Salivary ducts
- Parotid duct- located by maxillary bone, also known as Stensen's duct
- Submandibular duct- located on the edge of sublingual ridge
- Sublingual duct- several small ducts located alongside the sublingual gland
Equipment
Sialogram tray
- Gauze, sterile towels, spotlight, magnifying glasses, gloves, eyewear, mask
- Lemons- cut into wedges
- Lacrimal probes
- 5cc syringes
- Hemostats
- Sialogram catheters (Rabinov) needles or cannulas
Patient Prep- (no specific prep)
- rinse with oral mouth wash
- remove any metal- bridgework, tongue piercing
- proper patient history- present to radiologist before setting up tray
Procedure
- sialogram usually takes about 30 min
- sedation may be necessary for patients who are unable to remain calm or stay still
- patient in supine position
- after scout film (if necessary) a small catheter is placed into salivary duct
- contrast is then injected into the salivary duct
- an x ray is taken to better visualize any obstructions or strictures
- lemon wedges or lemon juice will be given to patient and additional images may be taken to see the flow of saliva into the mouth
- the lemon juice also aids in the secretion of contrast that may be left in the glands or ducts
Radiographs
- scout film- may or may not be taken depending on pathology
- AP- supine or erect; chin depressed toward chest- CR directed perpendicular to midpoint of IR
- lateral- seated erect or semiprone; head in true lateral position (MSP parallel to IR)- CR directed perpendicular to midpoint of IR
- lateral (modified)- seated erect or semiprone; head in modified lateral position (MSP rotated forward 15 degrees)- CR directed perpendicular to midpoint of IR
- oblique- semiprone or seated erect; head in true lateral position (MSP parallel to IR)- CR tube angled 25 degrees cephalad to enter inferior to and just behind angle of mandible
Pathology
- Parotitis- inflammation of parotid gland (mumps)
- Sialoliths- (salivary stones) calcified mass within a salivary gland
- Sialactesis- dilation of the ducts of the salivary glands, can be congenital
- Salivary tumors- salivary mass, most common in the parotid gland. In most cases painless and benign but can be malignant ans cancerous
Sialography
Jose Fernandez
David Contreras
Major salivary glands
Parotid- largest, located by EAM, mandibular ramus
Submandibular- located between 1st molar to gonion
Sublingual- smallest, located behind the mentum, under the sublingual fold
Sialography
The radiographic examination of salivary glands and ducts using contrast media.
contraindications
Contrast Media
- history of allergies to contrast media
- severe inflammation of salivary ducts
- pregnancy
Water based
- less dense
- absorbed faster
- no residue
- Conray, hypaque, isovue, renographin
Oil based
- more dense
- absorbed slower
- can cause granuloma (stones)
- hard for body to completely excrete
- ethiodol, sinographin
Thank You!
indications for exam
calculi (stones)
obstruction or strictures
pain, swelling
infections
masses or tumors