Lipiodol ultra-fluid – foreign body in the cheek

Abstract

We report a case in which Lipiodol Ultra Fluid (UF) leaked from an iatrogenic perforation of Stensen's canal and constituted a foreign body in the cheek. The distribution of contrast medium near the lower border of the mandible seems unusual. Two years after sialography it was still not being resorbed. No radiological signs of reactive inflammatory changes of soft tissue were observed. We think that the contrast agent arrived beneath the skin but external to the platysma through a simple perforation in either the duct and/or the mucosa.

Radiocontrast Dye Extravasation During Sialography

“…15,16 Reports have included the need for drainage of multiple sterile abscesses that migrated to the skin (Ethiodol), 17 buccal swelling with trismus requiring surgery to remove a lipogranuloma of the parotid and pterygomaxillary space lipogranuloma (Lipiodol), 18 and reports of persistent Lipiodol up to 70 months following ductal extravasation. 19…”

“…15,16 Reports have included the need for drainage of multiple sterile abscesses that migrated to the skin (Ethiodol), 17 buccal swelling with trismus requiring surgery to remove a lipogranuloma of the parotid and pterygomaxillary space lipogranuloma (Lipiodol), 18 and reports of persistent Lipiodol up to 70 months following ductal extravasation. 19 Schortinghuis et al 14 employed the term fausse route to identify the technical error whereby the "syringe is displaced through the main duct into the soft tissue" as they reported to occur in 10 (10/66) patients with 8 identified harboring retained radiocontrast imaged up to 49 months later. The high occurrence of these fausse routes was attributed by these investigators to performance of sialography by inexperienced residents but, as has been common practice, employed rigid instrumentation.…”

Sialoadenitis purulenta submaxilar producida por cuerpo extraño en el conducto de Wharton.

“…Para los estudios de TEM se administra una sustancia de contraste endovenoso, que contiene componentes orgánicos unidos por moléculas de yodo. El yodo es biocompatible y se administra con la finalidad de visualizar estructuras internas normales y patológicas, delimitar masas, cambios inflamatorios e infecciosos en los tejidos blandos y realzar las estructuras vasculares (1,8,9). Las TEM sin sustancia de contraste son muy útiles para la detección de cálculos o cuerpos extraños dentro de las glándulas o de sus conductos (1,7,8).…”

“…Los cuerpos extraños que se introducen en el organismo no siempre son fáciles de remover (3,4), por lo que es fundamental su localización precisa con diversas técnicas imaginológicas. Dependiendo del tipo de material que compone el cuerpo extraño, se emplearán radiografías convencionales, tomografía computarizada, ultrasonido o resonancia magnética, (7,8,9).…”

Retention of lipiodol after parotid gland sialography

“…Because of swelling and inflammation, the mass had to be surgically removed 15 . MACAN et al recently reported a case where lipiodol leaked from an iatrogenic perforation of Stensen's duct, which constituted a foreign body in the cheek 9 . In the present series, no adverse responses were observed after the sialography procedure with lipiodol, not even in the cases of a fausse route.…”