MRD 651 SIALOGRAPHY

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.

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?

ANATOMY OF THE GLAND

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

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

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

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

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.

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

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.

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?

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.

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?

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?

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

RELATED PATHOLOGY A. STRICTURE C. Radiolucent stone

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

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.

CONCLUSION Sialography – study of the gland XInvasive and simple procedure

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?