2. SIALOGRAPHY
INTRODUCTION
A radiographic examination of the
salivary glands(PAROTID &
Submandibular GLAND) and ducts
using contrast media
Cannulation of Sublingual gland ducts is
almost impossible
3. INDICATIONS FOR EXAM
Stones (Calculi) sialolithiasis
Obstruction / Strictures
Pain & Swelling (esp when recurrent)
Infection
Masses / Tumors
Changes secondary to trauma
When plain radiography is inconclusive
9. PAROTID GLAND
Largest salivary gland
Lies just below the ZYG arch in front & below
the ear
Parotid duct(Stensons duct) is 5cm long, runs
over the messeter & opens into oral vestibule
opposite 2nd upper molar
10.
11. SUBMANDIBULAR
GLANDS
Extends posteriorly from below
1st lower molar to angle of mandible
Forms part of soft tissues on the medial margin
of the mandible & the hyoid bone
Submandibular duct(whartsons duct ) is 5 cm
long, runs forward ,medially and upward &
opens into mouth on side of frenulum
12. SUB LINGUAL GLANDS
Smallest pair
Located in floor of mouth on the surface of
mylohyoid muscle.
Numerous, small sublingual ducts(ducts of
Rivinus) open into floor of mouth
Ducts may join to form a single(duct of
Bartholin) which empties into the submandibular
duct.
13. SALIVARY GLAND IMAGING
PLAIN RADIOGRAPHS
SIALOGRAPHY
CT(Glandular enlargement , tumors)
RADIONUCLIDE IMAGING(to provide
additional physiological info in cases of
over or under secretion )
MRI
14. SIALOGRAPHY
Radiologic exam of salivary glands and
ducts using contrast media
CT and MRI have largely replaced this
exam
15. PROCEDURE
Preliminary radiographs
Detect conditions that do not require contrast
Give pt secretory stimulant 2 to 3 minutes before
contrast administration
Pt asked to suck on lemon wedge
-Opens duct for easy identification
16. Duct orifice is sprayed with topical anaesthetic
Duct is cannulated, (dialator may be required),
contrast introduced with fluoroscopic guidance
Contrast (oil based or water soluble iodinated)
(conc = 240mg/ml)
Should be injected manually until pt feels
discomfort
Quantity needed may vary btw 1-2 ml
17. Images taken immediately after contrast is
complete
After taking req. images ,pt sucks on a
lemon wedge again to evacuate contrast
Take post-procedure(delayed) radiographs
after 5 minutes to confirm evacuation of
contrast/ demonstrate any residual contrast
18. Dilation with probe of Wharton’s duct of
the submandibular gland.
Cannulation of duct with intravenous
catheter (22 gauge).
24. Sialogram of the right parotid gland showing multiple
punctate glandular collections, 1 mm in diameter,
suggestive of punctate sialectasis
25. Sialoectasis
Sialogram of the parotid gland; lat. projection. In the glandular
parenchyma pools of contrast can be seen. The accessory parotid
gland is also affected (arrow).
27. DACROCYSTOGRAPHY
Introduction
A Radiographic examination of the
Naso lacrimal duct(s) following
administration of a contrast medium to
define the Lacrimal gland & NLD
system anatomically in search of
stenosis or obstruction
30. Anatomy
Tears (lacrimal fluid) are produced by
the lacrimal gland which is located at the
supero-lateral aspect of the orbit.
31. Drainage of the lacrimal fluid is achieved
by the lacrimal canaliculi, lacrimal sac,
and nasolacrimal duct.
The lacrimal fluid drains from the
nasolacrimal duct into the nasal cavity
via the inferior meatus
32.
33.
34.
35.
36. Preparation
Patient identification (3 'C's- correct
patient, correct side, correct procedure)
Completed consent form
No diet restrictions
Collect/review relevant previous imaging
for ease of access prior to procedure
37. TECHNIQUE
The patient lies supine on the
fluoroscopy table with the head in a
reverse occipito-mental position.
Support either side of the patient's head
by immobilization device, particularly if a
subtraction technique is employed.
Select a small field of view and fine
focus
Control images taken
38. TECHNIQUE(cont)
Anaesthetic eye drops are used for
patient comfort
A fine cannula is inserted into the puncta
of each eye, then the eye is closed and
the catheter taped to the patient's cheek
It may be necessary to dilate the puncta
to facilitate insertion of the cannula
39. TECHNIQUE(cont)
After the mask is acquired, commence
injection
Images are taken immediately after
injection
A drainage image can be taken after 15
minutes if considered necessary
41. Bilateral dacrocystogram with subtraction
Normal lacrimal duct on the left
Slower flow of contrast on the right (this may not be pathological- may reflect
note the amount of extravisated contrast medium on the right)
Demonstrated right duct appears normal
Reflux into superior lacrimal canal on right
Perfect X-ray beam collimation
adequate subtraction
42. Bilateral dacrocystogram with subtraction
Excellent X-ray beam collimation
effective subtraction
Reflux into superior lacrimal canal on right
46. Contrast or Subtraction Artifact?
It will not always be clear whether you have demonstrated contrast filling or
subtraction artifact
The consistency of the arrowed structure and its similarity to the other
subtraction artifacts suggests that it is not contrast medium
(Experience Required!!!)
47. Technique Notes
It is normal practice to image both sides
(comparison/increased incidence of bil. abns)
It is preferable to inject both sides at the same time
Collimate the X-ray beam to include the orbits
superiorly and laterally and the maxillary PNS
inferiorly
A sialogram needle (metal or plastic tip) can be
used for cannulation of the puncta (16 gauge or
similar)
48. A focused spotlight can be a useful aid for the
radiologist in locating the lacrimal punctum
Inferior punctum is often easier to canulate
Catheter should not be inserted too far into the
canaliculus
Dacrocystogram protocol may include adjunct
nuclear medicine study