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Sialography. Spring 2009 DRAFT. Salivary Glands. Parotid Gland Sublingual gland Submandibular gland. Parotid Gland. Largest of the glands Consists of flattened superficial portion and wedge shaped deep portion Parotid duct Conduct saliva from gland to the mouth. Submandibular Gland.

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sialography

Sialography

Spring 2009

DRAFT

salivary glands
Salivary Glands
  • Parotid Gland
  • Sublingual gland
  • Submandibular gland
parotid gland
Parotid Gland
  • Largest of the glands
  • Consists of flattened superficial portion and wedge shaped deep portion
  • Parotid duct
    • Conduct saliva from gland to the mouth
submandibular gland
Submandibular Gland
  • Irregularly shaped
  • Extends posteriorly from first molar to almost angle of mandible
sublingual gland
Sublingual Gland
  • Smallest pair
  • Located at floor of mouth beneath sublingual fold
  • In contact with the mandible laterally
  • Extends posteriorly from the side of frenulum to submandibular duct
  • Main sublingual duct opens beside the orifice of the submandibular duct
sialography6
Sialography
  • Term applied to radiographic exam of salivary glands
    • Only one gland done at a time
    • CT and MRI have largely replaced this exam for
      • Salivary stone or lesion is suspected
    • Used when a definitive diagnosis is necessary for a problem with one of the salivary ducts
indications
Indications
  • Tumors
  • Inflammatory lesions
  • Determine extent of salivary fistulae
  • Localize diverticulae strictures and calculi
  • Salivary duct obstruction
procedure
Procedure
  • Obtain preliminary radiographs
    • Any condition that is visibe w/o contrast
    • Optimum technique obtained
  • 2-3 min before procedure give patient lemon
  • Contrast media injected into main duct
  • After procedure suck on lemon to clear contrast
  • 10 min after procedure take radiograph
procedure differences
Procedure Differences
  • Most manually inject contrast
    • Using cannula or catheter
  • Others use hydrostatic pressure
    • Contrast solution barrel plunger removed
    • Attached to drip stand
    • 28” above pt’s mouth
  • Some inject under fluoro and obtain spot radiographs
radiation safety
Radiation Safety
  • Have shields for PT’s, DR and yourself
  • Question LMP and the possibility of being pregnant
  • Use cardinal rules
    • Time
    • Distance
    • Shielding
  • ALARA
    • Use pulse if possible
    • Save the last image on screen when possible
tangential supine
Tangential Supine
  • Rotate pt head toward side being examined so that parotid gland is perp to plane of IR
  • Rest head on occipitus
  • Center IR to parotid area
  • Mandibular ramus parallel with longitudinal axis of the IR
  • Fill mouth with air and puff cheeks
  • CR perp to plane of IR along lateral surface of the ramus
tangential prone
Tangential Prone
  • Rotate pt’s head away from side being examined
  • Rest pt’s head on chin
    • Forehead and nose if parotid duct does not need to be seenRotate pt head toward side being examined so that parotid gland is perp to plane of IR
  • Center IR to parotid area
  • Mandibular ramus parallel with longitudinal axis of the IR
  • Fill mouth with air and puff cheeks
  • CR perp to plane of IR along lateral surface of the ramus
tangential radiograph
Tangential Radiograph
  • Soft tissue dentisy
  • Most of parotid gland lateral to and clear of ramus
  • Mastoid overlapping only the upper portion of parotid gland
lateral parotid
Lateral Parotid
  • Affected side close to the IR
  • Extend mandible to clear c-spine
  • Center IR 1” superior to angle
  • Head 15 degrees from MSP toward IR
  • CR 1” superior to angle
  • Oblique often used as well
lateral parotid radiograph
Lateral Parotid Radiograph
  • Mandibular Rami free from overlap of c-spine
  • Parotid gland SI over the ramus
  • Axiolateral oblique of mandible can be used
lateral submandibular
LateralSubmandibular
  • Center IR to inferior margin of angle
  • PT head in true lateral
  • CR at inferior margin of angle
lateral submandibular radiograph and lateral oblique
Lateral Submandibular Radiograph and Lateral oblique
  • Rami free from overlap of C-spine
  • SI mandibular rami if no angualtion is used
  • Axiolateral oblique of mandible for better demonstration
review
Review

A

A

E

B

C

D

review23
REVIEW

A

B

E

C

F

D