Salivary Gland Imaging Flashcards
What are common problems related to salivary gland?
- Dry mouth
- Painful and swollen gland
- Lump in gland
What are causes of dry mouth
Diabetes
Medication
Radiotherapy
Immune- conditions
Examples of medications cause dry mouth?
Anti-cholinergics
Cytotoxic
Diuretics
Antidepressants
What can cause painful and swollen gland?
Sialadenitis
Can be chronic or acute
Bacterial or viral
What is likely cause of lump in saliva gland?
Tumour - benign or malignant
What imaging can be taken if dry mouth?
Ultrasound first line
If suspect Sjogren - sialography
What imaging can be taken is painful/swollen gland?
Plain radiography followed sialography
What imaging can be used if lump in gland?
Ultrasound
Need core biopsy for tissue diagnosis (if malignant MRI)
What is the only cause of dry mouth that can be identified on imaging?
Sjogrens syndrome
How does Sjogren’s present on imaging?
Normal gland replaced by inflammation = black spaces
Disease process destroy gland parenchyma
How does obstructive sialadentitis present?
Swollen and painful gland occurs at mealtime/ thinking/ smelling food
What causes obstructive sialadentitis?
Salivary calculi/ strictures or debris in ductal system
Where is it most common for obstructive sialadenitis to occur?
Submandibular gland
What gland is more prone to strictures?
Parotid
Why is obstruction of sublingual gland rare?
Doesn’t have single duct - multiple opening in floor of mouth
What radiographs are needed to identify submandibular obstruction?
Lower true occlusal
Posterior oblique occlusal film
How is sialography performed?
Inject iodine contract along duct - contrast makes duct densely radiopaque, stones are less dense than contrast so appear radiolucent
What gland should sialograpy not be performed in?
Sublingual
What expect to see on sialography if have calculi/ obstruction?
Radiolucent obstruction within duct
Dilation of duct
How does treatment of submandibular calculi vary?
Depends on size, location and mobility of stone
When can intra-oral surgical approach be used?
Stone in anterior 1/3rd of duct
When may basket removal be indicated?
Small and mobile stone
Anterior to mylohyoid bend
When is extra-oral approach taken?
Calculi large
Beyond mylohyoid bend
What is basket removal?
Intra-ductal technique under LA
How is basket removal carried out?
Closed helical wire inserted into duct opening
Advance wire past calculi
Open wire
Calculus snared in basket and drawn duct opening
Calculi released w/ small papillotomy incisor
Complication basket remova;?
Pain and swelling spot proceudre
Failure remove stone - esp if >1cm
Basket stuck in duct
Persistent symptoms
Why can symptoms carry on after calculus removed by basket
Possible ductal stenosis post incision
What common see sialography of parotid?
Strictures and narrowing of duct
How to treat parotid strictures?
Balloon-dilation
How to treat parotid strictures?
Balloon-dilation if extra-glandular
Superficial parotidectomy intra-glandular
How treat parotid stones?
Surgical excision - if at duct opening
Basket retrieval - if in extra-glandular duct
Superficial parotidectomy/ lithotripsy - if in gland parenchyma
What is lithotripsy?
Way to shatter stones using sound waves
How is balloon-dialtion carried out
Intra-ductal procedure under LA
Articaine mixed iodinated contract - allows identification stricture site
Technique of balloon dilation?
Parotid papilla dilated using lacrimal probe
Insert angioplasty balloon along duct
Balloon positioned across stricture using x-ray gudiance
Inflated 90 sec - can do 2/3 inflation
What are associated complication of balloon dilation?
Stricture can be too tight to pass balloon
Uncomfortable even with LA
Some strictures all not dilate
Re-stenosis
How do salivary gland tumours present?
Slow-growing solid masses
What features of salivary gland tumour would be indicative of malignancy?
Rapid growth
Fixation to skin/ underlying tissue
Pain
If in parotid - facial nerve weakness
Rule of thumb regarding salivary gland malignancy?
Smaller gland higher risk of malignancy
e.g
Sublingual 85% malignant
Minor salivary gland 50% malignant
Which gland is most likely to have malignant tumour?
Sublingual
What are two common benign salivary gland tumour?
Pleomorphic adenoma
Warthins tumour
What salivary gland tumour only occurs in parotid?
Warthin’s tumour
Most common benign salivary gland tumour?
Pleomorphic adenoma
Most common parotid
Can pleomorphic adenoma be malignant?
Small malignant transformation rate
When is it more likely to see Warthin tumour?
Tail of parotid
Elderly - over 60
Smokers
Males (2:1)
How can Warthins tumours present clinically?
10-15% bilateral
How do benign salivary gland lesions present imaging?
Well defined solid mass
Smooth/lobulated margin
How do malignant salivary gland lesion present on imaging?
Infiltrative
Speculated margin - ill-defined
Which salivary gland are lymph nodes found in?
Parotid - not submandibular or lingual
Why are nodes found in parotid?
Parotid is encapsulation after the development of lymphatic system - submand/lingual encapsulated before
What differential can be given to a parotid gland mass that isn’t given to submandbiualr/lingual mass?
Pathological intra-parotid lymph nodes
