SialographySialography

Spring 2009Spring 2009

DRAFTDRAFT

Salivary GlandsSalivary Glands

Parotid GlandParotid Gland

Sublingual glandSublingual gland

Submandibular glandSubmandibular gland

Parotid GlandParotid Gland

Largest of the glandsLargest of the glands

Consists of flattened Consists of flattened superficial portion and superficial portion and wedge shaped deep wedge shaped deep portionportion

Parotid ductParotid duct– Conduct saliva from Conduct saliva from

gland to the mouthgland to the mouth

Submandibular GlandSubmandibular Gland

Irregularly shapedIrregularly shaped

Extends posteriorly Extends posteriorly from first molar to from first molar to almost angle of almost angle of mandiblemandible

Sublingual GlandSublingual Gland Smallest pairSmallest pair

Located at floor of mouth Located at floor of mouth beneath sublingual foldbeneath sublingual fold

In contact with the In contact with the mandible laterallymandible laterally

Extends posteriorly from Extends posteriorly from the side of frenulum to the side of frenulum to submandibular ductsubmandibular duct

Main sublingual duct Main sublingual duct opens beside the orifice opens beside the orifice of the submandibular ductof the submandibular duct

SialographySialography

Term applied to radiographic exam of Term applied to radiographic exam of salivary glands salivary glands – Only one gland done at a timeOnly one gland done at a time

– CT and MRI have largely replaced this exam forCT and MRI have largely replaced this exam for Salivary stone or lesion is suspectedSalivary stone or lesion is suspected

– Used when a definitive diagnosis is necessary Used when a definitive diagnosis is necessary for a problem with one of the salivary ductsfor a problem with one of the salivary ducts

Indications Indications TumorsTumors

Inflammatory lesionsInflammatory lesions

Determine extent of salivary fistulaeDetermine extent of salivary fistulae

Localize diverticulae strictures and calculiLocalize diverticulae strictures and calculi

Salivary duct obstructionSalivary duct obstruction

Clinical Symptoms Clinical Symptoms

Clinical SymptomsClinical Symptoms

Sialogram Tray and CatheterSialogram Tray and Catheter

ProcedureProcedure

1.1. Obtain preliminary radiographsObtain preliminary radiographs• Any condition that is visibe w/o contrastAny condition that is visibe w/o contrast• Optimum technique obtainedOptimum technique obtained

2.2. 2-3 min before procedure give patient 2-3 min before procedure give patient lemonlemon

3.3. Contrast media injected into main ductContrast media injected into main duct4.4. After procedure suck on lemon to clear After procedure suck on lemon to clear

contrastcontrast5.5. 10 min after procedure take radiograph10 min after procedure take radiograph

Procedure DifferencesProcedure Differences

1.1. Most manually inject contrastMost manually inject contrast– Using cannula or catheterUsing cannula or catheter

2.2. Others use hydrostatic pressureOthers use hydrostatic pressure– Contrast solution barrel plunger removedContrast solution barrel plunger removed– Attached to drip standAttached to drip stand– 28” above pt’s mouth28” above pt’s mouth

3.3. Some inject under fluoro and obtain spot Some inject under fluoro and obtain spot radiographsradiographs

Radiation SafetyRadiation Safety

Have shields for PT’s, DR and yourselfHave shields for PT’s, DR and yourself

Question LMP and the possibility of being pregnantQuestion LMP and the possibility of being pregnant

Use cardinal rulesUse cardinal rules– TimeTime– DistanceDistance– ShieldingShielding

ALARAALARA– Use pulse if possibleUse pulse if possible– Save the last image on screen when possibleSave the last image on screen when possible

Tangential SupineTangential Supine

Rotate pt head toward side being Rotate pt head toward side being examined so that parotid gland is examined so that parotid gland is perp to plane of IRperp to plane of IR

Rest head on occipitusRest head on occipitus

Center IR to parotid areaCenter IR to parotid area

Mandibular ramus parallel with Mandibular ramus parallel with longitudinal axis of the IRlongitudinal axis of the IR

Fill mouth with air and puff cheeksFill mouth with air and puff cheeks

CR perp to plane of IR along lateral CR perp to plane of IR along lateral surface of the ramussurface of the ramus

TangentialTangential Prone Prone

Rotate pt’s head away from Rotate pt’s head away from side being examinedside being examined

Rest pt’s head on chinRest pt’s head on chin– Forehead and nose if parotid Forehead and nose if parotid

duct does not need to be duct does not need to be seenRotate pt head toward seenRotate pt head toward side being examined so that side being examined so that parotid gland is perp to plane parotid gland is perp to plane of IRof IR

Center IR to parotid areaCenter IR to parotid area

Mandibular ramus parallel with Mandibular ramus parallel with longitudinal axis of the IRlongitudinal axis of the IR

Fill mouth with air and puff Fill mouth with air and puff cheekscheeks

CR perp to plane of IR along CR perp to plane of IR along lateral surface of the ramuslateral surface of the ramus

Tangential RadiographTangential Radiograph

Soft tissue dentisySoft tissue dentisy

Most of parotid gland Most of parotid gland lateral to and clear of lateral to and clear of ramusramus

Mastoid overlapping Mastoid overlapping only the upper portion only the upper portion of parotid glandof parotid gland

Lateral ParotidLateral Parotid Affected side close to the Affected side close to the

IRIR

Extend mandible to clear Extend mandible to clear c-spinec-spine

Center IR 1” superior to Center IR 1” superior to angleangle

Head 15 degrees from Head 15 degrees from MSP toward IRMSP toward IR

CR 1” superior to angleCR 1” superior to angle

Oblique often used as Oblique often used as wellwell

Lateral Parotid RadiographLateral Parotid Radiograph

Mandibular Rami free Mandibular Rami free from overlap of c-spinefrom overlap of c-spine

Parotid gland SI over Parotid gland SI over the ramusthe ramus

Axiolateral oblique of Axiolateral oblique of mandible can be usedmandible can be used

LateralLateralSubmandibularSubmandibular

Center IR to inferior Center IR to inferior margin of anglemargin of angle

PT head in true lateralPT head in true lateral

CR at inferior margin CR at inferior margin of angleof angle

Lateral Submandibular Radiograph Lateral Submandibular Radiograph and Lateral obliqueand Lateral oblique

Rami free from overlap Rami free from overlap of C-spineof C-spine

SI mandibular rami if SI mandibular rami if no angualtion is usedno angualtion is used

Axiolateral oblique of Axiolateral oblique of mandible for better mandible for better demonstrationdemonstration

Axiolateral Oblique for Axiolateral Oblique for SubmandibularSubmandibular

ReviewReview

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REVIEWREVIEW

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