Sialography is an x-ray examination of the salivary glands that involves injecting contrast media into the ducts to evaluate any abnormalities. It can detect issues like stones, lesions, or masses that may be obstructing the ducts and causing pain or inflammation. There are three major pairs of salivary glands - parotid, submandibular, and sublingual - which produce saliva. Sialography can be used to evaluate masses, stones, pain, functional disorders, and suspected obstructions or strictures of the salivary glands. The procedure involves injecting contrast media under fluoroscopy and taking x-ray images to view the flow of saliva and identify any ob

1. 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. 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


5. 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

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

7. 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

8. 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 μg in 1 ml
Sodium bicarbonate, 8.4%, 200 ml

9. 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.

10. 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.

11. 1. 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.
2. Post-secretory - the same views are repeated 5 min after the
administration of a sialogogue. The purpose of this is to
demonstrate sialectasis.
3. Frontal view is taken with face rotated 5-10 degrees towards
the side of study.
4. Lateral view is taken with 15-20 degrees cranial tube tilt.
Positioning for submandibular gland
5. 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.

15. 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.

16. 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.