2. SIALOGRAPHY
A radiographic examination of the salivary gland
(parotid and submandibular gland) and respective ducts
using contrast media.
Cannulation of sublingual gland ducts is almost
impossible.
3. SALIVARY GLANDS
Salivary glands are exocrine glands, that produce saliva.
There are 3 large named pairs of salivary glands and
multiple minute unnamed glands in the submucosa of the
oral cavity(lips, palate & under surface of the tongue).
Parotid produces a serous, watery secretion.
Submandibular produces a mixed serous & mucous
secretion.
Sublingual secretes saliva that is predominantly mucous in
character.
4. PAROTID GLAND
Largest salivary gland.
Formed entirely of serous acini.
Position:
Wedged between mandibular ramus & masseter
anteriorly,
Mastoid process & sternomastoid muscle posteriorly
5. SHAPE
Triangular:
Apex behind angle of the mandible
Base directed upward just below the zygomatic arch,
external auditory meatus &TMJ.
Accessory part : A small part that is separated from
the main gland.
6. CAPSULE
Tight, derived from deep cervical fascia of
the neck.
The gland is divided into superficial & deep
parts, by the facial nerve fibers.
8. The Structures within the Parotid gland
From superficial to deep
1- Facial nerve :
It is the most superficial structure, it divides the gland into
superficial & deep parts.
2- Retromandibular vein:
Intermediate in position
Formed by the union of maxillary & superficial temporal
veins.
Before it leaves the gland it is divided into anterior &
posterior branches.
3- External carotid artery:
Most deep ,
It is divided into maxillary and superficial temporal arteries.
11. SUBMANDIBULAR DUCT OR
WHARTON DUCT
The duct emerges from the deep part of the gland.
It passes forward along the side of the tongue, under
the mucous membrane of the floor of the mouth.
It is crossed laterally by the lingual nerve
It opens on the summit of a small sublingual papilla,
which lies at the side of the frenulum of the tongue.
14. SUBLINGUAL DUCTS OR DUCTS
OF RIVINUS
The sublingual ducts are 8 to 20
in number.
Most open into the summit of the
sublingual fold, but a few may
open into the submandibular duct.
15. INDICATIONS
1. Calculi.
2. Chronic inflammatory disease.
3. Mass lesion.
4. Obstructive lesion.
5. Penetrating trauma.
6. Strictures.
7. Fistula.
8. Prior to CT evaluation of salivary glands.
17. EQUIPMENT
1. Contrast medium-water soluble, ionic contrast media like Triovideo 280,Conray 280 or non-ionic contrast
medium such as omnipaque-350.
2. Lacrimal cannula or disposable 22 G (Gelco/Venflon).
3. Lacrimal dilator. Liebreich's double ended lacrimal probe.
4. 2 cc syringe. Four grades (00/0, 1/2, 3/4 & 5/6) 00/0 and ½ are required for sialography. Outer diametre of
cannula 1.02 mm. Rabinov sialography catheter obtainable in a sterile pack and is recommonded.
5. Lemon/vitamin C tablet.
19. PROCEDURE
Preliminary radiographs : Detect conditions that do not require contrast
Give pt secretory stimulant 2 to 3 minutes before contrast administration.
- Pt asked to suck on lemon wedge (opens duct for easy identification)
Duct orifice is sprayed with topical anesthetic
Duct is cannulated, (dilator may be required), contrast introduced with fluoroscopic guidance
20. Contrast (oil based or water soluble iodinated) (conc = 240mg/ml) should be injected manually until pt
feels discomfort
Quantity needed may vary btw 1-2 ml
Images taken immediately after contrast is complete
After taking req. images , pt sucks on a lemon wedge again to evacuate contrast
Take post-procedure(delayed) radiographs after 5 minutes to confirm evacuation of contrast/ demonstrate
any residual contrast
21.
22. Plain radiograph of the angle of the mandible and parotid
region in lateral and lateral oblique projections showing
two small calculi (arrow) in the left (L) parotid gland. The
right side (R) is normal.
23. 5. Film exposure Positioning for parotids:
• 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.
24. Figure 2 Conventional X-ray sialography of parotid gland
showing a calculus (arrows) in the distal part of the duct.
Lateral oblique and AP projections.
25. The adjacent image is a sialogram of the
submandibular gland that demonstrates stricture
of the duct. In this study, contrast material has
been injected into the duct in the floor of the
mouth.
The adjacent image is a sialogram of the parotid
gland with severe inflammatory changes.
26. Aftercare: none If sialadenitis occurs after the procedure, it should be treated with antibiotics and anti-
inflammatory drugs.
Complications
• Sialadenitis and abscess
• Stricture of the ducts.
Disadvantages of sialogram
• Masses less than 1cm may not be detected.
• Contrast does not always penetrate the deep lobe of parotid gland.
27. DACROCYSTOGRAPHY
A Radiographic examination of the Nasolacrimal duct(s) following
administration of a contrast medium to define the Lacrimal gland
& NLD system anatomically in search of stenosis or obstruction
28. LACRIMAL APPARATUS
The lacrimal apparatus is the system responsible for
the drainage of lacrimal fluid from the orbit.
After secretion, lacrimal fluid circulates across the eye,
and accumulates in the lacrimal lake – located in the
medial canthus of the eye. From here, it drains into the
lacrimal sac via a series of canals.
The lacrimal sac is the dilated end of the nasolacrimal
duct, and is located in a groove formed by the lacrimal
bone and frontal process of the maxilla. Lacrimal fluid
drains down the nasolacrimal duct and empties into
the inferior meatus of the nasal cavity.
32. MATERIALS
• Lacrimal canula or 18G blunt needle with polythene catheter. [outside diametre 0.63 mm]
• Contrast - Lipiodol (Better opacification but more chances of granuloma formation) - Ionic/Non-ionic
contrast media.
• 2cc syringe
• Local anaesthetic drops-Lignocaine 4%
• Punctum dilator (Nettleship dilator)
• Cotton tipped applicator
33. TECHNIQUE
Preliminary anteroposterior, lateral and oblique views are obtained to exclude radio-opacities that might
interfere with interpretation.
Local anaesthetic drops are instilled. Lower end of lid is everted to locate lower canaliculus at the medial
end of lid.
Inferior punctum is dilated and inferior canaliculus canulated with lacrimal canula.
Upper punctum is occluded with cotton tipped applicator.
2-3ml of contrast is gently injected to opacify the entire nasolacrimal apparatus.
It is essential not to advance the catheter more than 3-4 mm into the canaliculus.
34. FILMS
• Anteroposterior
• Lateral
• Oblique views Films are taken during contrast injection (distension dacrocystography). 5 to 30 minute late
films are obtained to evaluate the dye retention.
Normal dacrocystogram shows complete filling of superior and inferior punctal ampullae, ascending and
descending canaliculi, common duct, lacrimal sac and nasolacrimal duct.
During procedure patient experiences mild local irritation, pain and bad taste in the mouth.
Bilateral injections are· advised as the abnormalities are usually bilateral.
