Transcript Sialography - El Camino College

Sialography
Spring 2009
DRAFT
Salivary Glands
 Parotid Gland
 Sublingual gland
 Submandibular gland
Parotid Gland
 Largest of the glands
 Consists of flattened
superficial portion and
wedge shaped deep
portion
 Parotid duct
– Conduct saliva from
gland to the mouth
Submandibular Gland
 Irregularly shaped
 Extends posteriorly
from first molar to
almost angle of
mandible
Sublingual Gland
 Smallest pair
 Located at floor of mouth
beneath sublingual fold
 In contact with the
mandible laterally
 Extends posteriorly from
the side of frenulum to
submandibular duct
 Main sublingual duct
opens beside the orifice
of the submandibular duct
Sialography
 Term applied to radiographic exam of
salivary glands
– Only one gland 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
Indications
 Tumors
 Inflammatory lesions
 Determine extent of salivary fistulae
 Localize diverticulae strictures and calculi
 Salivary duct obstruction
Clinical Symptoms
Clinical Symptoms
Sialogram Tray and Catheter
Procedure
1. Obtain preliminary radiographs
•
•
Any condition that is visibe w/o contrast
Optimum technique obtained
2. 2-3 min before procedure give patient
lemon
3. Contrast media injected into main duct
4. After procedure suck on lemon to clear
contrast
5. 10 min after procedure take radiograph
Procedure Differences
1. Most manually inject contrast
– Using cannula or catheter
2. Others use hydrostatic pressure
– Contrast solution barrel plunger removed
– Attached to drip stand
– 28” above pt’s mouth
3. Some inject under fluoro and obtain spot
radiographs
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
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
 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
Tangential
Prone
Tangential Radiograph
 Soft tissue dentisy
 Most of parotid gland
lateral to and clear of
ramus
 Mastoid overlapping
only the upper portion
of parotid gland
 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
Lateral Parotid
Lateral Parotid Radiograph
 Mandibular Rami free
from overlap of c-spine
 Parotid gland SI over
the ramus
 Axiolateral oblique of
mandible can be used
Lateral
Submandibular
 Center IR to inferior
margin of angle
 PT head in true lateral
 CR at inferior margin
of angle
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
Axiolateral Oblique for
Submandibular
Review
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E
B
C
REVIEW
A
B
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C
F
D