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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

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