Case of the Month

An intriguing dental scan and how to interpret it

CBCT Scanner: KaVo OP300

SCAN PROTOCOL: 13cm x 15cm FOV

EFFECTIVE DOSE: 5 mA x 89.8 Kv

CLINICAL DETAILS: Exam performed with CBCT technique, requested by an Otolaryngologist as a check-up of a symptomatic patient for confirmed rhinitis resistant to antihistamine-based cortisone therapy.

RADIOLOGICAL ANALYSIS

Through the CBCT scan, with Axial, Sagittal and Coronal sections, the frontal, maxillary and paranasal sinuses can be examined.

  • Presence of polypoid mucosal thickening affecting the maxillary sinuses particularly on the left with an image of inflammatory aggravation.
  • Left convex deviation of the nasal septum.
    Relative hypertrophy of the right middle turbinate with associated mucosal thickening.
  • Normal appearance of the sphenoid sinuses, the internal and external pterygoid processes.
    The mastoid cells appear with regular pneumatization without findings.
  • Normally pneumatized frontal sinuses. The anterior ethmoidal cells are partially occupied.
  • No alterations of the cribriform plate and erosions of the surrounding skeletal structure are noted.

IN-DEPTH 

The term Paranasal Sinuses Pathology means a large number of pathological conditions, ranging from simple acute sinusitis, to the presence of mono or bilateral new and growing formations of various kinds (benign or malignant).

The most frequent clinical picture is certainly RINOSINUSITE which generally means an inflammation of the paranasal sinuses which can be distinguished by its etiology (allergic, viral, bacterial, mycotic, odontogenic), or on the basis of a temporal criterion (acute, sub-acute, acute-recurrent and chronic or chronic exacerbated).

The inflammatory condition of the paranasal sinuses can get complicated with the creation of NASAL POLYPOSIS represented by the growth of mucous tissue rich in inflammatory cells and water, inside the sinus pneumatic cavities and nasal cavities, forming a more or less transparent fleshy new formations that occupy the respiratory space.

CAUSES

The nasal cavity and sinuses are aligned with the mucous membrane, the tissue that secretes mucus, which is crossed by numerous blood vessels and covered with tiny hairs called cilia. During the inhalation phase, the air travels through this “inlets and cracks” rich surface, where the air is heated and moistened before reaching the lungs, adequately purified of mucus and cilia.

Nasal polyps may form when the mucous membrane is constantly inflamed. This inflammation is generally defined as chronic if the signs and symptoms of inflammation last for more than 12 weeks and the continuous response of the immune system seems to contribute significantly to the formation of these growths. Polyps may develop anywhere in the nasal cavity and sinuses, but the area that’s most at risk is near the sinuses.


SYMPTOMS

The characteristic symptoms caused by nasal polyps are: ageusia, anosmia, headache, nasal congestion, breathing difficulty, facial pain, rhinorrhea and snoring.

The disease can sometimes be asymptomatic, especially when the size of the nasal polyps is negligible.
In severe cases, nasal polyps can give rise to serious complications, such as obstructive sleep apnea, spread of the infection to the eye, meningitis, aneurysms and asthma attacks.

 

DIAGNOSTICS

The most modern radiological systems available, such as CBCT (Cone Beam CT), allow an in-depth evaluation of the clinical state, comparable to traditional systems such as Spiral CT, a method of relevance and prevalence for paranasal sinuses and maxillofacial exams.

As we have already seen, the CBCT method has many advantages, from the reduction of radiation dose to the patient to the faster scanning times, even when compared to traditional CT. Furthermore, being a dental radiology dedicated device, CBCT makes it possible to obtain multiple evaluations of the scanned anatomical areas, giving an excellent perspective both on Implantological and Surgical aspects through a very good discrimination between the examined tissues.

More and more Specialists in the Dental and Maxillofacial Surgery sectors understand the importance of relying on new, cutting-edge techniques in order to obtain excellent diagnostic results and while safeguarding the patient’s health. For this reason, DentQ provides its centers with the most innovative machines dedicated to Dental Radiology, guaranteeing excellent results and excellent performance.

 

Elaborated by Dr. Lucisano Francesco – Lead Radiographer DentQ Italy