salivary glands radiology. Definition of Salivary Gland Disease. Dental diagnosticians have responsibility for detecting disorders of the salivary glands A familiarity with salivary gland disorders and
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applicable current imaging techniques is an essential element of the clinician ’ s armamentarium .
condition of the patient may provide important information.
the use of more sophisticated and expensive imaging techniques .
supported by a compatible history, suggests the presence of sialoliths
(stones or calculi).
ray directed in an anterior direction through the angle of the mandible, with the patient ’ s head tilted to the unaffected side and rotated back .
can be imaged on an intraoral film.
Periapical radiographs of the same case. Theradiopaque calculus can be localized lingual to the teeth by applying appropriate object localizationrules
gland, the lateral projection is modified by opening the mouth, extending the chin, and depressing the tongue with the index finger.
contrast solution into the ductalsystem .
until the patient feels discomfort (usually between 0.2 and 1.5 ml).
diseases and ductalpathoses. Contraindications include acute
infection, known sensitivity to iodine-containing compounds, and
immediately anticipated thyroid function tests.
SialographyA, Lateral projection of the parotid demonstrating opacificationall the way to the terminal ducts and acini. B, Anteroposterior projection of the same gland demonstrating“ parenchymal blushing ” from acinaropacification.
Sialogram of Normal Submandibular Gland. This lateralview demonstrates parenchymal blushing. Normal fine branching isvisible. Lack of parenchymal blushing at the anteroinferior margin iscaused by radiographic burnout.
CT Images with Soft Tissue Algorithm. A, Axial viewdemonstrating bilateral enlargement of the parotid glands (arrowheads).B, Coronal view of the same patient. The clinical/histopathologicdiagnosis was autoimmune parotitis.
These magnetic resonance images reveal a lymphoepithelial cyst involving the rightparotid gland. This axial T1-weighted image reveals a well-defined circular lesion involving the rightparotid gland with an internal signal isointense to muscle, and the matching T2-weighted image
Scintigraphy. A, 99m Tc-pertechnetatescan of the salivary glands (right and left anterioroblique views) demonstrates increased uptake ofradioisotope in the right parotid gland (blackarrowhead). B, Scintigram taken after administrationof a sialogog (lemon juice) demonstratesretention of isotope in right parotid gland (whitearrowheads). This is a typical presentation of salivarystasis, Warthin tumor, or oncocytoma.
Ultrasonography (US) Image of Right Parotid Gland. Awell-delineated solid mass is suggested by echo returns within thelesion (arrows). US appearance is typical of a benign salivary tumor
** calculus and salivary stones
** Formation of calcified obstruction within salivary gland duct
** Clinical features :
Chronic retrograde infection
Swelling and pain with eating
Major or minor S.G
Usually one S.G involved
Submandibular S.G >> 83% of the cases
* Vary from cigar to oval or round shape
* Homogeneous radiopaque internal structure
** sialography is helpful when obstruction is undetectable on plain RG .
** CT may also detect minimally calcified sialoliths not visible on plain films.
Sialography should not be performed if a radiopaque stone has been shown by plain radiography to be in the distal portion
of the duct
are detected as echo-dense spots in US images
dystrophic calcification of LN
Clinical features :
Untreated acute suppurative infections typically form abscesses.
can affect any of major S.G
causing extensive swelling and culminating in
may be a consequence of un-Tx acute sialadenitis or some types of obstruction .
intermittent swelling, pain when eating,
and superimposed infection resulting from salivary stasis
Sialography is contraindicated in acute infections
in recurrent parotitis and autoimmune disorders
US may distinguish between diffuse inflammation and suppuration
excision of the gland
** sialectasia or dilation of ductal system
** sausage-string appearance of the main
duct and its major branches
Tx : as tx of sialadenitis
a negative fill defect (arrow) representing a noncalcifiedsialolith
and prominent intermittent stricture and dilation of the main and secondary
ducts, which is typical of advanced sialodochitis.
** range from recurrent painless swelling of
the salivary glands (usually the parotid gland) to a stage that includes enlargement of the lacrimal glands
** xerostomia and xerophthalmia
Dry mouth, dry eyes, and rheumatoid disease.
** punctate and globular spheric collection
of contrast agent throughout the G >>>> sialectases
**main duct may appear normal, but the intraglandular ducts may be narrowed or not even evident
** the collections of contrast agent increase in size and are irregular in shape >> cavitarysialectases
** larger cavities of contrast agent and dilation of
the main ductal system may also be present
**Cavitation and glandular fibrosis are the result of recurrent
Lateral projection demonstrates punctatesialectases distribute throughout the gland, which is suggestive of autoimmune sialadenitis. Clinical/histopathologic diagnosis was Sjögren syndrome
Anteroposterior projection of
the same gland.
Punctate (small spheric), globular (larger spheric), and cavitary (larger, irregular) sialectases with some dilation of the main duct are suggestive of advanced autoimmune disease with parenchymal destruction with retrograde infection in lateral (A) and anteroposterior (B) projections. Clinical/histopathologic diagnosis was Sjögren syndrome
Relief of symptoms.
2- Cystic Lesions
3- Benign tumers : Benign Mixed Tumor
4- malignant tumers :
Malignant Mixed Tumor
vitamin deficiencies, and neurologic disorders
sialography>> may show enlarged (splayed duct) or normal S.G
CT and MRI>> provide a more straightforward depiction of the glands but
are nonspecific and require correlation with the clinical findings and history.
increased fluid intake
34-year-old female with hypothyroidism. (a) Digital sialogram right parotid gland shows attenuated main duct and the intraparenchymal branches. (b) Axial T2 weighted image demonstrates symmetrically enlarged parotid glands without any focal lesion
cysts of the salivary gland are rare (less than 5% of all salivary gland mass)
-most commonly occure unilaterally in parotid gland
-they may be congenital(branchial),lymphoepithelial,dermoid or acqurid including mucous retention cysts
-may be intraglandular or extraglandular
These four axial CT and magnetic resonance images depict an adenoid cystic carcinoma of the right submandibular gland. Note
a T2-weighted magnetic resonance image, the high signal of the tumor contrasts with the remaining gland