SIALOGRAPHY EXAMINATION.doc

8/18/2019 SIALOGRAPHY EXAMINATION.doc

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CHAPTER 1

INTRODUCTION

A. GENERAL

In the world of health, measures to diagnose a disease is needed, one of them

using x-rays to diagnose the disease called radiodiagnostic techniques. iagnostic

measures are frequently used !oth in hos"itals and health clinics. #herefore, in

radiodiagnostic techniques there are a $ariety of tests !oth in$ol$ing the !ones,

organs, and tissues in the human !ody. And e$ery radiogra"her should !e a!le to do

the entire examination radiodiagnostic well and s%illfully so that the results can

"ro$ide clear information as a !asis for diagnosing the disease. &ne was a!out the'ialogra"hic or examination sali$ary glands.

'ialogra"hic is the term used for radiological examination of the sali$ary

glands and ducts using contrast media are usually water solu!le iodine. In the

examination 'ialogra"hic used some "ro(ections, the tangential "ro(ection, the

lateral "ro(ection, axial "ro(ection )intraoral method*.

+. R&'E

&ur "ur"ose in discussing this matter is

a* #o %now "rocedures examination on 'ialogra"hy ins"ection.

!* #o determine the "ro(ections used in the 'ialogra"hic examination.

c* #o fulfill the tas% of Radiogra"hic #echnique I/.


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CHAPTER 2

DISCUSSION

A. E0INI#I&N 'IAL&GRA12 E3A4INA#I&N

'ialogra"hy is the term a""lied to radiologic examination of the sali$ary

glands and ducts with the use of a contrast material, usually one of the water-solu!le

iodinated media. +ecause of im"ro$ements ii com"uted tomogra"hy )5#* and

magnetic resonance imaging )4 R I* techniques, sialogra"hy is "erformed Iess

often than it once was. 6hen the "resence of a sali$ary stone or lesion is sus"ected,

5# or 4RI is often the modality of choice. 1owe$er, sialogra"hy remains a $ia!le

tool when definiti$e diagnosis is needed for a "ro!lem related to one of the sali$ary

ducts. #he "rocedure is used to demonstrate such conditions as inflammatory

lesions and tumors, to determine the extent of sali$ary fistulae, and to locali7e

di$erticula, strictures, and calculi. +ecause the glands are "aired and the "airs are in

such close "roximity, only one gland at a time can !e examined !y the sialogra"hic

method.

+. ANA#&42

#he three "airs of sali$ary glands "roduce a""roximately 8 liter of sali$a each day.

#he glands are named the "arotid, the su!mandi!ular, and the su!lingual.


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a* arotid glands#he largest of the sali$ary glands, each consist of a flattened su"erficial

"ortion and a wedge-sha"ed dee" "ortion. #he su"erficial "art lies

immediately anterior to the external ear and extends inferiorly to themandi!ular ramus and "osteriorly to the mastoid "rocess. #he dee", or

retromandi!ular, "ortion extends medially toward the "harynx. #he "arotid

duct runs anteriorly and medially to o"en into the oral $esti!ule o""osite the

second u""er molar.

!* 'u!mandi!ular glands#he su!mandi!ular glands are fairly large, irregularly sha"ed glands. &n

each side a su!mandi!ular gland extends "osteriorly from a "oint !elow the

first molar almost to the angle of the mandi!le. Although the u""er "art of

the gland rests against the inner surface of the mandi!ular !ody, its greater

"ortion "ro(ects !elow the mandi!le. #he su!mandi!ular duct extends

anteriorly and su"eriorly to o"en into the mouth on a small "a"illa at the side

of the frenulum of the tongue.


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c* 'u!lingual galnds#he su!lingual glands, the smallest "air, are narrow and elongated in form.

#hese glands are located in the floor of the mouth !eneath the su!lingual

fold. Each is in contact with the mandi!le laterally and extends "osteriorly

from the side of the frenulum of the tongue to the su!mandi!ular gland.

Numerous small su!lingual ducts exist. 'ome of these ducts o"en into the

floor of the mouth along the crest of the su!lingual fold, and others o"en

into the su!mandi!ular duct. #he main su!lingual duct o"ens !eside the

orifice of the su!mandi!ular duct.

5. A#1&L&G2

#he "rocedure is used to demonstrate such conditions as inflammatory lesions and

tumors, to determine the extent of sali$ary fistulae, and to locali7e di$erticulae,

strictures, and calculi. +ecause the glands are "aired and the "airs are in such close

"roximity, only one gland at a time can !e examined !y the sialogra"hic method.


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. R&5ERE

'ialogra"hy in$ol$es the following ste"s

a* In(ect the radio"aque medium into the main duct. 0rom there the contrast

flows into the intraglandular ductules, ma%ing it "ossi!le to demonstrate the

surrounding glandular "arenchyma, as well as the duct system.

!* &!tain "reliminary radiogra"hs to detect any condition demonstra!le

without the use of a contrast medium and to esta!lish the o"timum ex"osure

technique.c* A!out 9 or : minutes !efore the sialogra"hic "rocedure, gi$e the "atient a

secretory stimulant to o"en the duct for ready identification of its orifice and

for easier "assage of a cannula or catheter. 0or this "ur"ose, ha$e the "atient

suc% a wedge of fresh lemon. &n com"letion of the examination, ha$e the

"atient suc% on another lemon wedge to stimulate ra"id e$acuation of the

contrast medium.d* #a%e a radiogra"h a!out 8; minutes after the "rocedure to $erify clearance

of the contrast medium, if needed. 4ost "hysicians in(ect the contrast

medium !y manual "ressure )i.e., with a syringe attached to the cannula or

catheter*. &ther "hysicians ad$ocate deli$ery of the medium !y hydrostatic


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"ressure only. #he latter method requires the use of a water solu!le iodinated

medium, with the contrast solution container )usually a syringe !arrel with

the "lunger remo$ed* attached to a dri" stand and set at a distance of 9<

inches )=; cm* a!o$e the le$el of the "atient>s mouth. 'ome "hysicians

"erform the filling "rocedure under fluorosco"ic guidance and o!tain s"ot

radiogra"hs. )Articles cited in the !i!liogra"hy "ro$ide detailed descri"tions

of the numerous methods of "erform(ng sialogra"hy.*

E. E3A4INA#I&N #E51NI?E'

a. Parotid glands

Tangential projection

Image rece"tor < x 8 ; inch )8 < x 9@ cm* lengthwise

Position o patienta* lace the "atient in either a recum!ent or seated "osition.

!* +ecause the "arotid gland lies midway !etween the anterior and

"osterior surfaces of the s%ull, o!tain the tangential "ro(ection of the

glandular region from either the "osterior or the anterior direction.

Position o part

'u"ine !ody "osition

a* 6ith the "atient su"ine, rotate the head slightly toward the side !eing

examined so that the "arotid area is "er"endicular to the "lane of the IR.

!* 5enter the I R to the "arotid area.

c* 6ith the "atient>s head resting on the occi"ut, ad(ust the head so that the

mand(!ular ramus is "arallel with the longitudinal axis of the IR.

rone !ody "osition

a* 6ith the "atient "rone, rotate the head so that the "arotid area !eing

examined is "er"endicular to the "lane of the IR. !* 5enter the IR to the "arotid region.

c* 6ith the "atient>s head resting on the chin, ad(ust the flexion of the

head so that the mandi!ular ramus is "arallel with the longitudinal axisof the IR.

d* 6hen the "arotid )'tensen>s* duct does not ha$e to !e demonstrated,

rest the "atient>s head on the forehead and nose.

e* 'hield gonads.


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f* Res"iration Im"ro$ed radiogra"hic quality can !e o!tained,

"articularly for the demonstration of calculi, !y ha$ing the "atient fill

the mouth with air and then "uff the chee%s out as much as "ossi!le.

6hen this cannot !e done, as% the "atient to sus"end res"iration for

the ex"osure.

Central ra!

er"endicular to the "lane of the IR, directed along the lateral surface of the

mandi!ular ramus

Str"ct"res s#o$n

A tangential "ro(ection demonstrates the region of the "arotid gland and

duct. #hese structures are clearly outlined when an o"aque medium is used.


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E%al"ation criteria

#he following should !e clearly demonstrated

a* 'oft tissue density

!* 4ost of the "arotid gland lateral to, and clear of, the mandi!ular ramusc* 4astoid o$erla""ing only the u""er "ortion of the "arotid gland

&. Parotid and s"&'andi&"lar glands

(ateral projection )R or ( position*

Image rece"tor < x 8 ; inch ) l < 3 9@ cm* lengthwise


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Position ot patient

lace the "atient in a semi "rone or seated and u"right "osition.

Position o part

arotid gland

a* 6ith the affected side closest to the IR, extend the "atient>s nec% so that thes"ace !etween the cer$ical area of the s"ine and the mandi!ular rami is

cleared. !* 5enter the IR to a "oint a""roximately I inch )9. cm* su"erior to the

mandi!ular angle.

c* Ad(ust the head so that the midsagittal "lane is rotated a""roximately 8

degrees toward the IR from a true lateral "osition.

'u!mandi!ular glanda* 5enter the I R to the inferior margin of the angle of the mandi!le.

!* Ad(ust the "atient>s head in a true lateral "osition.c* Iglauer> suggested de"ressing the floor of the mouth to dis"lace the

su!mandi!ular gland !elow the mandi!le. 6hen the "atient>s throat is not

too sensiti$e, accom"lish this !y ha$ing the "atient "lace an index finger on

the !ac% of the tongue on the affected side.

'hield gonads.

Res"iration 'us"end.

Central ra!er"endicular to the center of the IR and directed )I* at a "oint I inch )9. cm*

su"erior to the mandi!ular angle to demonstrate the "arotid gland or )9* at the

inferior margin of the mandi!ular angle to demonstrate the su!mandi!ular

gland.


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Str"ct"res s#o$n

A lateral image demonstrates the !ony structures and any calcific de"osit or

swelling in the uno!scured areas of the "arotid and su!mandi!ular glands. #he

glands and their ducts are well outlined when an o"aque medium is used.

E%al"ation criteria

a* #he following should !e clearly demonstrated

!* 4andi!ular rami free of o$erla" from the cer$ical $erte!rae to !est show

the "arotid gland su"erim"osed o$er the ramusc* 'u"erim"osed mandi!ular rami and angles if no tu!e angulation or head

rotation is used for the su!mandi!ular gland

d* &!lique "osition for the "arotid gland.


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c. S"&'andi&"lar dan s"&ling"al glands

A+ial projection )Intraoral 'et#od*

Image rece"tor &cclusal film = 3=B mm

Position o patient

a* Ele$ate the "atient>s thorax on se$eral firm "illows. !* 0lex the "atient>s %nees to relax the a!dominal muscles and there!y allow

full extension of the nec%.c* Ad(ust the shoulders to lie in the same trans$erse "lane.

Place'ent o il'

a* #a"e a side mar%er )R or L* on one corner of the ex"osure surface of the

occlusal film "ac%et.

!* lace the film in the mouth with the long axis directed trans$ersely.

c* 5enter the "ac%et to the m(dsagittal "lane, and gently insert it far enough so

that it is in contact with the anterior !orders of the mandi!ular rami.

d* Instruct the "atient to gently close the mouth )to hold the "ac%et in

"osition*.e* After "lacement of the occlusal film, fully extend the "atient>s nec% and rest

it on the $ertex with the midsagittal "lane $ertical.'hield gonads.

Res"iration 'us"end.

Central ra!

er"endicular to the "lane of the film and directed to the intersection of the

midsagittal "lane and a coronal "lane "assing through the second molars.


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Str"ct"res s#o$n

An axial image of the floor of the mouth is demonstrated, showing the entire

su!lingual gland areas and the duct and anteromedial "art of the su!mandi!ular

gland areas.

E%al"ation criteria

#he following should !e clearly demonstrateda* 'oft tissue density of the floor of the mouth

!* +oth sides of the mandi!le and dental arches symmetric

c* 'u!lingual glands in their entirety along with a "ortion of the su!mandi!ular

glands when the film includes the lower molars.


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CHAPTER ,

C(OSIN-

5&N5L#E

a* 'ali$ary glands is di$ided into three "arts "arotid, su!mandi!ular gland, su!lingual

gland.

!* #he "ro(ection used in the examination of 'ialogra"hy there are three, namely

tangential "ro(ection )A and A*, Lateral "ro(ection and axial "ro(ection )intraoral

method*


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REERENCES

+allinger, .6. 9;;:. 4errillCs Atlas of Radiogra"hic ositions and Radiologic rocedures,

$olume 9, 8;th edition. 'aint Luis 'A #he 5/. 4os!y 2ear +oo%.Inc

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SIALOGRAPHY EXAMINATION.doc