SIALOGRAPHY & THE SALIVARY GLANDS

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Presentation transcript:

SIALOGRAPHY & THE SALIVARY GLANDS A radiographic examination of the salivary glands and ducts using contrast media

Injection of contrast media into salivary ducts OIL BASED CONTRAST SINOGRAPHIN WATER BASED (IONIC)

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

CONTRAINDICATIONS: History of contrast media allergies Parotits (mumps) Severe inflammation of the salivary ducts

SNOPEK – CH 21 & BALLINGER – VOL. 2 CH. 14 SIALOGRAPHY SNOPEK – 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-

DUCTS Parotid duct – Submandibular Duct – located on end of 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

1. Parotid Gland 2. Submandibular Gland

Mostly replaced now by MRI & CT EQUIPMENT NEEDS RAD/ FLUORO ROOM Safe and simple but difficult to perform – hard to located and catheterize ducts Mostly replaced now by MRI & CT

PROCEDURE Sialogram 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

PATIENT PREP (No specific prep = oral mouthwash in nice) Remove any metal – bridgework, tongue piercing Get History – present to radiologist BEFORE setting up tray

32 gauge Sialogram needle “Rabinov” catheter

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

SUBMANDIBULAR GLAND

PAROTID GLAND

SUBMANDIBULAR GLAND

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

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

Tangential parotid gland, supine position. CR - “skims” – side of face Cr is directed along lateral side for unobstructed image of parotid gland

“True” Lateral Parotid gland is superimposed Over the mandibular rami

THE END Questions?