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SIALOGRAPHY & THE SALIVARY

GLANDS

A radiographic examination of the salivary glands and ducts

using contrast media

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Injection of contrast media into salivary ducts

OIL BASED CONTRASTSINOGRAPHIN

WATER BASED (IONIC)

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INDICATIONS FOR EXAM

Stones (Calculi) sialolithiasis Obstruction / Strictures Pain & Swelling Infection Masses / Tumors

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CONTRAINDICATIONS:

History of contrast media allergies Parotits (mumps) Severe inflammation of the

salivary ducts

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SIALOGRAPHYSNOPEK – CH 21 & BALLINGER – VOL. 2 CH. 14

 

3 SALIVARY GLANDS –PAROTID – LARGEST – LOCATED BY EAM -

MANDIBULAR RAMUS 

SUBMANDIBULAR / SUBMAXILLARY – 1st molar to Gonion 

SUBLINGUAL – LOCATED BEHIND THE MENTUM under the sublingual fold SMALLEST-

 

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9DUCTS

 Parotid duct – located by maxillary bone– 2nd upper molar) Stensen’s duct PAROTID GLAND

Submandibular Duct – located on end of sublingual ridge to fill submandibular

Wharton’s duct SUBMAXILLARY

Sublingual duct (several small) located alongside submandibular duct to SUBLINGUAL GLAND

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1. Parotid Gland2. Submandibular Gland

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EQUIPMENT NEEDS RAD/ FLUORO ROOM

Mostly replaced now by MRI & CT

Safe and simple but difficult to perform – hard to located and catheterize ducts

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PROCEDURESialogram Tray – Gauze, Sterile towels, Spot Light,

Magnifying glasses, Gloves, Eyewear, mask

LEMONS - cut into wedges Lacrimal Probes Hemostats 5 cc syringes Sialogram Catheter (Rabinov) needles or canulas

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PATIENT PREP 

(No specific prep = oral mouthwash in nice)

Remove any metal – bridgework, tongue piercing

Get History – present to radiologist BEFORE setting up tray

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32 gauge Sialogram needle

“Rabinov” catheter

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RADIOGRAPHS

1. SCOUT FILMS – important to r/o stone for SOFT TISSUE (LIGHT EXPOSURE)

Like mandible series = AP (OML) (Grid ) Both Obliques (Ext. cassette) True Lateral (x-table) (Grid or extremity cassette) Tangential films may be required Mentum or Parotid 2. Give lemon - contast injected 3. SPOT FILMS – taken by DR during fluoro 4. Post films – taken 10 min after injections – check

drainage

16SUBMANDIBULAR GLAND

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PAROTID GLAND

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SUBMANDIBULAR GLAND

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Contrast media Water based iodinated

(ionic or nonionic)

Less dense – absorbed faster –no residue

Conray, Hypaque, Isovue, Renographin (60/76)

Oil-based

More dense, absorb slower –

can cause granuloma (stones)

hard to completely excrete

Ethiodol, Sinographin

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DUCTS

Parotid duct – located by maxillary bone– 2nd upper molar) - PAROTID GLAND Stensen’s duct

Submandibular Duct – located on end of sublingual ridge to fill submandibular / SUBMAXILLARY Wharton’s duct

Sublingual duct (several small) located alongside submandibular duct to SUBLINGUAL GLAND

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Tangential parotid gland, supine position.

CR - “skims” – side of face

Cr is directed along lateral side for unobstructed image of parotid gland

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“True” Lateral Parotid gland is

superimposed Over the

mandibular rami

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THE END

Questions?