CHAPTER…
SIALOGRAPHY
Chapter 10: Sialography: Illuminating the Salivary System
Introduction
Sialography is a vital radiological procedure designed to provide detailed imaging of the salivary
glands and their associated ductal systems. This chapter explores the nuances of sialography, its
clinical significance, procedural intricacies, and the information it offers to healthcare
practitioners.
Section 1: Understanding the Salivary System
To comprehend the significance of sialography, it is crucial to first grasp the anatomical and
physiological aspects of the salivary glands. These glands, including the parotid, submandibular,
and sublingual glands, play pivotal roles in oral health and digestion.
Section 2: Purpose and Indications
Sialography serves as an indispensable diagnostic tool for a range of salivary gland disorders. It
is particularly valuable in assessing obstructive disorders, detecting stones or strictures, and
evaluating ductal abnormalities. Understanding its indications allows for targeted utilization in
clinical practice.
Section 3: Preparing for Sialography
Effective patient preparation is essential for a successful sialographic procedure. This involves
providing clear instructions, including fasting requirements and the importance of informed
consent. Additionally, being aware of any contraindications or precautions is critical in ensuring
patient safety.
Section 4: The Sialographic Procedure
Executing a sialographic examination involves a series of carefully orchestrated steps. It
necessitates the use of specialized equipment, including contrast agents and radiographic
imaging modalities. Proper patient positioning is paramount to obtain optimal images of the
salivary glands and ducts.
Section 5: Interpreting Sialographic Images
Interpreting sialographic images demands a discerning eye and a comprehensive understanding
of normal and abnormal findings. This section guides practitioners in recognizing common
pathologies, such as sialolithiasis, strictures, and ductal dilatation. Emphasis is placed on
correlating radiographic findings with clinical symptoms for accurate diagnosis.
Section 6: Potential Complications and Follow-up Care
While sialography is generally considered safe, being prepared for potential complications is
essential. This section outlines strategies for managing adverse events and highlights the
significance of post-procedural care and follow-up.
Section 7: Advancements in Sialography
As technology continues to advance, so do the techniques and tools employed in sialography.
This section touches on emerging trends and innovations, including the integration of digital
imaging technologies and the potential for three-dimensional reconstructions.
Conclusion
Sialography stands as a cornerstone in the diagnostic repertoire of radiology, providing
indispensable insights into the health and function of the salivary glands. Armed with the
knowledge gleaned from this chapter, healthcare practitioners are better equipped to leverage
sialography effectively in the assessment and management of salivary gland disorders. Every
sialographic image tells a unique story, guiding clinicians towards accurate diagnoses and
personalized patient care.
Note: The information presented in this chapter is based on general knowledge and does not
directly quote or paraphrase specific sources. It is intended to provide a comprehensive overview
of sialography for educational purposes.
It is the radiographic study to demonstrate the ductal anatomy of various salivary glands
parotid/submandibular glands and
their ducts by the injection of contrast into their duct system.


It can be conventional / CT/ MR sialography
We shall discuss conventional sialography as it is most commonly asked in exams.
Indications

suspected salivary duct obstruction or sialolithiasis

Suspected ductal strictures

Recurrent pain and unyielding usg report.
Types of sialography
1.
conventional/fluoroscopic sialography
2.
CT sialography
3.
MR sialography
Procedure
Technique ( Conventional sialography)

Patient is given lemon juice/ secretagogues to increase salivary secretions 2-3 minutes
before the procedure
o
To make the salivary duct opening conspicuous for cannulation

Scout image/ Control images: serves as baseline and detects any radiopaque calculus.

Supine position : to detect any radiopaque calculi
o

Lateral oblique and anteroposterior views, using tongue depressors for submandibular
Cannulation
o
21 gauge catheter for Stensen's duct

o
located near the crown of the second upper molar in the buccal mucosa
24 or 27 gauge for Wharton's duct

at the base of the frenulum of the tongue
Volume: about 2 mL of iohexol is instilled

Avoid air into the salivary ducts, as it can mimic a ductal calculus on sialography
Advantages

Accurate delineation of second- and third-order branches

Provides roadmap for sialoendoscopy for removal of sialoliths
Disadvantages

Invasive nature of procedure

High failure rates:
o
lack of skill, inability to cannulate, lack of patient compliance, pain, etc.

Radiation exposure

Potential allergic reaction
Normal sialography of submandibular gland
Sialography: showing stricture in the duct
(Image Courtesy:
https://www.urmc.rochester.edu/imaging/specialties/procedures/sialogram.aspx)