sialography spring 2011 final

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Sialography Sialography Spring 2011 Spring 2011 FINAL FINAL

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Salivary Glands

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Page 1: Sialography Spring 2011 FINAL

SialographySialography

Spring 2011Spring 2011FINALFINAL

Page 2: Sialography Spring 2011 FINAL

Salivary GlandsSalivary Glands

Page 3: Sialography Spring 2011 FINAL

Parotid GlandParotid Gland _______ of the glands_______ of the glands

Consists of ________ Consists of ________ superficial portionsuperficial portion

___________ shaped ___________ shaped deep portiondeep portion

Parotid ductParotid duct– ______________________________________

Page 4: Sialography Spring 2011 FINAL

Submandibular GlandSubmandibular Gland

____________ shaped____________ shaped

Extends posteriorly Extends posteriorly from ________molar from ________molar to almost _________ to almost _________ of mandibleof mandible

Page 5: Sialography Spring 2011 FINAL

Sublingual GlandSublingual Gland _________________pair_________________pair

Located at floor of mouth Located at floor of mouth beneath _____________beneath _____________

In contact with the In contact with the mandible laterallymandible laterally

Extends posteriorly from Extends posteriorly from the side of _________ to the side of _________ to _________________duct_________________duct

Main sublingual duct Main sublingual duct opens beside the orifice opens beside the orifice of the submandibular ductof the submandibular duct

Page 6: Sialography Spring 2011 FINAL

SialographySialography

Term applied to radiographic exam of Term applied to radiographic exam of salivary glands salivary glands – Only __________________done at a timeOnly __________________done at a time

– CT and MRI have largely replaced this exam forCT and MRI have largely replaced this exam for Salivary stone or lesion is suspectedSalivary stone or lesion is suspected

– Used when a definitive diagnosis is necessary Used when a definitive diagnosis is necessary for a problem with one of the salivary ductsfor a problem with one of the salivary ducts

Page 7: Sialography Spring 2011 FINAL

Indications Indications ________________________________________________

________________________________________________

________________________________________________

________________________________________________

__________________________________________________

Page 8: Sialography Spring 2011 FINAL

Tumors of Salivary GlandsTumors of Salivary Glands

Page 9: Sialography Spring 2011 FINAL

RanulaRanula

Page 10: Sialography Spring 2011 FINAL

InfectionsInfections

Page 11: Sialography Spring 2011 FINAL

StricturesStrictures

Page 12: Sialography Spring 2011 FINAL

Salivary Gland CalculiSalivary Gland Calculi

Page 13: Sialography Spring 2011 FINAL

Salivary StonesSalivary Stones

Page 14: Sialography Spring 2011 FINAL

Sialogram Tray and suppliesSialogram Tray and supplies

Page 15: Sialography Spring 2011 FINAL

Contrast MediaContrast Media

________________________________________________– When tomography may be usedWhen tomography may be used– Contraindicated if there is a chance of stones Contraindicated if there is a chance of stones

________________________________________________– Stones and stricturesStones and strictures– 1-2ml1-2ml

Page 16: Sialography Spring 2011 FINAL

ProcedureProcedure1.1. Obtain preliminary radiographsObtain preliminary radiographs

• Any condition that is visibe w/o contrastAny condition that is visibe w/o contrast• Optimum technique obtainedOptimum technique obtained

2.2. _____ before procedure give patient _________ before procedure give patient ____

3.3. Contrast media injected into main ductContrast media injected into main duct

4.4. After procedure _______ to clear contrastAfter procedure _______ to clear contrast

5.5. _____min after procedure take radiograph_____min after procedure take radiograph

Page 17: Sialography Spring 2011 FINAL

Procedure DifferencesProcedure Differences

1.1. Most manually inject contrastMost manually inject contrast– ________________________________________________

2.2. Others use hydrostatic pressureOthers use hydrostatic pressure– ____________________________________________________________________– ____________________________________________________________________– ____________________________________________________________________

3.3. Some inject under fluoro and obtain spot Some inject under fluoro and obtain spot radiographsradiographs

Page 18: Sialography Spring 2011 FINAL

Radiation SafetyRadiation Safety Have shields for PT’s, DR and yourselfHave shields for PT’s, DR and yourself

Question LMP and the possibility of being pregnantQuestion LMP and the possibility of being pregnant

Use cardinal rulesUse cardinal rules– TimeTime– DistanceDistance– ShieldingShielding

ALARAALARA– Use pulse if possibleUse pulse if possible– Save the last image on screen when possibleSave the last image on screen when possible

Page 19: Sialography Spring 2011 FINAL

Tangential SupineTangential Supine

Rotate pt head toward side being Rotate pt head toward side being examined so that parotid gland is examined so that parotid gland is perp to plane of IRperp to plane of IR

Rest head on occipitusRest head on occipitus

Center IR to parotid areaCenter IR to parotid area

Mandibular ramus parallel with Mandibular ramus parallel with longitudinal axis of the IRlongitudinal axis of the IR

Fill mouth with air and puff cheeksFill mouth with air and puff cheeks

CR perp to plane of IR along lateral CR perp to plane of IR along lateral surface of the ramussurface of the ramus

Page 20: Sialography Spring 2011 FINAL

TangentialTangential Prone Prone

Rotate pt’s head away from Rotate pt’s head away from side being examinedside being examined

Rest pt’s head on chinRest pt’s head on chin– Forehead and nose if parotid Forehead and nose if parotid

duct does not need to be duct does not need to be seenRotate pt head toward seenRotate pt head toward side being examined so that side being examined so that parotid gland is perp to plane parotid gland is perp to plane of IRof IR

Center IR to parotid areaCenter IR to parotid area

Mandibular ramus parallel with Mandibular ramus parallel with longitudinal axis of the IRlongitudinal axis of the IR

Fill mouth with air and puff Fill mouth with air and puff cheekscheeks

CR perp to plane of IR along CR perp to plane of IR along lateral surface of the ramuslateral surface of the ramus

Page 21: Sialography Spring 2011 FINAL

Tangential RadiographTangential Radiograph

Soft tissue dentisySoft tissue dentisy

Most of parotid gland Most of parotid gland lateral to and clear of lateral to and clear of ramusramus

Mastoid overlapping Mastoid overlapping only the upper portion only the upper portion of parotid glandof parotid gland

Page 22: Sialography Spring 2011 FINAL

Lateral ParotidLateral Parotid Affected side close to the Affected side close to the IRIR

Extend mandible to clear Extend mandible to clear c-spinec-spine

Center IR 1” superior to Center IR 1” superior to angleangle

Head 15 degrees from Head 15 degrees from MSP toward IRMSP toward IR

CR 1” superior to angleCR 1” superior to angle

Oblique often used as Oblique often used as wellwell

Page 23: Sialography Spring 2011 FINAL

Lateral Parotid RadiographLateral Parotid Radiograph

Mandibular Rami free Mandibular Rami free from overlap of c-spinefrom overlap of c-spine

Parotid gland SI over Parotid gland SI over the ramusthe ramus

Axiolateral oblique of Axiolateral oblique of mandible can be usedmandible can be used

Page 24: Sialography Spring 2011 FINAL

LateralLateralSubmandibularSubmandibular

Center IR to inferior Center IR to inferior margin of anglemargin of angle

PT head in true lateralPT head in true lateral

CR at inferior margin CR at inferior margin of angleof angle

Page 25: Sialography Spring 2011 FINAL

Lateral Submandibular Radiograph Lateral Submandibular Radiograph and Lateral obliqueand Lateral oblique

Rami free from overlap Rami free from overlap of C-spineof C-spine

SI mandibular rami if SI mandibular rami if no angualtion is usedno angualtion is used

Axiolateral oblique of Axiolateral oblique of mandible for better mandible for better demonstrationdemonstration

Page 26: Sialography Spring 2011 FINAL

Axiolateral Oblique for Axiolateral Oblique for SubmandibularSubmandibular

Page 27: Sialography Spring 2011 FINAL

SialogramsSialograms