This is the study to demonstrate the parotid or submandibular glands by injection of contrast medium into the duct system.
1. Recurrent pain or swelling with nondiagnostic US
2. Sicca syndrome
3. Endoluminal interventional procedures such a basket retrieval of calculi and balloon dilatation of strictures
- clinically active infection or inflammation.
Equipment varies, widely depending on the operator’s preference:
1. Skull unit (using macroradiography technique) or fluoroscopic unit
2. Silver lacrimal dilator and probe set (size 0–2)
3. Silver cannula or blunt needle (18–24G) with polythene catheter
4. Focused light and magnifying glasses Patient Preparation Any radio-opaque artifacts are removed (e.g. false teeth)
1. LOCM 240–370 mg I mL−1
Ultra Fluid Higher iodine concentration in Lipiodol provides excellent ductal delineation. However, foreign body reactions have been reported with lipid-soluble contrast agents.
Plain radiograph should be taken before embarking on sialography because a considerable pathology is associated with opaque calculi within the glands themselves or their ducts, particularly in the submandibular gland.
2. Locating duct openings
- Parotid duct opens opposite 2nd upper molar tooth on the buccal surface of the cheek.
- Submandibular duct opens at the base of the frenulum of the tongue.
- In case the ostium is not visible, apply pressure on the glandor give a sialogogue like lime. Then saliva will be seen pouring through the punctum.
3. Dilate the punctum with lacrimal dilator.
Two techniques for cannulating the ducts are by using:
(b)Lacrimal cannula technique.
If we are using an intra cath, we should cut enough plastic tubing from the tip of intracath with fine scissors such that 2 mm of the inner wire stilette is still protruding. Now the punctum is cannulated for 5 mm. Now withdraw the stilette such that it no longer protrudes the outer tube.
The inner stilette produces stiffness during introduction ofcatheter. The stilette is removed and outer tube is attached topolythene tube.
•Now the contrast is injected.
•In the lacrimal cannula method, contrast is injected into the cannula which is introduced through the duct opening.
Contrast is injected till the patient complains of pain by a pre arranged signal.
•About 0.5-1.0 cc of contrast is required.
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.
If sialadenitis occurs after the procedure, it should be treated withantibiotics and anti-inflammatory drugs.
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.