SIALOGRAPHY.pptx

SIALOGRAPHY IS DESCRIBED IN DETAIL IN THIS PPT.
CONTENT TAKEN FROM MULTIPLE BOOKS AND JOURNALS.

1. SIALOGRAPHY Mr. Rohit Bansal Assistant Professor (Radio-Physics)

2. 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 There are three pairs of the major salivary gland; they are- parotid, submandibular and sublingual. 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. Location of the major salivary gland The parotid gland located near in pre-auricular region The sublingual gland located under the tongue The submandibular gland located below the floor of mouth

4. INDICATION 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

5. CONTRA INDICATION Hypersensitivity to iodine Suspected pregnancy Acute inflammation in salivary gland Severe infection (sialadenitis) Ductile opening Calculus

6. EQUIPMENT 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

7. Emergency Tray Oxygen - piped or in a cylinder Suction and catheters Face mask - adult and paediatric sizes Airway - adult and paediatric sizes Laryngoscope Endotracheal tubes Ventilation bag Needles and syringes I.V. giving set Scalpel, blade and French's needle Stethoscope and sphygmomanometer Drugs: Adrenaline 1:1000 Atropine 600 μg in 1 ml Hydrocortisone 100 mg Diazepam 10 mg in 2 ml Dopamine 800 mg in 5 ml to be diluted in 500 ml Naloxone 400 μ g in 1 ml Sodium bicarbonate, 8.4%, 200 ml

8. PATIENT PREPRATION 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.

9. 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.

10. 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.

11. 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.

12. AFTER CARE 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.