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

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

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

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

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

9. 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

10. 1. Parotid Gland 2. Submandibular Gland

11. 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

12. 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

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

14. 32 gauge
Sialogram needle
“Rabinov” catheter

15. 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

16. SUBMANDIBULAR GLAND

17. PAROTID GLAND

18. SUBMANDIBULAR GLAND

24. 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

25. 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

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

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

31. THE END
Questions?