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PA119
IMPORTANCE OF CBCT SIALOGRAMS : CASE REPORT ON CONE BEAM COMPUTED SIALOGRAPHY OF RADIOLUCENT SIALOLITHS
Case report: relevant findings• 60 yr old female c/o chronic pain in left parotid region
since 2 years.
• No relevant medical history
• Dental history reveals multiple extractions a year back in 2nd quadrant in the pursuit of pain relief.
• Previously diagnosed with chronic bacterial sialadenitis
and was being treated for the same , the past one year.
• Scout film OPG as well ultrasound imaging was non contributory
INVESTIGATIONS
CBCT scan of early emptying
Sialolith seen in the deep lobe
Sialolith identified in the superior lobe distal to isthmus
TREATMENT• by sialoendoscopy two sialoliths were
retrieved.
Discussion•newer novel technique for imaging major
salivary glands
•overcomes shortcomings of other imaging modalities scout films, Ultrasound, CT , MRI
• when compared to 2D plain film sialography result was overwhelming.
Sialoliths•most common obstructive condition
•male predilection, 3rd – 6 th decade of life
•submandibular gland>parotid gland>sublingual
•radiopaque and radiolucent calculi
•pain and swelling / asymptomatic
Sialography• Radiographic examination of the salivary glands and ducts
after the introduction of a radiopaque dye into the ducts.
• PROCEDURE: Cannulation of Duct– Localize– Dilate– Cannulate– Secure– Injection – Imaging
• Phases : ductal phase , acinar phase, post evacuation phase
CBCT•latest imaging modality
•high resolution , low radiation dose , fast scanning time , geometrically accurate image
•3D reconstruction , visualization in any direction, in any slice thickness and from which cross sectional slices can be obtained in any direction.
REVIEW OF LITERATURE• Rarely been reported
• Drage and Brown were pioneers in reporting cases of CBCT sialography to identify sialolith (2009)
• in 2010 and 2013 Jadu et al studied effective radiation doses between cbct and plain radiography for sialography and also diagnostic capabilities between the two sialographic imaging modalities
• Nagla’a Abdel-Wahed in 2013 has also done an assessment of the role of cone beam computed sialography in diagnosing salivary gland lesions
Significance• Importance in diagnosis & identification of the
problem
• Rare approach to a regular case
• Modification in treatment planning.
• Assists in sialoendoscopic removal of etiology
CONCLUSION In obstructive salivary gland diseases, CBCT
sialograms can guide precision sialoendoscopic
retrieval thereby providing amazing results
leading to saving patients from more morbid
treatment plans.
REFERENCES1. Drage NA, Brown JE. Cone beam computed sialography of sialoliths. Dentomaxillofac Radiol 2009; 38 : 301-5.
2. Jadu FM, Yaffe MJ, Lam EW. A comparative study of the effective radiation doses from cone beam computed tomography and plain radiography for sialography. Dentomaxillofac Radiol 2010;39:257-263.
3. B Li, X Long,Y Cheng , S Wang. Cone Beam CT sialography of Stafne Bone Cavity. Dentomaxillofacial Radiology 2011: 40: 519-523,2011
4. Jadu FM, Lamm EWN. A comparative study of the diagnostic capabilities of 2D plain radiograph and 3D cone beam CT sialography . Dentomaxillofacial Radiol 2013:42:20110319
5. Nagla’a Abdel-Wahed, Maha E. Amer, Noha Saleh Mahmoud Abo-Taleb. Assessment of the role of cone beam computed sialography in diagnosing salivary gland lesions.Imaging Science in Dentistry 2013; 43 : 17-23•