SIALOGRAPHY for education of university LEC1.pptx

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1. SIALOGRAPHY LECTURER: MS. UROOJ FATIMA

2. What is Sialography? It is a radiographic examination of the salivary glands by introducing a radio opaque contrast media into the ductile system to evaluate the abnormalities of the salivary glands. During the examination, a small amount of contrast media injected into salivary glands. After the injection of contrast media, several radiographs are taken to evaluate the structural or functional abnormalities of the salivary gland. Sometimes salivary gland stone, lesion, and mass may obstruct the salivary ducts that cause pain and inflammation.

3. ANATOMY The salivary glands are exocrine glands that produce saliva into the mouth. The saliva contain the enzyme amylase which helps in the digestion of food. The salivary glands make saliva and empty it into your mouth through openings called ducts. Saliva helps with swallowing and chewing. It can also help prevent infections from developing in your mouth or throat. There are two types of salivary glands: the major salivary glands the minor salivary glands

4. MAJOR SALIVARY GLAND The major salivary glands are the largest and most important salivary glands. They produce most of the saliva in your mouth. There are three pairs of major salivary glands: the parotid glands, the submandibular glands, and the sublingual glands. 1. THE PAROTID GLAND The parotid glands are the largest salivary glands. They are located just in front of the ears. The saliva produced in these glands is secreted into the mouth from a duct near your upper second molar.

5. 2. SUBMANDIBULAR GLAND About the size of a walnut, the submandibular glands are located below the jaw (below the floor of the mouth) 3. SUBLINGUAL GLAND The sublingual glands are the smallest of the major salivary glands. These almond-shaped structures are located under the floor of the mouth and below either side of the tongue.

6. MINOR SALIVARY GLANDS There are hundreds of minor salivary glands throughout the mouth and the aerodigestive tract. Unlike the major salivary glands, these glands are too small to be seen without a microscope. Most are found in the lining of the lips, the tongue, and the roof of the mouth, as well as inside the cheeks, nose, sinuses, and larynx (voice box). Minor salivary gland tumors are extremely rare. However, they are more likely to be cancerous than benign. Cancers of the minor salivary glands most often begin in the roof of the mouth.

7. INDICATIONS Facial swelling Evaluation of mass lesion in salivary gland Determination of stone in salivary gland ( sialolithiasis ) Pain and swelling in the salivary gland To evaluate the functional disorder of salivary gland Suspected strictures

8. CONTRAINDICATIONS Hypersensitivity to iodine Suspected pregnancy Acute inflammation in salivary gland Severe infection (sialadenitis) Ductile opening Calculus

9. TYPES OF SIALOGRAPHY There are three types: conventional/fluoroscopic sialography (with or without digital subtraction) CT sialography (ultrafast technique) MR sialography

10. EQUIPMENTS Fluoroscopy unit with spot film device/ Image receptor Topical anesthesia Lacrimal duct dilator Contrast media lodinated water-soluble ionic Cannula / cannula sleeve 2cc syringe Lemon- to stimulate secration /saliva Gauze Sterile towel Antiseptic solution Normal saline Mouthwash

11. PATIENT PREPARATION Any radio-opaque artefacts are removed (e.g. false teeth). On the day of examination describe the whole procedure to the patient. Technologist should obtain consent from the patient for permission of procedure. Ask the patient to remove clothing and wear a Hospital gown. An intravenous line is inserted into the patient arm and sedative medication is given through line to make patient relax. Ask the patient to rinse the mouth with mouthwash. The scout film of salivary gland would be taken, to see the pathology before the examination.

12. PROCEDURE The examination is performed in the radiology department Place the patient supine on the X-ray fluoroscopic table with a wide open mouth. The specific salivary duct orifice is anesthetized with topical anesthetic spray. If the duct orifice is not visible lemon juice is given to detect the correct location of the ostium . After detecting the ostium of the salivary gland, the radiologist insert cannula into the salivary gland. Then 1 or 2 ML, Iodinated contrast media is injected manually under the fluoroscopic guidance until the patient feels discomfort. The maximum quantity of contrast media for a single duct is 2 ML. After injection of contrast media, spot films or face radiographs are taken in Anterioposterior , lateral and the oblique projection. The series of radiographs demonstrate the flow of saliva and the location of the obstruction. After completion of the radiographs, the cannula is removed, and instructs the patient to rinse the mouth. Again the lemon juice is given to the patient to evaluate contrast media evacuation from the duct. After the 5 minutes, several radiographs of the mandible are taken for the assessment of residual contrast media.

13. FILMING Immediate - the same views as for the preliminary films are repeated. The occlusal film for the submandibular gland may be omitted, as this is only to demonstrate calculi. Post- secretory - the same views are repeated 5 min after the administration of a sialogogue . The purpose of this is to demonstrate sialectasis . Frontal view is taken with face rotated 5-10 degrees towards the side of study. Lateral view is taken with 15-20 degrees cranial tube tilt. Positioning for submandibular gland Lateral view is taken with 15-20 degrees cranial tube tilt. Films are taken during injection. The catheter is left in place till the adequacy of films is ensured.

14. COMPLICATIONS Ductile rupture of salivary gland Infection at the injection site Inflammation in salivary gland due to contrast media Sialadenitis and abscess Stricture of the ducts. Due to Contrast • Minor reactions (5%): Nausea, vomiting, mild rash, light headache, mild dyspnoea . • Intermediate reactions (1 %): Extensive urticaria , facial oedema , bronchospasm , laryngeal oedema , dyspnoea , hypotension. • Severe reactions (0.05%): Circulatory collapse, pulmonary oedema , severe angina, myocardial infarction, convulsions, coma, cardiac or respiratory arrest.

15. AFTERCARE If sialadenitis occurs after the procedure, it should be treated with antibiotics and anti-inflammatory drugs. Patients will be allowed to leave the examination room after completion of the examination.

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