Purpose: In pediatric imaging, the risk associated with ionizing radiation is a major concern. Compared to adults, children have increased tissue sensitivity. Cone-beam CT (CBCT) is a recent imaging modality with increased spatial resolution and relatively reduced patient’s radiation dose. Various protocols exist in different CBCT machines, as well as in the same machine, which vary in their radiation dose. The aim of this presentation was to demonstrate our experience in imaging pediatric patient using CBCT.
Materials and methods: We chose a particular case in order to demonstrate imaging of a very young patient with bone pathology, in our imaging center. A 2-years-old girl, which suffers from permanent nasal congestion, breathing difficulties and limited mouth opening due to undiagnosed septic arthritis of the TMJ in the neonatal period. Patient was referred from oral maxillofacial surgery department to perform TMJ-oriented CBCT. For this case, we selected a specific CBCT protocol with low radiation and short duration.
Results: During the CBCT scan, the patient was restrained to the machine chair with special stripes. Management was insignificant. There was no need for sedation or relaxation methods other than patient’s reassurance. The selected protocol was FOV 100X100, half turn, voxel=0.25, 6mA, 90KV, 9s, CTDIw=4.23mGy, DAP=1,120mGycm2. CBCT scan demonstrated abnormal left TMJ structures: with prominent enlargement of condylar head, osteosclerosis and irregularities of both condylar and glenoid bone surfaces and hypodense regional center between them. The radiological were suggestive with left TMJ ankyloses, which correlated to the clinical signs. Furthermore, bilateral ossification of maxillary sinuses and obstruction of sinus’ OMC, condensed mucosa in ethmoid and sphenoid sinuses were found, which were compatible with bilateral maxillary, sphenoid and ethmoidal chronic sinusitis.
Conclusion: This case demonstrates the ability of the CBCT to illustrate bony structure in a relevant valuable appearance without the need for additional pharmacological management. We suggest that CBCT as an imaging modality should be one of the options used in various bone pathologies, especially in pediatric population, where “image friendly” radiation theme, should be implemented.
