Efficacy of Beam Computer Tomography (CBCT) in Diagnosis of

Disease Lesions in Paranasal Sinuses

Edward Kijak

Department of Prosthetic Dentistry, Faculty of Medicine and Dentistry, Pomeranian Medical University,

Rybacka 1, 70-204 Szczecin, Poland

Keywords: Volumetric Tomography, TMJ Dysfunction, Sinus Disease.

Abstract: Different techniques of X-ray imaging often confirm the suspected diagnosis, but not infrequently redirect the

diagnostic process in other areas. A modern ultrahigh-resolution volumetric tomography, called a cone beam

computed tomography (CBCT) also, is one of the most innovative technique and able to visualise these ana-

tomical structures that conventional techniques are not. A differential diagnosis of TMJ dysfunction is partic-

ularly difficult due to the quantity of factors that influence the generation of symptoms. Laying on of symp-

toms that mask the main disease means that frequently, without additional examinations, it is not possible, in

an univocal way, to describe the type and extent of this disease. The study assesses the usefulness of volu-

metric tomography ( CBCT ) in an accidental detecting in the maxillary lesions sinuses of a temporomandib-

ular joints dysfunction. The analysis was performed on the base of 249 studies of volumetric tomography.

The face part of the skull was made by the a camera with a large imaging field (FOV) 17 cm x 23 cm i-CAT

Next Generation (ISI). It was found that a significant number of patients (almost half) with TMD have the

changes in paranasal sinuses. Based on the observations, the relevance and legitimacy of tested technique

helping in stomatognathic system diseases diagnosis was analysed.

1 INTRODUCTION

Different X-ray imaging techniques used in dentistry

have different accuracy of image of anatomical de-

tails of a diagnosed area (Różyło-Kalinowska, 2011).

The diagnostic value of conventional static and func-

tional panoramic imaging (including digital) largely

depends on human factors, mainly the skills and con-

sistency of a radiologist who performs the examina-

tion. An incorrect positioning of the examined pa-

tient, an incorrect angle of incidence during exposure

to radiation and instability of above factors can have

a negative influence on a detailed, correct analysis. In

addition, the conventional radiographic techniques

provide a two-dimensional back projection image

with overlapping various anatomical details. A tech-

nological progress in this area forces physicians to

change their approach to diagnostic algorithms.

Radiological examination using cone beam com-

puted tomography (CBTC) allows for the imaging of

hard and soft anatomical structures in three projec-

tions. CBTC provides an undistorted real-size image

allowing for accurate measurements. The accuracy of

images reconstructed by volumetric tomography is so

superior that all anatomical details in the area under

investigation do not require additional testing; a

three-dimensional image reconstruction gives a detail

insight into the topography of skeletal structures (Ró-

żyło-Kalinowska, 2009, Szkutnik, 2001). CBCT is

used also successfully in laryngology. Because of the

accuracy of this imaging technique it is possible to

diagnose and plan treatment for paranasal sinusitis

simultaneously. Importantly, the technique is safe for

patients since the dose of ionizing radiation is re-

duced. The average dose of radiation in CBCT is in

the range of 20-650 μSv depending on the size of an

imaging field and an image resolution (Jager, 2001,

Kijak, 2012, Loubele M, 2009, Bargan, 2010, Anjos,

2012) and it is about 20-30-fold lower than in con-

ventional multi-slice CT CBCT is increasingly being

used for diagnosis of patients with suspected dysfunc-

tion of the tempormandibular joints (TMD), suffering

from pain, located in the vicinity of the front of the

ear and middle part of the face. Differential diagnosis

of TMJ dysfunction is particularly difficult due to the

quantity of factors that could infuence the generation

of symptoms. The laying on of symptoms that mask

the basic disease means that frequently, without

148

Kijak, E.

Efﬁcacy of Beam Computer Tomography (CBCT) in Diagnosis of Disease Lesions in Paranasal Sinuses.

DOI: 10.5220/0006657101480152

In Proceedings of the 11th International Joint Conference on Biomedical Engineering Systems and Technologies (BIOSTEC 2018) - Volume 2: BIOIMAGING, pages 148-152

ISBN: 978-989-758-278-3

additional examinations, it is not possible, in a univo-

cal way, to describe the type and extent of the disease.

Very often, the result of specialized laryngologi-

cal examination is negative and the patient returns to

a dentist. With non-specific subjective symptoms,

limited only to painful problems, the study of volu-

metric tomography leads to accidental detection of le-

sions in the maxillary sinuses. Often the patient is re-

ferred to a laryngologist or maxillofacial surgeon. It

was provided that these are not individual cases.

The aim of the study was the analysis of imagines

obtained by CBCT with a medium and large imaging

field in diagnosis of the lesions in paranasal sinuses

and commissioned causing dysfunction of temporo-

mandibular joints.

2 MATERIALS AND METHODS

2.1 Materials

The material consisted of 249 studies of volumetric

tomography. The face part of the skull was made by

a the camera with a large imaging field (FOV) 17 cm

x 23 cm i-CAT Next Generation (ISI).

Figure 1: Size and gender of the study group.

A total of 249 subjects (182 F and 67 M) aged 13

to 88 years were enrolled, who reported to the Depart-

ment of Prosthetic Dentistry Pomeranian Medical

University due to TMD-related ailments.

Figure 2: Age of tested people.

2.2 Methods

An important feature of the device is a short scanning

time from 5 seconds at low volumes up to 27 seconds

at the largest imaging field that can be adjusted by

varying the test resolution in the range of 0.125 to 0.4.

Patient’ sitting position with correctly setting head

minimizes the presence of motion artefacts. Using

Quantum IQ software, soft-tissue imagines were ob-

tained that were much better than other types of ima-

gines (Photo 1). The exposure parameters were 110

kV and 5 mAs. The exposure time was 14 seconds

and 0.3 voxel resolution was used the most com-

monly.

Photo 1: CBCT - large imaging field.

3 RESULTS

Volumetric tomography allows the diagnosis of even

the smallest pathological lesions located in the max-

illary sinuses (Photo 2) beginning from the most com-

monly diagnosed inflammatory conditions (edema)

of the sinus lining (Photo 3), through various types

and extent of hyperplasia (Photo 4) until the total air

loss of one of the bays – Photo 5.

Photo 2: Limited pathological change in the bottom of the

left maxillary sinus.

200

400

F + M F M

249

182

Study group - sex

40,53

100

F M

Group structure - age

MIN MAX MID

Efﬁcacy of Beam Computer Tomography (CBCT) in Diagnosis of Disease Lesions in Paranasal Sinuses

149

Photo 3: Oedematous mucosa of alveolar recess of the two

maxillary sinuses.

Photo 4: The disease process includes the entire light of the

right maxillary sinus.

Photo 5: The disease process includes the entire light of the

right maxillary sinus.

Figure 3: The incidence of lesions disease of maxillary si-

nuses detected by CBCT.

The studies have shown that the incidence of le-

sions is relatively high at almost 50%.

Photo 6: The root appex of the teeth 25, 26, 27 in the max-

illary sinus.

From the point of view of the therapeutic possibil-

ities available to the dentist, we are interested in teeth

related changes that are located in the alveolar recess

of the maxillary sinuses: roots in the sinuses (Photo

6),pushed through the endodontic treatment of the

material (Photo 7), and unerupted tooth located in the

immediate vicinity of the bay.

Photo 7: The material stuffed as a result of endodontic treat-

ment in the bottom of the left sinus.

CBCT and the capabilities of computer programs

that support this imaging method greatly extend the

249

114

135

50%

100%

Number of studies No changes disease

Study with changes

45.78%

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150

potential for the effective topological evaluation of

pathological lesions "accidentally" detected. Even

when they are diagnosed in a traditional pantomo-

graphic examination, a lesion derived from the alve-

olar recess as observed in a volumetric study, the di-

agnosis has to be change.

Photo 8: Disease lesion in the right maxillary sinus cavity -

image in volumetric tomography.

Photo 8 shows a classic pantomographic imaging

performed by CBTC, which was helpful in the diag-

nosis of a polyp lesion that originates from the alveo-

lar sinus of the right maxillary sinus. Further evalua-

tion of the same image diametrically changed our

view of this pathology (Photo 9). The disease is not

associated with the teeth because it is clearly visible

in the axial projection that it originates from the an-

tero-medial walls of the sinus.

Photo 9: The same lesion (Figure 8) - CBCT image in axial

projection.

The precise identification of the source of a dis-

ease process directs the further course of diagnostic

and therapeutic procedures. Random detected patho-

logical changes are not necessarily a direct cause of

ailments. It may reflect an asymptomatic condition

that is accompanied by a main disease. This should

not, however, slow down the doctor from further

diagnosis, which is becoming more targeted and eas-

ier. The disease lesions detected in both bays in the

study population recorded in more than one-fifth of

cases.

Figure 4: Disease lesions in both sinuses.

The CBCT images obtained, evaluated in a multi-

faceted image reconstruction, allow for the precise

definition of a disease process extention. Frequently,

a study of volumetric tomography, with a large field

of imaging, is a diagnostic procedure that is suffi-

ciently adequate to an implement proper treatment in

the therapeutic process.

4 DISCUSSION

Detection of various pathological processes occurring

in the sinus of the paranasal sinuses with the diagnosis

of dysfunction of the chewing organ is not uncommon

(Phothikhun, 2012). The accuracy of CBCT studies is

so significant that it is impossible to compare such

tests with traditional and routine radiology proce-

dures used in dentistry (Różyło- Kalinowska, 2009,

2011). The ability to choose the size of the imaging

(cone), gives the possibility of the radiological pro-

tection by lowering the dose of ionizing radiation. In

the case of functional abnormalities of the chewing

organs, the multitude of anatomical and physiological

details cause a multi-faceted pain. Symptoms often

correlate with the clinical picture of the stomatog-

nathic system functional evaluation (Anjos, 2012).

Often, a dentist dealing with the problem faces a di-

lemma: adhere to radiological protection rules and

commission CBCT examinations limited to the tem-

poral and temporal joints, or extend the examination

to adjoining areas. The choice is difficult especially

in the absence of pathognomonic symptoms. Radio-

logical protection should be superior. Adherence to

the principles developed by the European Academy

of DentoMaxilloFacial Radiology (EADMFR)

should not, however, limit diagnostic possibilities

Zmiany w obu zatokach

(55)

(249)

22.43%

77.56%

Efﬁcacy of Beam Computer Tomography (CBCT) in Diagnosis of Disease Lesions in Paranasal Sinuses

151

(Scarfe, 2008)). In case of maxillofacial dysfunction

there are unfortunately no uniform procedures. The

difference in dose of ionizing radiation between pan-

tomographic imaging supplemented with conven-

tional sinus radiographs and CBCT with medium to

large imaging with modern imaging is not as signifi-

cant (Loubbele, 2008). The benefit of the evaluation

of paranasal sinuses in volumetric thomography is un-

doubtedly greater (Rege, 2012), so it should account

for the balance of gains and losses.

5 CONCLUSIONS

Volumetric Tomography is a valuable x-ray imaging

technique useful in the differential diagnosis of TM

dysfunction. The laying on of symptoms that mask

the main disease means that frequently, without addi-

tional examinations, it is not possible, in a univocal

way, to describe the type and extent of a disease. The

diagnosis of functional disorders of the muscular of

the chewing systems should take into account the dis-

ease lesions in the maxillary sinus. Detection of vari-

ous pathological processes occurring in the sinuses

paranasal, during of the diagnosis of dysfunction of

the chewing organ is not uncommon.

Limiting the imaging field in a volumetric tomog-

raphy study significantly reduces the diagnostic po-

tential of the study. The advantage of the possibility

of additional evaluation of the collateral sinuses and

the diagnosis of the underlying disease process is un-

doubtedly greater.

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