Download - Salivary gland imaging
SALIVARY GLAND IMAGINGINDICATIONS OF IMAGING:
Whether inflammatory disease or neoplasmDiffuse disease or focal suppurative diseaseAny sialoliths, ductal morphologyAnatomic location of tumor, selection of biopsy site
STRATEGIES FOR DIAGNOSTIC IMAGING:
1. PROJECTION RADIOGRAPH2. CONVENTIONAL SIALOGRAPHY
PROJECTION RADIOGRAPH Cost benefit Demonstrate sialoliths & possible involvement of adjacent osseous structure
INTRA ORAL RADIOGRAPH:Anterior 2/3rd submandibular duct by- OCCLUSAL PROJECTION Posterior part demonstrated by- LATERAL OBLIQUE VIEWParotid sialoliths are more difficult to demonstrate
EXTRA ORAL RADIOGRAPH:It has less value as sialoliths are superimposed over the ramus or body of mandibleTo demonstrate sialoliths in the submandibular gland, the lateral projection is modified by opening mouth extending chin and depressing tongue by index finger. This improves image of sialolith by moving it inferior to the mandibular border
SIALOGRAPHY – IT IS A RADIOGRAPHIC TECHNIQUE WHERE A RADIOGRAPHIC CONTRAST AGENT IS INFUSED BEFORE
IMAGING WITH PLAIN FILMS/DIGITAL IMAGE RECEPTORS, FLUOROSCOPY, PANAROMIC
RADIOGRAPH, CBCT, MDCTADVANTAGES- Multiplanar & three dimensional visualization and ability to remove overlapping.
INDICATIONS- Tumours, Inflammatory lesions, Determination the extent of salivary fistulae, Salivary
duct obstructionCONTRAINDICATIONS- IT IS CONTRAINDICATED IN ACUTE INFECTION & IN CASE OF PATIENT ALLERGIC
TO IODINE / CONTRAST MEDIUM
SIALOGRAPHIC PROCEDURE-- 1.Dilate ductal orifice 2.Canula connected to syringe containing contrast medium(Lipid soluble-Ethiodol,Water soluble-Sinografin) 3. Inject 4. Allowed for 5 minutes without stimulation 5. Take radiograph
Projection radiograph of the submandibular region in AP (A) and lateral oblique (B) projection showing soft tissue swelling associated with a small calculus (arrow) visible on lateral
oblique view taken with depressed tongue
CBCTINDICATIONS: Evaluating structures in and adjacent to salivary glandADVANTAGES: Differentiates osseous structure from soft tissueMinimal calcified lesion is well depicted3D visualizationDISADVANTAGES: Cannot resolve in differences b/w soft tissue densities
MDCT
INDICATIONS: Useful in evaluating structures in and adjacent to the salivary gland
ADVANTAGES: It displays both soft and hard tissues and minute differences in soft tissue densitiesDISADVANTAGES:Not recognize as sensitive study for Salivary tumors
MAGNETIC RESONANANCE IMAGING
INDICATIONS: Radio opaque soft tissue lesionsADVANTAGES: Excellent soft tissue resolution with ability to differentiate osseous structure from soft tissueNo radiation burdenDISADVANTAGES: Dental scatterContraindicated in pacemaker, metal implant
ULTRASONOGRAPHYINDICATIONS: Biopsy guidance mass detectionADVANTAGES: Non invasiveCost effectiveDISADVANTAGES: Limited visibility to deeper portions of glandNo morphological information
SOME IMAGING MODALITIES
1-Plain radiograph of the submandibular region in AP (A) and lateral oblique (B) projection showing soft tissue swelling associated with a small calculus (arrow) visible on lateral oblique view taken with depressed tongue
MDCT image shows a sialolith in the submanibular(wharton’s) duct T2-weighted image,left parotid tumor shoeing high signal with central necrosis suggestive of granulomatous disease
HRUS images show altered echopattern of the parotid gland with ductal dilatation (thin arrow) and small calculus (thick arrow) at its terminal end
By- SK AZIZ IKBALFinal Year ( 2015-16)DEPT. OF ORAL MEDICINE & RADIOLOGY & DIAGNOSISGuided by – Dr. ANIRBAN DAS