Lecture

Sialography, Dacro-cystography
Anatomy of the salivary glands
Anatomy of the salivary glands
• Accessory organ of digestion
• Secretes most of the saliva in the oral cavity and help to
dissolve food and facilitate digestion
• The glands communicate with the mouth via ducts
• Each gland composed of numerous small lobes that make up
large lobes of the gland
• Small lobes contain small ductules that combine to form larger
branches that unite to form major ducts that empty into the oral
cavity
Anatomy of the salivary glands
• Parotid gland
• Located anterior and
inferior to the ears
• The largest of the salivary
glands
• Stensen’s duct
Anatomy of the salivary glands
• Submandibular gland
• Second largest glands
• Located medial and
inferior to the body of the
mandible
• Wharton’s duct
Anatomy of the salivary glands
• Sublingual
• Smallest of the glands
• Located beneath the
mucous membrane of the
floor of the mouth directly
beneath the sublingual fold
• 12 small Ducts of Rivinus
• 1 or 2 of these ducts are
larger in size (Bartholin’s
duct/s) and may connect
with the submandibular
duct.
Sialography
Definition
Radiographic examination of the salivary glands
following the injection of contrast medium:
• The glands and ducts include the sublingual gland
and ducts; The submandibular glands and duct; the
parotid gland and duct
• The sublingual rarely investigated radiographically
because of difficulty accessing the ducts
Indications
• Inflammatory lesions (obstructive or non-obstructive) with symptoms
of recurrent pain or swelling in the area of the parotid or
submandibular glands.
• Palpable mass in the area of the glands
• Symptoms of calculi
• Dryness of the mouth of unknown origin
• Strictures
• Tumours within the ducts
• Dilation of a duct
• Fistula
Contraindications
• Known allergy to the contrast medium
• Parotitis (Mumps) which is a viral disease affecting primarily
the parotid gland.
• Any kind of inflammation or infection of the gland and ducts
Patient preparation
• No premedication or fasting necessary
• Procedure and its complications should be explained to the
patient.
• All dentures and radio-opaque items such as jewelry to be
removed from the head and neck
• Informed consent is signed
Injection procedure
• Of the 3 pairs of salivary glands, only the parotid and
submandibular glands are examined using contrast medium
• The sublingual gland is not examined by contrast medium
because of the difficulty in locating the orifice of
Bartholin’s duct and in distinguishing it from Wharton’s
duct.
Injection procedure
• Prior to catheterization of the ducts, the patient is directed
to suck on a lemon wedge.
• This stimulates the secretion of saliva and consequent
opening of the ducts
• Where the duct is not sufficiently open, then it is dilated
using a blunt-tipped needle probe
Injection procedure
• When the duct is located and dilated, it is then catheterized
and contrast is injected at low pressure via a syringe
• The contrast is injected until the patient experiences
pressure or pain within the gland
• When the gland and ducts are full of contrast medium,
the syringe is disconnected and the catheter clamped to
prevent escape of the contrast medium
• 0.5 to 1.5 mls of contrast for the parotid
• 0.2 to 0.5 mls for the submandibular
Positioning – Parotid gland
• True AP or PA with the central ray directed through the ramus of the
mandible of the affected side
• True lateral (which is a universal view for all 3 glands; central ray
directed through the parotid gland
• Tangential AP projection with the head rotated 10-15° toward the
affected side
• The patient may be asked to puff the cheek out with air to provide a
background of air around the contrast –filled duct for better visualization
Positioning- Parotid gland

Anterior-Posterior Lateral
Positioning – parotid gland
• Lateral oblique with the patient’s head tilted 35° toward the
affected side from the true lateral to project the body of the
opposite side away from the area
• the central ray is directed through the parotid gland of
interest
• Once the contrast images are completed the patient is given
a lemon wedge, and following expectoration of saliva and
contrast medium, a post-drainage image is taken to complete
the study
Positioning- Submandibular glands
• A true lateral of the mandible with the central ray directed
through the area of the gland
• A lateral oblique with the central ray through the area of the
gland
• Optional projections include the Submento-vertical (SMV)
and a Water’s position.
Positioning- Submandibular glands
Dacrocystography
• Radiographic
examination of the
lacrimal system following
introduction of contrast
medium
Anatomy of the lacrimal system
Comprises:
• Lacrimal gland which
secretes tears
• Lacrimal sac and the
ducts through which tears
pass into the nasal cavity
Anatomy of the lacrimal system
• The lacrimal gland lies anteriorly
in the upper outer quadrant of
the orbit
• Communicates with the lacrimal
sac via the lacrimal canaliculi
• Tears wash over the surface of
the eye and drain through the
canaliculi into the lacrimal sac
through 2 openings (puncta
lacrimalia situated on the medial
aspects of the upper and lower
eyelids
Anatomy of the lacrimal system
• The lacrimal sac drains
into the naso-lacrimal
duct which opens into
the nasal cavity below
the inferior nasal concha
Indications
• Complete obstructions: determination of the exact location
of an obstruction (common canaliculus, sac)
• Incomplete obstructions and intermittent tearing: location of
the stenosis; diverticuli; stones
• Failed lacrimal surgery: size of the sac
• Suspicion of sac tumors
• Cases of epiphora (watery eyes) to demonstrate the
presence and extent of obstruction
Patient preparation
A small quantity of local anaesthetic is dropped into the inner
canthus of the eye prior to cannulation of the punctum
lacrimalia
Procedure
The lower punctum is dilated using a dilator, and the tip of the
lacrimal cannula is inserted through the punctum into the
lacrimal canaliculus
• 1-2 mls of non-ionic, water-soluble contrast medium is
injected
• The injection is terminated when the contrast is observed
spilling into the nasopharynx or when obstruction is
demonstrated
Positioning
• Mento-occipital projection
• Chin raised to bring the
BBL at 30° to the
horizontal
• The beam is centered 2
cm below the inner
canthus of the eye of the
side under investigation