Imaging in Salivary Glands

Question 1

Which salivary gland produces the most saliva?

Answer 1

Submandibular

Question 2

What are the main classifications for salivary glands disease?

Answer 2

1) Infection (sialadenitis)
2) Salivary cyst (mucous retention cyst, ranulus)
3) Salivary tumours (benign or malignant)
4) Systemic conditions (sialosis, sarcoid, lymphoma, HIV, autoimmune)
5) Salivary obstruction (salivary calculi, salivary duct strictures)

Question 3

What is the typical cause for these salivary gland presentations?
1) Persistent localised swelling within a gland
2) Persistent diffuse swelling affecting whole glands
3) Intermittent non-meal related sydrome
4) Intermittent meal time related syndrome

Answer 3

1) Tumour
2) Sjorgrens syndrome, sialadenitis, sialosis (neoplastic swelling of salivary gland)
3) Sialadenitis
4) Obstruction

Question 4

What are the main images we take for salivary glands?

Answer 4

• Ultrasound (1st line investigation, simple and inexpensive, good patient compliance)
• Plain X rays (mainly for submandibular glands to detect radio-opaque salivary calculi)
• Sialography (endoscopy, MRI, MR spectroscopy)

Question 5

What is sialography and how does it work?

Answer 5

Radop-opaque solution injected into duct of salivary gland and radiological techniques used to view the image.
Live image can be viewed on screen.

Question 6

What are the advantages of sialography?

Answer 6

• To identify filling defects e.g. stones, mucous plugs
• Indications of where strictures are
• Ductal architecture
• Suggests function of the gland
• Superior resolution and detail
• Best sensitivity for differentiating stones and stenosis

Question 7

What are the 3 main indications for sialography?

Answer 7

1. Salivary stones
2. Duct strictures
3. Sialadenitis

Question 8

Why is a CT not ideal for salivary gland imaging?

Answer 8

• Poor for fine duct detail, duct dilation and stenosis

Question 9

When undertaking surgery to the parotid gland, which nerve is at risk?

Answer 9

Facial nerve

Question 10

What are the complications of salivary gland surgery?

Answer 10

1) Nerve damage (facial nerve for parotid gland and lingual nerve damage to the submandibular gland)

2) Facial Scarring

3) Post-operative infection

4) Salivary fistula

5) Freys syndrome (nerves to parotid gland then attach to skin after surgery and causes sweating)

Question 11

What are the minimally invasive treatment options for stones and strictures?

Answer 11

Stones = extracorporeal shockwave lithotripsy, endoscopic stone removal with basket,

Strictures = balloon dilatation

Question 12

What is the maximum % of the stone compared to the duct can occur to allow for basket retrieval?

Answer 12

Stone diameter no greater than 25% of duct diameter

Question 13

What are the contra-indications to basket retrieval?

Answer 13

• Larger stone / small ductal diameter
• Unsuitable position
• Stricture / stenosis anterior to stone

Question 14

What is the risks for imaging for stones?

Answer 14

• Pain
• Bleeding
• Swelling
• Bruising
• Infection
• Unable to capture stone in basket
• Stone within basket through

Question 15

What is sialoductoplasty? What is it used to treat?
What are the indications?

Answer 15

Placing a balloon into the duct to open it up.
Used to treat strictures.
Indications:
oPartial stenosis / multiple strictures of duct of major salivary gland
oCan open pathway for sialotiths beyond stricture to be removed +- basket or following extracorporeal lithotripsy

Question 16

What is the technique for sialoductplasty? (balloon dilatation)

Answer 16

Conventional non-cutting balloon that inflates to expand and stretch tissue.
The balloon is compromised of a guide wire and a inflation port to control pressure of balloon.