Imaging modalities of Salivary Gland.

1. INDICATIONS OF IMAGING:
Whether inflammatory disease or neoplasm
Diffuse disease or focal suppurative disease
Any sialoliths, ductal morphology
Anatomic location of tumor, selection of biopsy site
STRATEGIES FOR DIAGNOSTIC IMAGING:
1. PROJECTION RADIOGRAPH
2. CONVENTIONAL SIALOGRAPHY
PROJECTION RADIOGRAPH
Cost benefit
Demonstrate sialoliths & possible involvement of adjacent osseous structure
INTRA ORAL RADIOGRAPH:
Anterior 2/3rd submandibular duct by- OCCLUSAL PROJECTION
 Posterior part demonstrated by- LATERAL OBLIQUE VIEW
Parotid sialoliths are more difficult to demonstrate
EXTRA ORAL RADIOGRAPH:
It has less value as sialoliths are superimposed over the ramus or body of
mandible
To demonstrate sialoliths in the submandibular gland, the lateral projection
is modified by opening mouth extending chin and depressing tongue by index
finger. This improves image of sialolith by moving it inferior to the mandibular
border
SIALOGRAPHY – IT IS A RADIOGRAPHIC TECHNIQUE
WHERE A RADIOGRAPHIC CONTRAST AGENT IS INFUSED
BEFORE IMAGING WITH PLAIN FILMS/DIGITAL IMAGE
RECEPTORS, FLUOROSCOPY, PANAROMIC RADIOGRAPH,
CBCT, MDCT
ADVANTAGES- Multiplanar & three dimensional
visualization and ability to remove overlapping.
INDICATIONS- Tumours, Inflammatory lesions,
Determination the extent of salivary fistulae, Salivary
duct obstruction
CONTRAINDICATIONS- IT IS CONTRAINDICATED IN
ACUTE INFECTION & IN CASE OF PATIENT ALLERGIC
TO IODINE / CONTRAST MEDIUM
SIALOGRAPHIC PROCEDURE-- 1.Dilate ductal orifice 2.Canula connected to syringe containing contrast medium(Lipid
soluble-Ethiodol,Water soluble-Sinografin) 3. Inject 4. Allowed for 5 minutes without stimulation 5. Take radiograph
Projection radiograph of the submandibular region in AP (A) and
lateral oblique (B) projection showing soft tissue swelling
associated with a small calculus (arrow) visible on lateral
oblique view taken with depressed tongue
CBCT
INDICATIONS: Evaluating structures in and adjacent to
salivary gland
ADVANTAGES: Differentiates osseous structure from
soft tissue
Minimal calcified lesion is well depicted
3D visualization
DISADVANTAGES: Cannot resolve in differences b/w
soft tissue densities
MDCT
INDICATIONS: Useful in evaluating structures in and
adjacent to the salivary gland
ADVANTAGES: It displays both soft and hard tissues
and minute differences in soft tissue densities
DISADVANTAGES:Not recognize as sensitive study
for Salivary tumors
MAGNETIC RESONANANCE IMAGING
INDICATIONS: Radio opaque soft tissue lesions
ADVANTAGES: Excellent soft tissue resolution with
ability to differentiate osseous structure from soft
tissue
No radiation burden
DISADVANTAGES: Dental scatter
Contraindicated in pacemaker, metal implant
ULTRASONOGRAPHY
INDICATIONS: Biopsy guidance mass detection
ADVANTAGES: Non invasive
Cost effective
DISADVANTAGES: Limited visibility to deeper
portions of gland
No morphological information
SOME IMAGING MODALITIES
1-Plain radiograph of the submandibular region in AP (A) and lateral oblique (B)
projection showing soft tissue swelling associated with a small calculus (arrow)
visible on lateral oblique view taken with depressed tongue
MDCT image shows a sialolith in the submanibular(wharton’s) duct T2-weighted image,left parotid tumor shoeing high signal with
central necrosis suggestive of granulomatous disease
HRUS images show altered echopattern of the parotid gland
with ductal dilatation (thin arrow) and small calculus (thick
arrow) at its terminal end
By- SK AZIZ IKBAL
Final Year ( 2015-16)
DEPT. OF ORAL MEDICINE & RADIOLOGY & DIAGNOSIS
Guided by –
Dr. ANIRBAN DAS