Salivary Gland and Calcifications Flashcards
List the location of sialoliths in descending order of frequency
- Submandibular gland (83%) (high mineral content)
- Parotid gland (10%)
- Sublingual gland (7%)
NOTE: Along the path of the duct. 90 degree bend around the mylohyoid muscle most common location for submandibular sialolith
Clinical presentation of sialolith
- More common in middle age men
- Often asymptomatic
- Pain and swelling at mealtime due to stimulated salivary flow. Stone blocks partially or completely the flow.
Radiographic appearance of sialoliths
- Calcified stones are well-defined in outline, but not all are always calcified
- Submandibular gland sialoliths are cylindrical in duct, round in gland
- Multiple layers of calcification
Best view for submandibular sialoliths
Standard mandibular occlusals (if anterior to the 90 degree bend)
Best method of imaging parotid sialolith
Film placed in the cheek of the patient
Method of taking radiographs of sialoliths
- Radiographs should be underexposed (stone often poorly calcified)
- 1/2 usual exposure recommended
- Blow-out of cheek recommended for parotid
NOTE: 20% of submandibular gland sialoliths and 40% of parotid gland sialoliths are radiolucent
6 steps of sialography
- Dilatation of sphincter at the oricie of the duct with a probe + stimulation with lemon juice
- Orifice of parotid gland or submandibular gland is canulated with a cannula connected to a syringe with a plastic tube
- Radiopaque (iodine) contrast agent injected at the opening of the duct
- Contrast agent fills the duct and acini
- Imaging is done with plain film, pan, and/or CT
- Architecture of the ductal system is studied
2 indications sialography
- Obstructive disease
- Inflammatory disease
Age of patients with clinical Stafne’s defect
Middle aged adults; no children
Define Stafne’s defect
- Well-defined depressiong on lingual aspect of the mandible that ccomodates a lobe of the submandibular gland
- Inferior to mandibular canal
- Just anterior to the antegonial notch
NOTE: Similar depressions are occasionally found more anteriorly for the sublingual gland
7 radiographic qualities of Stafne’s defect
- Inferior to mandibular canal
- Just above the antegonial notch
- Posterior to third molar
- Round or ovoid
- Variation in size
- Very well-define, thick sclerotic periphery
7 mechanisms for dystrophic calcification
- Coagulative necrosis
- Enzymatic fat necrosis
- Old scars
- Certain tumors (leiomyoma, thyroid adenoma)
- Certain microbiolic infections
- Advanced atherosclerosis
- Fibromatosis, hematomas, and cartilaginous areas after trauma
7 head and neck areas of calcifications
- Styloid ligament (Eagle syndrome)
- Lymph nodes
- Triticeous cartilage
- Superior cornu of the thyroid cartilage
- Carotid walls
- Tonsils
- Osteoma Cutis
Define Eagle’s Syndrome
Abnormally long ossified stylohyoid ligament impinges on anatomical structures
NOTE: Average length of normal styloid process is 22.5 mm long
5 symptoms of Eagle’s syndrome
- Recurrent throat pain
- Foreign body sensation
- Dysphagia
- Facial or neck pain irradiating to the ipsilateral ear
- History of neck trauma (tonsillectomy) for Eagle
Descrbie the radiographic appearance of stylohyoid calcification
- On panoramic radiographcs, it extends from the mastoid region to the hyoid bone often reaching the angle of the mandible
- Inferior aspect is tapering
- Severely calcified ligament often have one or multiple “joints”
Decribe the clinical presentation of calcified lymph nodes
- Follow chronic infection of the nodes
- Often seen in patients with a history of tuberculosis - scrofula
- Incidental finding
- Asymptomatic patient
Describe the radiographic appearance of calcified lymph nodes
- Single or multiple, the entire neck chain can be affected
- Round of ovoid radiopacity of uneven density with an irregular outline
- Cauliflower appearance
- Region of angle of mandible
Differential diagnosis for calcified lymph nodes
Submandibular gland sialolith
Describe the characteristics of tonsilloliths (4)
- One or more calcifications in the tonsillar crypts of the palatine tonsils
- Visible on panoramic radiographs
- Single or more frequently multiple punctate irregular radiopacities superimposed over the ramus
- Often bilateral
Describe 4 characteristics of calcified triticeous cartilage
- Small bilateral ovoid structures located below the hyoid bone in the lateral thyrohyoid ligament at approx C3-C4 level
- Faint opacification immediately inferior to the tip of the greater cornu of the hyoid bone
- Largest and most superior of the cartilages of the larynx
- Suspended immediately below the hyoid bone by the thyrohyoid membrane, median and lateral thyrohyoid ligaments
Location of carotid calcifications
- Atheromatous plaque in the wall of the extracranial carotid artery = major contributing source of cerebrovascular embolic and occlusive disease
- Bifurcation of common carotid into internal and external carotids
NOTE: Can help identify patients at risk for stroke on radiography
Describe the radiology of carotid calcifications (5)
- Punctate of verticolinear radiopacities
- Inferior to the angle of the mandible
- Opposite C3 and C4 vertebral bodies or their intervertebral space
- Adjacent but not contiguous with hyoid bone
- Unilateral 61%, bilateral 38%
