1. Sialography
Spring 2011
FINAL

2. Salivary Glands

3. Parotid Gland _______ of the glands
Consists of ________ superficial portion
___________ shaped deep portion
Parotid duct
___________________
Superficial portion lies immediately anterior to external ear and extends ineriorly to ramus and posteriorly to mastiod process.
Deep portion or retromandibular portion extends medially toward the pharynx.

4. Submandibular Gland ____________ shaped
Extends posteriorly from ________molar to almost _________ of mandible

5. Sublingual Gland _________________pair
Located at floor of mouth beneath _____________
In contact with the mandible laterally
Extends posteriorly from the side of _________ to _________________duct
Main sublingual duct opens beside the orifice of the submandibular duct

6. Sialography Term applied to radiographic exam of salivary glands
Only __________________done at a time
CT and MRI have largely replaced this exam for
Salivary stone or lesion is suspected
Used when a definitive diagnosis is necessary for a problem with one of the salivary ducts
One gland is done at a time because they are in close proximity to each other and paired.

7. Indications ________________________ _________________________
ran·u·la (rny-l) n. A cyst on the underside of the tongue or the mouth floor caused by an obstructed salivary gland duct. Also called ptyalocele, sialocele, sublingual cyst.

8. Tumors of Salivary Glands

9. Ranula
ran·u·la (rny-l) n. A cyst on the underside of the tongue or the mouth floor caused by an obstructed salivary gland duct. Also called ptyalocele, sialocele, sublingual cyst.

10. Infections

11. Strictures

12. Salivary Gland Calculi

13. Salivary Stones

14. Sialogram Tray and supplies
Rabinov catheter

15. Contrast Media ________________________ When tomography may be used
Contraindicated if there is a chance of stones
Stones and strictures
1-2ml

16. Procedure Obtain preliminary radiographs
Any condition that is visibe w/o contrast
Optimum technique obtained
_____ before procedure give patient ____
Contrast media injected into main duct
After procedure _______ to clear contrast
_____min after procedure take radiograph

17. Procedure Differences
Most manually inject contrast
________________________
Others use hydrostatic pressure
__________________________________
Some inject under fluoro and obtain spot radiographs

18. Radiation Safety Have shields for PT’s, DR and yourself
Question LMP and the possibility of being pregnant
Use cardinal rules
Time
Distance
Shielding
ALARA
Use pulse if possible
Save the last image on screen when possible

19. Tangential Supine
Rotate pt head toward side being examined so that parotid gland is perp to plane of IR
Rest head on occipitus
Center IR to parotid area
Mandibular ramus parallel with longitudinal axis of the IR
Fill mouth with air and puff cheeks
CR perp to plane of IR along lateral surface of the ramus

20. Tangential Prone Rotate pt’s head away from side being examined
Rest pt’s head on chin
Forehead and nose if parotid duct does not need to be seenRotate pt head toward side being examined so that parotid gland is perp to plane of IR
Center IR to parotid area
Mandibular ramus parallel with longitudinal axis of the IR
Fill mouth with air and puff cheeks
CR perp to plane of IR along lateral surface of the ramus

21. Tangential Radiograph
Soft tissue dentisy
Most of parotid gland lateral to and clear of ramus
Mastoid overlapping only the upper portion of parotid gland

22. Lateral Parotid Affected side close to the IR
Extend mandible to clear c-spine
Center IR 1” superior to angle
Head 15 degrees from MSP toward IR
CR 1” superior to angle
Oblique often used as well

23. Lateral Parotid Radiograph
Mandibular Rami free from overlap of c-spine
Parotid gland SI over the ramus
Axiolateral oblique of mandible can be used
Sialogram of parotid with normal ductal findings. Digital subtraction shows better delineation of the ductal morphology and enables visualization of the intraductal branches. Because of its normal small size, the stenson duct shows some focal signal voids in the MRI of the same PT.
A= MRI
B+ sialogram with digital subtraction

24. Lateral Submandibular
Center IR to inferior margin of angle
PT head in true lateral
CR at inferior margin of angle

25. Lateral Submandibular Radiograph and Lateral oblique
Rami free from overlap of C-spine
SI mandibular rami if no angualtion is used
Axiolateral oblique of mandible for better demonstration

26. Axiolateral Oblique for Submandibular

27. Sialograms