the things you discover with CBCT

If you haven't visited this blog in a few days, I highly recommend going back and reading yesterday's post before you continue.  This post is an update about something I first mentioned yesterday.

After seeing the patient with the ridiculous swelling on his face yesterday, Mindi and I were quite curious as to whatever became of him and what sort of treatment he received.  We ran into the doctor that had been working in the screening area yesterday and initially encouraged us to go take a look at the patient's face.  Turns out that the patient did not have an abscessed tooth.  It was cancer.  He had two rather large, malignant tumors.

We decided to go speak with the radiology professor to take a look at the patient's x-rays.  They had taken a cone beam CT.  (This is a relatively new type of imaging system in dentistry.  Regular CTs have been commonly used in medicine since the 1980s.  Only in the past 10 years have they developed a variation that works well in dentistry.)  This type of radiographic image allows us to visualize the entire head in 3 dimensions.  A small sample of information from a CBCT would look a little something like this.

This is NOT from a patient at our clinic.  Thank you google image search for posting random CBCT scans.

When I saw the CT scan, I was shocked.  The tumors had completely eaten away and destroyed the patient's mandible (jaw bone).  A large portion of the bone was just gone.  Disappeared.  In its place was a large amount of soft tissue, which had completely taken over huge parts of his face and pushed some remaining areas of bone out of the proper position.  On the CBCT scan, it was amazing because you could see both the missing and displaced portions of bone surrounded by the outline of his face and the distortion of his skin and muscles caused by the tumor.  Medical imaging has certainly come a very log way; it is truly amazing the things that you can see with a 3D CBCT.  I have never seen anything like it. We completely grilled the professor with questions about the case.  Where did the bone go?  How could you tell it was malignant simply by looking at the x-ray?  How did this not cause pain until now?  

It was truly fascinating and deeply saddening at the same time.  There is a high probability that the tumor is a metastasis from cancer at another site, which means the prognosis is poor.  Right now, I'm sure the patient is at the hospital undergoing massive tests.  At minimum they will do a biopsy of the facial tumors and a body scan to look for more cancer.  Eventually, to treat the cancer, the patient will need to have his jaw resected. (This is a "polite" way of saying that they will cut off a large portion of his face.  To put it in perspective, Roger Ebert had a jaw resection.)  It truly is a sad, sad situation.