SALIVARY GLAND IMAGINGINDICATIONS OF IMAGING:

Whether inflammatory disease or neoplasmDiffuse disease or focal suppurative diseaseAny sialoliths, ductal morphologyAnatomic location of tumor, selection of biopsy site

STRATEGIES FOR DIAGNOSTIC IMAGING:

1. PROJECTION RADIOGRAPH2. 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 VIEWParotid sialoliths are more difficult to demonstrate

EXTRA ORAL RADIOGRAPH:It has less value as sialoliths are superimposed over the ramus or body of mandibleTo 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, MDCTADVANTAGES- Multiplanar & three dimensional visualization and ability to remove overlapping.

INDICATIONS- Tumours, Inflammatory lesions, Determination the extent of salivary fistulae, Salivary

duct obstructionCONTRAINDICATIONS- 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

CBCTINDICATIONS: Evaluating structures in and adjacent to salivary glandADVANTAGES: Differentiates osseous structure from soft tissueMinimal calcified lesion is well depicted3D visualizationDISADVANTAGES: 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 densitiesDISADVANTAGES:Not recognize as sensitive study for Salivary tumors

MAGNETIC RESONANANCE IMAGING

INDICATIONS: Radio opaque soft tissue lesionsADVANTAGES: Excellent soft tissue resolution with ability to differentiate osseous structure from soft tissueNo radiation burdenDISADVANTAGES: Dental scatterContraindicated in pacemaker, metal implant

ULTRASONOGRAPHYINDICATIONS: Biopsy guidance mass detectionADVANTAGES: Non invasiveCost effectiveDISADVANTAGES: Limited visibility to deeper portions of glandNo 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 IKBALFinal Year ( 2015-16)DEPT. OF ORAL MEDICINE & RADIOLOGY & DIAGNOSISGuided by – Dr. ANIRBAN DAS