Salivary Disease Imaging Flashcards
what are common salivary gland issues?
Dry mouth
Painful and swollen gland
Lump in gland
Possible causes of dry mouth/
Diabetes - raised blood sugar Medication - antidepressants, diuretics, cytotoxic Radiotherapy Autoimmune conditions Sjogrens
What could cause pain and swelling of the glands?
Sialadenitis - salivary gland infection
What are the types of sialadenitis?
Acute or chronic
Acute - bacterial or viral
Chronic - secondary to reduced saliva flow
What can be the cause of lumps in saliva gland?
Tumours - can be benign or malignant
What glands contain lymph nodes?
Parotid contains small lymph nodes
Submandibular/ lingual don’t
What imaging is appropriate for dry mouth?
Ultrasound first line
If suspect Sjogrens - sialography
What imaging is appropriate for painful swollen gland?
Plain radiography
Sialography
What imaging appropriate for lump?
Ultrasound
Core biopsy for tissue diagnosis
If malignant - MRI
What is the only cause of dry mouth that can be identified on imaging?
Sjogrens - disease destroys gland parenchyma
What would you expect to see on imaging of Sjogrens?
Normal gland replaced by black spaces
How does obstructive sialadenitis present?
Swollen and painful gland occur at mealtimes
What causes obstructive sialadeniis?
Calculi, structures or debris in ductal system
Where is calculi most common?
Submandibular gland
Where are strictures most common?
Parotid
Which gland is least likely to be obstructed
Sublingual -lacks a single duct - multiple small duct
How to investigate salivary obstruction?
Plain film radiograph
Ultrasound can identify stones - not as sensitive as sailogram
How to investigate submandibular obstruction?
Lower true occlusal
Posterior oblique
How to investigate parotid obstruction?
AP extra-oral film
What is sialography
Injecting contrast into duct - iodine in contrast radiopque
Stones less dense than contrast so show as filling defect
How to tx submandibular calculi?
If visible anterior 1/3 - surgical excision
Small and mobile- basket removal
Beyond mylohyoid bend - excision via extra-oral approach
What is basket removal?
Intra-ductal technique
Basket inserted closed into duct and advanced passed calculus
Basked opened and drawn to opening
Complications of basket removal?
Pain and swelling
failure to remove stone
get basket stuck in duct
How to tx strictures in parotid gland?
Balloon-dilation
Or superficial parotidectomy
How to tx stones in parotid gland?
If at duct opening - excision
Extra-glandular duct - basket retrieval
If in parenchyma - lithotripsy/ parotidectomy
What is balloon dilation?
Intra-ductal technique
Dilation of papilla w/ lacrimal probe followed by insertion of angioplasty balloon
Uninflated balloon positioned across stricture under x-ray guidance and inflated
Complications of balloon dilation?
Stricture can be too tight
Can be uncomfortable - even with LA
Some strictures won’t dilate
1/3 will re-stenose
What is the success of baskets and balloons?
Basket - 68%
Balloon - 76% - reduce 50% after 2 years
Common feature of salivary gland tumour?
slow-growing solid mass
What features would be more predictive of a malignant tumour?
Rapid growth, fixation to skin/ underlying tissue, pain
What would you see with malignant parotid tumour?
Facial nerve weakness
Rule of thumb for gland tumour?
Smaller the gland the higher the chance of malignancy
What are the two common benign salivary gland tumours?
Pelomorphic adenoma
Warthin’s tumour
What is plemorphic adenoma and who does it affect?
Benign tumour
Affect male:female 1:1
Affect 30-60 year olds
Where does Warthin’s tumour appear?
Only in parotid - in parotid tail
and only in smokers
Imaging features of benign salivary neoplasms?
Well-defined solid mass w/ smooth-lobulated margin
Imaging features of malignant salivary gland tumour?
Infiltrative, ill-defined margin
Why are lymph nodes found in parotid but not submandibular/lingual?
Embryological development - parotid in encapsulated after devleopment of lymphatic system (sub encapsulated before)
