Salivary Disease - Imaging Flashcards
Causes of xerostomia?
Diabetes (increased blood glucose and polyuria) RT Autoimmune - Sjogrens Meds - Anti-cholinergics - Anti-depressants - Sympathomimetics - adrenaline - Diuretics - thiazide
Imaging needed for xerostomia?
Ultrasound if suspect sjogrens = only cause of xerostomia to be identifiable on imaging = destruction of gland paranchyma
Sialography can be useful
Imaging for painful and swollen gland?
Radiography followed by sialography
Submandibular obstruction = common cause
- Submandibular: Lower true 90 degree occlusal and posterior oblique occlusal, possibly sectional OPT
Parotid: AP E/O film and small dental film inside cheek
Imaging for lump in the gland?
Ultrasound with core biopsy of the tissue - if malignant follow up with MRI
What is obstructive sialoadenitis?
Swollen and painful gland that occurs at meal times and/or when thinking/smelling food
Caused by salivary calculi, strictures or debris/sludge in the ductal system
- Salivary calculi most commonly submandibular
- Strictures (focal narrowing) most commonly parotid
- Obstruction in sublingual rare due to it not having a single duct
Submandibular sialography mechanism?
Injects iodinated contrast along the duct
Iodine = radiopaque, stones are less dense and appear as radiolucent filling defects on the image
Treatment of submandibular calculi?
If visible in anterior 3rd of duct = surgical incision under LA by intra-oral approach
If small, mobile and anterior to mylohyoid bend = basket removal
If beyond mylohyoid bend or too big to remove with basket = excision of submandibular gland via an e/o approach
Basket removal of submandibular calculi?
An intra-ductal technique done under LA
Helical wire basket is inserted into duct opening whilst closed. Advance past calculus and open the basket. Calculus sneared within basket and drawn to the duct opening.
Calculus released from the duct with a small papillotomy incision - no suturing required as causes stenosis
Complications of baskets?
Post op pain and swelling
Symptoms may persist despite removal (ductal stenosis post incision?)
Basket gets stuck in duct
Failure to remove stone
Treatment of parotid obstruction?
Strictures
- Balloon-dilation if in the extra-glandular duct
- Superficial parotidectomy if not
Stones
- If visible at duct opening = surgical excision
- If in extra-glandular duct, anterior to the posterior border of the ramus, small and mobile = basket removal as per submandibular stones
- If in gland parenchyma or too large to pass down the duct, lithotripsy (shattered with sound waves) or superficial parotidectomy
How does balloon dilation of ductal strictures work?
Intra-ductal technique under LA
- Usually articaine with iodinated contrast and submucosal buccal lignocaine along the course of the duct
- Dilation of parotid papilla
- Insertion of angioplasty balloon along the duct
- Balloon is inflated
Complications of balloon dilation?
Stricture may be too tight for balloon to pass
Discomfort when inflated
Some strictures will not dilate
1/3 of dilated parotid strictures will re-stenose within 2 yrs of treatment
