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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•