Sialogram: The Procedure, Uses, Risks

What is contrast radiography? Explain sialography in detail.
Answer:

Contrast Radiography: Contrast radiography is a technique in which radiopaque substances namely the contrast media is used to enhance the absorption or transmission of the X-rays to increase the contrast and density of the subject of interest to meet specific diagnostic needs.

Different types of contrast radiography are:

1. Sialography
2. Lymphangiography
3. Arthrography
4. Angiography
5. Urography

Contrast Radiography Sialography:

Read And Learn More: Oral Medicine and Radiology Question And Answers

Sialography Definition: Sialography is a contrast radiographic procedure which involves the use of retrograde filling of the radiopaque contrast media, performed for the detection of disorders of the major salivary glands.

Sialography Contrast Agents:

• Ideal requirements:
  • Safe to use and handle
  • Nontoxic
  • Easily excreted from the body
  • No residual side effects
  • No penetration through the cell membrane or blood-brain barrier
  • Limited transfer of breast milk and placental passage
  • Low viscosity to ensure rapid injection and avoid microcirculatory problems.

Contrast Agents Used In Sialography:

• Iodized, lipid soluble contrast media:
  • Ethiodal
  • Lipoidal

Sialography Advantages:

• A satisfactory degree of radiographic opacification
• Good resolution of peripheral ducts.

Magnetic Imaging Resonance

Sialography Disadvantages:

• Discomfort to patients
• Retention in case of overfilling
• Inflammation, granuloma, and fibrosis
• Water soluble organic iodine compounds:
  • Hypaque 50, 73
  • Omnipaque
  • Conray 420

Water soluble organic iodine Advantages:

• Permits filling of the finer duct system
• Rapidly removed from tissues.

Water soluble organic iodine Disadvantages:

• Radiographic contrast is low
• Immediate radiographs after installation of the medium is needed.

Contrast Sialography Equipment:

• Polyethylene tubing
• 5-10 mL syringe
• Lacrimal dilator
• Contrast medium
• Lemon slices (sialogogue).

Contrast Sialography Procedure:

• Identification of duct orifices
• Exploration of the duct with a lacrimal probe
• Cannulation of the duct:
  • The duct orifice is enlarged to insert a salivary cannula
• Introduction of radiographic dye.

Slow injection with the quantity assessed by fluoroscopic observation and is stopped when the patient feels fullness.

0.76-1 mL dye for the parotid gland and 0.5.0.75 mL dye for the submandibular gland.

Three Stages of the Procedure:

1. Ductal phase: The duct orifice is dilated and cannulated to inject the contrast agent. A radiograph is taken to assess the major duct.
2. Acinar phase: Both the duct and the gland parenchyma are filled with the contrast agent.
3. Evacuation phase: The cannula needs to be removed, and the patient should thoroughly rinse for 2-3 minutes. A radiograph should be taken

Radiographic View:

Contrast Sialography Interpretation:

• Normal parotid gland: Leafless tree or tree in winter appearance.
• Normal submandibular gland: Bush in winter
• Sjogren’s syndrome: “Cherry blossom” or “branchless—fruit-laden tree”
• Chronic Inflammation: Punctate sialactasis
• Tumor: Ball in-hand appearance

Contrast Sialography Indications:

• To detect:
  • Sialolith or foreign bodies are seen as filling defects.
  • Fistula, diverticula, strictures, stenosis of the duct.
  • Recurrent swelling and inflammatory processes.
  • Tumor location, size, and origin.
  • The extent of glandular destruction.
  • Ductal architecture and to detect ductal pathology.

Contrast Sialography Contraindications:

• Salivary gland inflammation
• Patients allergic to iodine
• Salivary calculus closer to duct orifice.