British Journal of Radiology (2004) 77, 1040-1041
© 2004 British Institute of Radiology
doi: 10.1259/bjr/76963558
Lipiodol UF retention in dental sialography
D Özdemir, DDS1,
N T Polat, DDS, PhD1 and
S Polat, DDS, PhD2
1 Department of Prosthodontics and 2 Department of Oral and Maxillofacial Surgery, Cumhuriyet University, Faculty of Dentistry, 58140, Sivas, Turkey
Correspondence: Dr Serkan Polat
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Abstract
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Lipiodol is a lipid based contrast medium and is very useful in sialography. It gives very fine images and clearly shows the details of the gland. It is viscous and has a relatively high iodine content. However, lipiodol UF drops sometimes remain in the salivary gland and in the adjacent tissues for a long time and may cause irritation. We report a case where lipiodol UF leaked from Stensen's duct and was not resorbed after a period of 70 months.
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Introduction
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Sialography was first described by Arcelin in 1913 and is still a widely performed procedure [1]. Oil based contrast media such as lipiodol UF are commonly used in sialography. They are considered by some clinicians to be unsuitable for routine usage in sialography, due to their invasiveness and poor tolerance especially in Sjögren's Syndrome patients [2]. The following report is of a case where lipiodol UF leaked out of Stensen's canal and was not resorbed.
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Case report
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A 23-year-old woman visited the dental clinic on May 2001 with a complaint of dental pain. There was no apparent swelling, fever or fistula on clinical examination.
The periapical radiograph of the upper left 1st premolar (24) showed a radiolucent area at the apex. There were small spherical radiopacities in the periapical region of teeth distal to 24 (Figure 1
). On checking the clinical history with the patient sialography had been performed using Lipiodol® Ultra-Fluide (Tamaç, Turkey) to investigate the cause of a painless swelling 3 years previously in the region of left masseter. After history taking, clinical examination and sialography the patient was diagnosed as having muscle hypertrophy due to a one-sided chewing habit. Unfortunately none of the prior radiographs were available on this occasion. On this occasion an ortopantomogram (OPT) was taken and demonstrated radiopacities in the vicinity of Stensen's duct on the left (Figure 2).
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Figure 1. Periapical radiography taken 39 months post sialography (before root canal filling replacement).
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The root canal filling previously applied to tooth number 24 was replaced. The patient's pain subsequently resolved.
Since there were no symptoms or clinical findings relating to the lipiodol UF retention, regular follow-up radiological examinations were suggested. The results of these are as follows.
On the OPT taken 53 months post sialography there was no significant change in the radiopacities. On the CT (Figure 3) taken 59 months post sialography the contrast medium that had leaked out of the duct can easily be observed. On the OPT (Figure 4) taken 70 months post sialography the number and size of radiopacities were slightly decreased. On this OPT it was noticed there was a radiopacity in the left angulus region, which may be due to a sialolith in the submandibular gland duct (Warton's duct). Although there were no complaints related to this lesion in the patient, we planned to perform sialography using a water-based contrast medium, but the patient refused because of her previous sialography experience.
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Discussion
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After the introduction of water-based contrast fluids in the 1950s, these fluids have been increasingly advocated for use in sialography because they are better tolerated by the human body [3]. Water-soluble media are rapidly removed from tissues and have been found to cause fewer adverse reactions [1, 4, 5]. Most of the water-soluble media show almost complete resolution in 5 min [1, 6]. Because of this the use of a water-soluble medium requires that radiographs be obtained as soon as possible after introduction of the agent [6].
Lipid-based contrast media produce good images in sialography [1, 6]. Kalk et al [3] defend the use of a lipid based contrast media such as lipiodol UF which has a high viscosity and iodine concentration [7].
Furthermore, in a comparative study, it appears that there is no significant difference in the side effects between lipid based and water based contrast media [3].
However, if a glandular duct is excessively filled, contrast media may leak from the duct and stay in the tissues for a long time (up to 7 days) without being resorbed [6]. In our case, significant resorption was not seen for a much longer period (approximately 6 years) of a lipid based contrast medium that had leaked from a duct.
Extensive destruction of the parenchyma and the formation of contrast medium vacuoles [6], chronic inflammation [8] and formation of lipogranuloma [4] have been observed after glandular overfilling with lipiodol UF.
Furthermore, one study [1] suggested that complaints of swelling occurred in 53% and of pain in of 70% in patients injected with lipiodol UF. Therefore, many practitioners do not recommend its routine use [3].
It is probably best to avoid the use of a lipid based contrast medium for sialography, but it used, glandular overfilling should be avoided.
Received for publication May 6, 2003.
Revision received March 23, 2004.
Accepted for publication May 19, 2004.
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References
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- Daniels TE, Fox PC. Salivary and oral components of Sjögren's syndrome. Rheum Dis Clin North Am 1992;18:571–89.[Medline]
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- Shigetaka Y, Masatsugu S, Yoshikuni F, Yoshihiro T. Parotid and pterygomaxillary lipogranuloma caused by oil-based contrast medium used for sialography: report of a case. J Oral Maxillofac Surg 1996;54:350–3.[Medline]
- Guang-yan Y, Zhao-ju Z, Yi-sheng W. Computed tomography of parotid masses. Chin Med J 1989;102:243–50.[Medline]
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- Manashil GB. Sialography-a simple procedure. Med Radiogr Photogr 1976;52:34–42.[Medline]
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171 - 174.
[Abstract]
[Full Text]
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Abstract
Introduction
