019;24:e12)
Radiology images
Contributed by Richard J. Vargo, D.M.D., M.B.A.
Well circumscribed radiolucency of mandible
Bilateral radiolucencies of mandible
Bilateral concave mandibular radiolucencies
Sublingual radiolucency
Prognostic factors
- Prognosis is excellent; Stafne defects are benign and are typically incidental findings on routine radiographic examination (Dentomaxillofac Radiol 2020;49:20190475)
Case reports
- 46 year old man with chief concern of a concavity on the lingual aspect of his left anterior mandible (Oral Surg Oral Med Oral Pathol Oral Radiol 2012;113:e1)
- 48 year old woman with an ovoid radiolucency of the right mandible found incidentally on panoramic imaging (Ann Transl Med 2019;7:399)
- 62 year old man with well defined, partially corticated radiolucent lesions of the left and right mandible found on a routine panoramic radiograph (Cureus 2023;15:e39091)
Treatment
- No treatment is required
Microscopic (histologic) description
- Depending on how anterior or posterior the defect is in the mandible, either benign sublingual, submandibular or less commonly, parotid gland tissue is observed, respectively (Dentomaxillofac Radiol 2020;49:20190475)
- In some cases, the salivary gland tissue exhibits inflammatory changes; associated adipose tissue, connective tissue, blood vessels (i.e., arteries and veins) and fragments of bone may also be observed (Oral Surg Oral Med Oral Pathol 1957;10:1086)
- In some cases, Stafne defects may not harbor salivary gland tissue and only contain adipose tissue or muscle
Microscopic (histologic) images
Contributed by Joshua Seth Goldfaden, D.D.S.
Fragments of submandibular gland
Focus of chronic inflammation
Adipose tissue and vasculature
Positive stains
- Immunohistochemistry is often unnecessary for diagnosis
- Zymogen granules of serous acini within the submandibular gland can be best appreciated with PASD (Head Neck Pathol 2017;11:288)
- PAS, Alcian blue (pH 2.5) and mucicarmine may be used to highlight the mucus acini of ectopic submandibular gland or sublingual gland tissue (Radiother Oncol 2021;161:92, Stain Technol 1962;37:125, Am J Pathol 1988;132:187)
Sample pathology report
- Mandible, right, lingual of #27, excisional biopsy:
- Fragments of benign sublingual gland tissue (see comment)
- Comment: In conjunction with the radiographic findings, the lesion is most consistent with a Stafne defect.
Differential diagnosis
- Radiographic differential for a well defined, unilocular radiolucency with a sclerotic border below the inferior alveolar nerve canal of the mandible may include but is not limited to the following
- Focal osteoporotic bone marrow defect:
- Normal hematopoietic cells, adipose tissue and trabeculae of bone are seen
- Erythroid, granulocytic, monocytic and lymphocytic cells are present in addition to megakaryocytes (Int J Implant Dent 2015;1:18)
- Normal hematopoietic cells, adipose tissue and trabeculae of bone are seen
- Intraosseous capillary hemangioma:
- Lobules of capillary sized vessels with a lumen lined by flattened endothelial cells
- These capillaries lack a smooth muscle tunica media
- Lymphocytic inflammatory infiltrate may be seen
- Lobules of capillary sized vessels with a lumen lined by flattened endothelial cells
- Central giant cell granuloma:
- Lobules of fibroblasts with uneven scattering of multinucleated giant cells
- Lesions lack a fibrous capsule
- Extravasated erythrocytes and deposits of hemosiderin are often appreciated
- Metaplastic or osteoblastic bone formation may be identified; dystrophic calcifications may be present as well
- Lobules of fibroblasts with uneven scattering of multinucleated giant cells
- Aneurysmal bone cyst:
- Multicystic spaces filled with blood and separated by septa consisting of fibroblasts, giant cells and woven bone
- Mitotic activity is often notable; however, no overt cytologic atypia is seen
- Focal osteoporotic bone marrow defect:
Practice question #1
A 62 year old man presents with a well defined, circular shaped unilocular radiolucency with a sclerotic border in the left posterior mandible, below the inferior alveolar nerve canal, on a panoramic radiograph. The lesion was an incidental finding. Given this radiographic description in conjunction with the above photomicrograph, what is the most appropriate diagnosis?
- Central giant cell granuloma
- Focal osteoporotic marrow defect
- Intraosseous capillary hemangioma
- Stafne defect
Practice answer #1
D. Stafne defect. The photomicrograph reveals fragments of submandibular gland tissue, which is composed of mucous and serous acini. Answer A is incorrect because central giant cell granulomas consist of nonencapsulated lobules of fibroblasts with unevenly scattered multinucleated giant cells, extravasated erythrocytes with hemosiderin deposits and occasionally bone formation or dystrophic calcifications. Answer B is incorrect because focal osteoporotic marrow defects consist of normal hematopoietic cells (erythroid, granulocytic, monocytic and lymphocytic cells, as well as megakaryocytes), adipose tissue and trabeculae of bone. Answer C is incorrect because intraosseous capillary hemangiomas appear as lobules of capillary sized vessels with a lumen lined by flattened endothelial cells that lack a smooth muscle tunica media; additionally, lymphocytic inflammatory infiltrate may be seen.
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Reference: Stafne defect
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Reference: Stafne defect
