SIALOGRAPHY THE SALIVARY GLANDS A radiographic examination of

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SIALOGRAPHY & THE SALIVARY GLANDS A radiographic examination of the salivary glands and ducts

SIALOGRAPHY & THE SALIVARY GLANDS A radiographic examination of the salivary glands and ducts using contrast media 1

Injection of contrast media into salivary ducts OIL BASED CONTRAST SINOGRAPHIN WATER BASED (IONIC)

Injection of contrast media into salivary ducts OIL BASED CONTRAST SINOGRAPHIN WATER BASED (IONIC) 2

3 INDICATIONS FOR EXAM n n n Stones (Calculi) sialolithiasis Obstruction / Strictures Pain

3 INDICATIONS FOR EXAM n n n Stones (Calculi) sialolithiasis Obstruction / Strictures Pain & Swelling Infection Masses / Tumors

4 CONTRAINDICATIONS: n n n History of contrast media allergies Parotits (mumps) Severe inflammation

4 CONTRAINDICATIONS: n n n History of contrast media allergies Parotits (mumps) Severe inflammation of the salivary ducts

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6 SIALOGRAPHY SNOPEK – CH 21 & BALLINGER – VOL. 2 CH. 14 3

6 SIALOGRAPHY SNOPEK – CH 21 & BALLINGER – VOL. 2 CH. 14 3 SALIVARY GLANDS – PAROTID – LARGEST – LOCATED BY EAM MANDIBULAR RAMUS SUBMANDIBULAR / SUBMAXILLARY – 1 st molar to Gonion SUBLINGUAL – LOCATED BEHIND THE MENTUM under the sublingual fold SMALLEST-

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9 DUCTS Parotid duct – located by maxillary bone– 2 nd upper molar) Stensen’s

9 DUCTS Parotid duct – located by maxillary bone– 2 nd upper molar) Stensen’s duct PAROTID GLAND Submandibular Duct – located on end of sublingual ridge to fill submandibular Wharton’s duct SUBMAXILLARY Sublingual duct (several small) located alongside submandibular duct to SUBLINGUAL GLAND

10 1. Parotid Gland 2. Submandibular Gland

10 1. Parotid Gland 2. Submandibular Gland

11 EQUIPMENT NEEDS n n RAD/ FLUORO ROOM Safe and simple but difficult to

11 EQUIPMENT NEEDS n n RAD/ FLUORO ROOM Safe and simple but difficult to perform – hard to located and catheterize ducts Mostly replaced now by MRI & CT

12 PROCEDURE Sialogram Tray – n Gauze, Sterile towels, Spot Light, Magnifying glasses, Gloves,

12 PROCEDURE Sialogram Tray – n Gauze, Sterile towels, Spot Light, Magnifying glasses, Gloves, Eyewear, mask n LEMONS - cut into wedges n Lacrimal Probes n Hemostats n 5 cc syringes n Sialogram Catheter (Rabinov) needles or canulas

13 PATIENT PREP (No specific prep = oral mouthwash in nice) n Remove any

13 PATIENT PREP (No specific prep = oral mouthwash in nice) n Remove any metal – bridgework, tongue piercing n Get History – present to radiologist BEFORE setting up tray

14 n 32 gauge Sialogram needle n “Rabinov” catheter n

14 n 32 gauge Sialogram needle n “Rabinov” catheter n

15 n n n n RADIOGRAPHS 1. SCOUT FILMS – important to r/o stone

15 n n n n RADIOGRAPHS 1. SCOUT FILMS – important to r/o stone for SOFT TISSUE (LIGHT EXPOSURE) Like mandible series = AP (OML) (Grid ) Both Obliques (Ext. cassette) True Lateral (x-table) (Grid or extremity cassette) Tangential films may be required Mentum or Parotid 2. Give lemon - contast injected 3. SPOT FILMS – taken by DR during fluoro 4. Post films – taken 10 min after injections – check drainage

16 SUBMANDIBULAR GLAND

16 SUBMANDIBULAR GLAND

17 PAROTID GLAND

17 PAROTID GLAND

18 SUBMANDIBULAR GLAND

18 SUBMANDIBULAR GLAND

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24 Contrast media n n Water based iodinated (ionic or nonionic) Less dense –

24 Contrast media n n Water based iodinated (ionic or nonionic) Less dense – absorbed faster –no residue n n n Conray, Hypaque, Isovue, Renographin (60/76) n Oil-based More dense, absorb slower – can cause granuloma (stones) hard to completely excrete Ethiodol, Sinographin

25 DUCTS n n n Parotid duct – located by maxillary bone– 2 nd

25 DUCTS n n n Parotid duct – located by maxillary bone– 2 nd upper molar) - PAROTID GLAND Stensen’s duct Submandibular Duct – located on end of sublingual ridge to fill submandibular / SUBMAXILLARY Wharton’s duct Sublingual duct (several small) located alongside submandibular duct to SUBLINGUAL GLAND

26 Tangential parotid gland, supine position. CR - “skims” – side of face Cr

26 Tangential parotid gland, supine position. CR - “skims” – side of face Cr is directed along lateral side for unobstructed image of parotid gland

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28 “True” Lateral n n Parotid gland is superimposed Over the mandibular rami

28 “True” Lateral n n Parotid gland is superimposed Over the mandibular rami

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THE END Questions? 31

THE END Questions? 31