SIALOGRAPHY

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SIALOGRAPHY :

The radiographic visualization of the salivary glands and ducts is called sialography. The evaluation of the salivary glands is most often accomplished with computed tomography or magnetic resonance imaging; however, sialography becomes the method of choice when a definitive diagnosis is required for pathology such as sialadenitis (inflammation of the salivary glands) and the oral component of ’Sjögren’s syndrome (an autoimmune disease process that causes dry eyes and dry mouth). Sialography involves the introduction of a water-soluble contrast agent into the orifices of the salivary ducts. In most cases, this procedure requires a minimum of specialized equipment and can be performed in a regular radiographic or fluoroscopic room.

INDICATIONS AND CONTRAINDICATIONS

Sialography is used to demonstrate the relation of the salivary glands to their adjacent structures. It provides both diagnostic and preoperative information in cases of salivary gland pathology. Other indications for sialography are calculi, strictures of the ducts, sialectasia (dilation of a duct), fistulas, and demonstration of pleomorphic salivary gland tumors, commonly called mixed parotid tumors.

Contraindications for this procedure include severe inflammation of the salivary ducts and history of sensitivity to iodinated contrast media.

CONTRAST AGENTS

 Two types of contrast media—water-soluble and oily—are used to opacify the salivary glands. The final choice remains with the physician performing the procedure. Certain factors govern the use of a specific type of contrast medium for a particular procedure. Contrast media, such as Ethiodol, have a very slow excretion rate and can cause granulomatous tissue formation, which can be disadvantageous in cases in which complete removal of the contrast medium is impossible. It contains 37% iodine (475mg/ml) combined with ethyl esters of the fatty acids of poppyseed oil. This type of contrast medium provides a greater density in the ducts and parenchyma when tomography is used. For routine sialography, a water-soluble contrast medium is usually used.

PATIENT PREPARATION

Sialography does not require specific preprocedural preparation by the patient. A history should be taken before the study to determine if the patient has allergies or has had prior reactions to iodinated contrast media. It is important to have the patient remove any radiopaque materials such as false teeth or removable bridgework prior to the examination. The patient should be monitored for signs of reaction during the examination. At the conclusion of the study, the patient is usually given a secretory stimulant to clear the contrast medium from the gland and ducts.

PROCEDURE

Scout films of the area of interest may or may not be taken. In cases of suspected sialolithiasis (salivary gland or salivary duct calculi), scout films are mandatory. In cases in which scout films are not taken, stones may be obliterated by the contrast medium, causing an inaccurate diagnosis to be made. The study may be performed with fluoroscopic visualization and spot filming as well as with overhead radiographic projections. Computed tomography, ultrasonography, and magnetic resonance imaging are replacing conventional sialography. Although the primary means of diagnosis has been ultrasonography, conventional sialography still has a place in the realm of interventional radiography for the treatment of pathology of the salivary glands.

After scout films have been taken, the radiologist locates the orifices of the salivary ducts by having the patient express some saliva. The physician can either palpate the salivary gland or have the patient suck on a lemon slice. When the salivary duct is located, it is dilated with standard double-ended blunt dilators or with silver lacrimal probes. After dilation of the orifice, the duct is cannulated. Several types of cannulas are available, but the use of a modified Abbott butterfly set has proved successful in most cases, especially if the patient has to be moved to another location for additional study. The modification is accomplished by filing the beveled tip of the needle flat and smooth with a medium-fine metal file. The wings of the butterfly are then secured with a hemostat. This allows for ease of insertion of the cannula into the duct. The cannula should be prefilled with the contrast medium to avoid injection of air bubbles.

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