1. MRD 651
SIALOGRAPHY

2. LEARNING OUTCOME
At the end of the session, the students should be able to:
Define sialography.
Describe the indications and contraindications for sialography.
Briefly describe pre and post patient care for the procedures.
Briefly discuss patient positioning for routine images sequences including radiation protection and image characteristics.
Identify related equipments use.
Identify the role of the technologist before, during and after the procedure.
Identify all the related structures on radiographs, diagrams and other images produced in routine projections/view in sialography.

3. INTRODUCTION
A radiographic procedure use to study the salivary ducts/glands with the aids of contrast.
Commonly done to evaluate the parotid and sub-mandibular gland.
Is it common nowadays?
What about the sublingual gland?
If the patient refuse to undergo sialography, any other options to evaluate the glands pathology?

4. ANATOMY OF THE GLAND

5. INDICATIONS Ductul obstructions due to stones (Sialolithiasis)
Ductul obstructions(tumor)
Dialodenitis(duct inflamm) and sialodochitis(gland inflamm)

6. CONTRAINDICATIONS Total obstructions Allergies to contrast media
Severe infections of the glands
Total obstructions
Allergies to contrast media

7. PATIENT PREPARATION
Make sure patient aware of discomfort during the procedure
Explain the procedure carefully
Take of any dentures or metal at the head and neck area.
Take consent

8. EQUIPTMENTS FLUOROSCOPY UNITS CANNULA(NEEDLE, TUBE OR ANGIOCATHETER)
USUALLY 1F/S
CANNULA(NEEDLE, TUBE OR ANGIOCATHETER)
CONNECTING TUBES
DUCT'S DILATORS
SYRINGE (5ml)
OVERHEAD LAMPS/TORCHLIGHT
GAUZES
TAPE
LEMON OR LIME JUICE

9. Parotid Gland: AP and LATERAL mandible
PRELIMANARY FILMS
Parotid Gland: AP and LATERAL mandible
LATERAL & LATERAL OBLIQUE
Ref: Clark: Whitley A., S., Sloane C. et al. (2005) Positioning in Radiography.(12th edn.). Horder Arnold. London.

10. AP MANDIBLE
Ref: Clark: Whitley A., S., Sloane C. et al. (2005) Positioning in Radiography.(12th edn.). Horder Arnold. London.

11. PRELIMANARY FILMS
Submandibular Glands: AP, LATERAL, LATERAL OBLIQUE and OCCLUSAL VIEW
OCCLUSAL
Ref: Clark: Whitley A., S., Sloane C. et al. (2005) Positioning in Radiography.(12th edn.). Horder Arnold. London.

12. QUESTIONS Is it all prelim necessary?
The prelim taken using II/Fluoro or conventional x ray?
What is the different of using II/Fluoro and conventional x-ray for preliminary film?

13. STEPS OF PROCEDURE Prepare the room
Call and explain the procedure to the patients
Only change the shirt
Patient supine comfort rest on the table with slight head tilt and chin up
Prelim films taken
Equipment prepared
Open mouth, dilator placed at the duct's orifice.

14. STEPS OF PROCEDURE
Close the mouth, attached the syringe filled with CM and injected into the duct
The II used to screen the mandible area.
CM inserted slowly. no force should be applied.
Lime is given to expel the contrast from the ducts.
SO, WHEN WILL THE TORCHLIGHT, CONNECTING TUBES, GAUZE AND TAPE ARE USED?

15. IMAGE PROCESSING/SELECTION
The image is depend on radiologist preferable
Usually taken at the site of obstruction/pathologic.
Commonly AP, LATERAL or LATERAL OBLIQUE.
Contrast injected to show opacity of the gland's route
WHEN WILL THE TANGENTIAL VIEW IS NECESSARY?

16. RELATED PATHOLOGY
Diffuse stricture before entrance of parotid gland hilum. B. After ballooning
Ref: Adam. A. & Dixon A. K. (2008). Diagnostic Radiology: A textbook of Medical Imaging. (5th edition) Elsevier. China

17. RELATED PATHOLOGY
A. STRICTURE C. Radiolucent stone

18. RADIATION PROTECTIONS
Reduce fluoro screening time
Gonadal and thyroid shielding
Effective communication and explaination to the patients
Optimum exposure applied
Make sure the door is lock
Collimation of the fluoro during screening

19. POST PROCEDURE CARE
Inform the patient to take lime to take out the remaining CM in the gland
Risk of localize swelling may occur
Inform if any bleeding or problem arise after the procedure.

20. CONCLUSION Sialography – study of the gland
XInvasive and simple procedure

21. Q AND A SESSION
Q1.
WHAT WILL HAPPEN IF THE CONTRAST SPILL INSIDE THE MOUTH?
ANY ACTIONS NEED TO BE TAKEN?
Q2.
CAN THE PROCEDURE DONE FOR PAEDIATRICS PATIENTS?
CAN IT BE DONE DURING THE PATIENTS SLEEP/UNDER GA?
Q3.
WHAT IS THE SIZE OPTIONS OF THE DILATORS?
THE UNITS?