Sialography Spring 2009 DRAFT. Salivary Glands Parotid Gland Sublingual gland Submandibular...
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Transcript of Sialography Spring 2009 DRAFT. Salivary Glands Parotid Gland Sublingual gland Submandibular...
SialographySialography
Spring 2009Spring 2009
DRAFTDRAFT
Salivary GlandsSalivary Glands
Parotid GlandParotid Gland
Sublingual glandSublingual gland
Submandibular glandSubmandibular gland
Parotid GlandParotid Gland
Largest of the glandsLargest of the glands
Consists of flattened Consists of flattened superficial portion and superficial portion and wedge shaped deep wedge shaped deep portionportion
Parotid ductParotid duct– Conduct saliva from Conduct saliva from
gland to the mouthgland to the mouth
Submandibular GlandSubmandibular Gland
Irregularly shapedIrregularly shaped
Extends posteriorly Extends posteriorly from first molar to from first molar to almost angle of almost angle of mandiblemandible
Sublingual GlandSublingual Gland Smallest pairSmallest pair
Located at floor of mouth Located at floor of mouth beneath sublingual foldbeneath sublingual fold
In contact with the In contact with the mandible laterallymandible laterally
Extends posteriorly from Extends posteriorly from the side of frenulum to the side of frenulum to submandibular ductsubmandibular duct
Main sublingual duct Main sublingual duct opens beside the orifice opens beside the orifice of the submandibular ductof the submandibular duct
SialographySialography
Term applied to radiographic exam of Term applied to radiographic exam of salivary glands salivary glands – Only one gland done at a timeOnly one gland done at a time
– CT and MRI have largely replaced this exam forCT and MRI have largely replaced this exam for Salivary stone or lesion is suspectedSalivary stone or lesion is suspected
– Used when a definitive diagnosis is necessary Used when a definitive diagnosis is necessary for a problem with one of the salivary ductsfor a problem with one of the salivary ducts
Indications Indications TumorsTumors
Inflammatory lesionsInflammatory lesions
Determine extent of salivary fistulaeDetermine extent of salivary fistulae
Localize diverticulae strictures and calculiLocalize diverticulae strictures and calculi
Salivary duct obstructionSalivary duct obstruction
Clinical Symptoms Clinical Symptoms
Clinical SymptomsClinical Symptoms
Sialogram Tray and CatheterSialogram Tray and Catheter
ProcedureProcedure
1.1. Obtain preliminary radiographsObtain preliminary radiographs• Any condition that is visibe w/o contrastAny condition that is visibe w/o contrast• Optimum technique obtainedOptimum technique obtained
2.2. 2-3 min before procedure give patient 2-3 min before procedure give patient lemonlemon
3.3. Contrast media injected into main ductContrast media injected into main duct4.4. After procedure suck on lemon to clear After procedure suck on lemon to clear
contrastcontrast5.5. 10 min after procedure take radiograph10 min after procedure take radiograph
Procedure DifferencesProcedure Differences
1.1. Most manually inject contrastMost manually inject contrast– Using cannula or catheterUsing cannula or catheter
2.2. Others use hydrostatic pressureOthers use hydrostatic pressure– Contrast solution barrel plunger removedContrast solution barrel plunger removed– Attached to drip standAttached to drip stand– 28” above pt’s mouth28” above pt’s mouth
3.3. Some inject under fluoro and obtain spot Some inject under fluoro and obtain spot radiographsradiographs
Radiation SafetyRadiation Safety
Have shields for PT’s, DR and yourselfHave shields for PT’s, DR and yourself
Question LMP and the possibility of being pregnantQuestion LMP and the possibility of being pregnant
Use cardinal rulesUse cardinal rules– TimeTime– DistanceDistance– ShieldingShielding
ALARAALARA– Use pulse if possibleUse pulse if possible– Save the last image on screen when possibleSave the last image on screen when possible
Tangential SupineTangential Supine
Rotate pt head toward side being Rotate pt head toward side being examined so that parotid gland is examined so that parotid gland is perp to plane of IRperp to plane of IR
Rest head on occipitusRest head on occipitus
Center IR to parotid areaCenter IR to parotid area
Mandibular ramus parallel with Mandibular ramus parallel with longitudinal axis of the IRlongitudinal axis of the IR
Fill mouth with air and puff cheeksFill mouth with air and puff cheeks
CR perp to plane of IR along lateral CR perp to plane of IR along lateral surface of the ramussurface of the ramus
TangentialTangential Prone Prone
Rotate pt’s head away from Rotate pt’s head away from side being examinedside being examined
Rest pt’s head on chinRest pt’s head on chin– Forehead and nose if parotid Forehead and nose if parotid
duct does not need to be duct does not need to be seenRotate pt head toward seenRotate pt head toward side being examined so that side being examined so that parotid gland is perp to plane parotid gland is perp to plane of IRof IR
Center IR to parotid areaCenter IR to parotid area
Mandibular ramus parallel with Mandibular ramus parallel with longitudinal axis of the IRlongitudinal axis of the IR
Fill mouth with air and puff Fill mouth with air and puff cheekscheeks
CR perp to plane of IR along CR perp to plane of IR along lateral surface of the ramuslateral surface of the ramus
Tangential RadiographTangential Radiograph
Soft tissue dentisySoft tissue dentisy
Most of parotid gland Most of parotid gland lateral to and clear of lateral to and clear of ramusramus
Mastoid overlapping Mastoid overlapping only the upper portion only the upper portion of parotid glandof parotid gland
Lateral ParotidLateral Parotid Affected side close to the Affected side close to the
IRIR
Extend mandible to clear Extend mandible to clear c-spinec-spine
Center IR 1” superior to Center IR 1” superior to angleangle
Head 15 degrees from Head 15 degrees from MSP toward IRMSP toward IR
CR 1” superior to angleCR 1” superior to angle
Oblique often used as Oblique often used as wellwell
Lateral Parotid RadiographLateral Parotid Radiograph
Mandibular Rami free Mandibular Rami free from overlap of c-spinefrom overlap of c-spine
Parotid gland SI over Parotid gland SI over the ramusthe ramus
Axiolateral oblique of Axiolateral oblique of mandible can be usedmandible can be used
LateralLateralSubmandibularSubmandibular
Center IR to inferior Center IR to inferior margin of anglemargin of angle
PT head in true lateralPT head in true lateral
CR at inferior margin CR at inferior margin of angleof angle
Lateral Submandibular Radiograph Lateral Submandibular Radiograph and Lateral obliqueand Lateral oblique
Rami free from overlap Rami free from overlap of C-spineof C-spine
SI mandibular rami if SI mandibular rami if no angualtion is usedno angualtion is used
Axiolateral oblique of Axiolateral oblique of mandible for better mandible for better demonstrationdemonstration
Axiolateral Oblique for Axiolateral Oblique for SubmandibularSubmandibular
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