Sialography

Sialography
Intervention
Sialogram in a patient suspected of Sjögren's syndrome
MeSH	D012796
MedlinePlus	003812

Sialography (also termed radiosialography) is the radiographic examination of the salivary glands. It usually involves the injection of a small amount of contrast medium into the salivary duct of a single gland, followed by routine X-ray projections.^[1]

The resulting diagram is called a sialogram.

Indications

Indications include:

In the evaluation of the functional integrity of the salivary glands
In case of obstructions
To evaluate the ductal pattern
In case of facial swellings, to rule out salivary gland pathology
In case of intra-glandular neoplasms.

Contraindications include:

Persons who are allergic to iodine and/or contrast medium.
Cases where there is acute infection,
patients with thyroid function tests
When calculi are located in anterior part of the salivary gland duct

Procedure

Contrast agents are classified into two groups: fat-soluble contrast agents and water-soluble contrast agents. Water-soluble contrast agents can fill the finer elements of the ductal system. Fat-soluble contrast agents are viscous and can cause allergic reactions. These can also cause discomfort to the patients. Fat-soluble contrast agents do not fill finer elements of the duct.

A baseline radiograph (scout film) of the required salivary gland would be taken, the duct is dilated using graded lacrimal probes, a cannula then is inserted in this salivary gland duct's opening in the mouth, then a Radio-opaque fluid (Contrast medium) is injected in the duct through a small tube.

A series of radiographs would then be taken to determine the flow of the fluid, identify any obstructions and its location, the rate of fluid excretion from the gland.

Usually the radiographs taken are lateral oblique views of the face^[2] as Orthopantomogram's are not useful for the purpose of locating the area due to superimpositions and the way they are taken to put the teeth in the main field.

Interpretation

This study is interpreted by evaluating the morphology of the salivary ducts for obstructions and chronic inflammation. Sialodochitis is a term describing dilation of the ducts caused by repeated inflammatory or infective processes. There is also irregular salivary duct stricture (narrowing) of the duct, which creates an appearance known as "sausage link" pattern on a sialogram. Suggestions of abscesses and autoimmune diseases such as Sjögren syndrome can also be elicited. Sialadenitis is inflammation of the salivary glands, which may cause acinar atrophy and create an appearance known as "pruning of the tree" on a sialogram, where there are less branches visible from the duct system. A space occupying lesion that occurs within or adjacent to a salivary gland can displace the normal anatomy of the gland. This may create an appearance known as "ball in hand" on an sialogram, where the ducts are curved around the mass of the lesion.^[3]

Adverse effects

Like any medical imaging utilizing ionizing radiation, there will be a degree of direct ionizing damage and indirect damage from free radicals created during the ionization of water molecules within cells. The risk of causing the development of a malignant tumor is incredibly small, and is weighed against the benefits of the investigation on a case by case basis.

Possible complications include:

Pain on injection,
Post procedural infection,
Ductal rupture,
Extravasation of contrast media,
Allergic reaction to iodine (which may present with urticaria, dyspnoea, and hypotension).

References

↑ "Sialogram on MedlinePlus". NIH / NLM. Retrieved 18 April 2013.
↑ "Sialography". Medcyclopaedia. GE.
↑ Hupp JR, Ellis E, Tucker MR (2008). Contemporary oral and maxillofacial surgery (5th ed.). St. Louis, Mo.: Mosby Elsevier. pp. 402–405. ISBN 9780323049030.

Surgical procedures involving the digestive system (ICD-9-CM V3 42–54, ICD-10-PCS 0D)

Digestive tract

Upper GI tract

SGs / Esophagus	Esophagectomy Heller myotomy Sialography Impedance–pH monitoring Esophageal pH monitoring Esophageal motility study

Stomach	Bariatric surgery Adjustable gastric band Gastric bypass surgery Sleeve gastrectomy Vertical banded gastroplasty surgery Collis gastroplasty Gastrectomy Billroth I Billroth II Roux-en-Y Gastroenterostomy Gastropexy Gastrostomy Percutaneous endoscopic gastrostomy Hill repair Nissen fundoplication Pyloromyotomy

Medical imaging	Endoscopy: Esophagogastroduodenoscopy Barium swallow Upper gastrointestinal series

Lower GI tract

Small bowel	Bariatric surgery Duodenal switch Jejunoileal bypass Bowel resection Ileostomy Intestine transplantation Jejunostomy Partial ileal bypass surgery Strictureplasty

Large bowel	Appendicectomy Colectomy Colonic polypectomy Colostomy Hartmann's operation

Rectum	Abdominoperineal resection / Miles operation Lower anterior resection Total mesorectal excision

Anal canal	Anal sphincterotomy Anorectal manometry Lateral internal sphincterotomy Rubber band ligation Transanal hemorrhoidal dearterialization

Medical imaging	Endoscopy: Colonoscopy Anoscopy Capsule endoscopy Enteroscopy Proctoscopy Sigmoidoscopy Abdominal ultrasonography Defecography Double-contrast barium enema Endoanal ultrasound Enteroclysis Lower gastrointestinal series Small-bowel follow-through Transrectal ultrasonography Virtual colonoscopy

Stool tests	Fecal fat test Fecal pH test Stool guaiac test

Accessory

Liver	Artificial extracorporeal liver support Bioartificial liver devices Liver dialysis Hepatectomy Liver biopsy Liver transplantation Portal hypertension Transjugular intrahepatic portosystemic shunt [TIPS] Distal splenorenal shunt procedure

Gallbladder, bile duct	Cholecystectomy Cholecystostomy ERCP Hepatoportoenterostomy Medical imaging: Cholangiography IV MRCP PTC Cholecystography Cholescintigraphy

Pancreas	Frey's procedure Pancreas transplantation Pancreatectomy Pancreaticoduodenectomy Puestow procedure

Abdominopelvic

Peritoneum	Diagnostic peritoneal lavage Intraperitoneal injection Laparoscopy Omentopexy Paracentesis Peritoneal dialysis

Hernia	Hernia repair: Inguinal hernia surgery Femoral hernia repair

Other

CPRs

Medical imaging (ICD-9-CM V3 87–88, ICD-10-PCS B, CPT 70010–79999)

X-ray/
medical radiography/
Industrial radiography

Medical:	Pneumoencephalography Dental radiography Sialography Myelography CXR Bronchography AXR KUB DXA/DXR Upper gastrointestinal series/Small-bowel follow-through/Lower gastrointestinal series Cholangiography/Cholecystography Mammography Pyelogram Cystography Arthrogram Hysterosalpingography Skeletal survey Angiography Angiocardiography Aortography Venography Lymphogram

Industrial:	Radiographic testing

3D / XCT

Medical:	CT pulmonary angiogram Computed tomography of the heart Computed tomography of the abdomen and pelvis Virtual colonoscopy CT angiography Computed tomography of the head Quantitative computed tomography Spiral computed tomography High resolution CT Whole body imaging Full-body CT scan X-ray microtomography Electron beam tomography

Industrial:	Industrial computed tomography

Other

MRI

Ultrasound

Radionuclide

2D / scintigraphy

Cholescintigraphy Scintimammography Ventilation/perfusion scan Radionuclide ventriculography Radionuclide angiography Radioisotope renography Sestamibi parathyroid scintigraphy Radioactive iodine uptake test Bone scintigraphy Immunoscintigraphy

Full body:	Octreotide scan Gallium 67 scan Indium-111 WBC scan

3D / ECT

SPECT gamma ray: Myocardial perfusion imaging

PET (positron):	Brain PET Cardiac PET PET mammography PET-CT

Optical laser

Thermography

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