Salivary Disease Imaging

Question 1

what are common salivary gland issues?

Answer 1

Dry mouth
Painful and swollen gland
Lump in gland

Question 2

Possible causes of dry mouth/

Answer 2

Diabetes - raised blood sugar 
Medication - antidepressants, diuretics, cytotoxic
Radiotherapy
Autoimmune conditions
Sjogrens

Question 3

What could cause pain and swelling of the glands?

Answer 3

Sialadenitis - salivary gland infection

Question 4

What are the types of sialadenitis?

Answer 4

Acute or chronic

Acute - bacterial or viral
Chronic - secondary to reduced saliva flow

Question 5

What can be the cause of lumps in saliva gland?

Answer 5

Tumours - can be benign or malignant

Question 6

What glands contain lymph nodes?

Answer 6

Parotid contains small lymph nodes

Submandibular/ lingual don’t

Question 7

What imaging is appropriate for dry mouth?

Answer 7

Ultrasound first line

If suspect Sjogrens - sialography

Question 8

What imaging is appropriate for painful swollen gland?

Answer 8

Plain radiography

Sialography

Question 9

What imaging appropriate for lump?

Answer 9

Ultrasound
Core biopsy for tissue diagnosis
If malignant - MRI

Question 10

What is the only cause of dry mouth that can be identified on imaging?

Answer 10

Sjogrens - disease destroys gland parenchyma

Question 11

What would you expect to see on imaging of Sjogrens?

Answer 11

Normal gland replaced by black spaces

Question 12

How does obstructive sialadenitis present?

Answer 12

Swollen and painful gland occur at mealtimes

Question 13

What causes obstructive sialadeniis?

Answer 13

Calculi, structures or debris in ductal system

Question 14

Where is calculi most common?

Answer 14

Submandibular gland

Question 15

Where are strictures most common?

Answer 15

Parotid

Question 16

Which gland is least likely to be obstructed

Answer 16

Sublingual -lacks a single duct - multiple small duct

Question 17

How to investigate salivary obstruction?

Answer 17

Plain film radiograph

Ultrasound can identify stones - not as sensitive as sailogram

Question 18

How to investigate submandibular obstruction?

Answer 18

Lower true occlusal

Posterior oblique

Question 19

How to investigate parotid obstruction?

Answer 19

AP extra-oral film

Question 20

What is sialography

Answer 20

Injecting contrast into duct - iodine in contrast radiopque

Stones less dense than contrast so show as filling defect

Question 21

How to tx submandibular calculi?

Answer 21

If visible anterior 1/3 - surgical excision
Small and mobile- basket removal
Beyond mylohyoid bend - excision via extra-oral approach

Question 22

What is basket removal?

Answer 22

Intra-ductal technique
Basket inserted closed into duct and advanced passed calculus
Basked opened and drawn to opening

Question 23

Complications of basket removal?

Answer 23

Pain and swelling
failure to remove stone
get basket stuck in duct

Question 24

How to tx strictures in parotid gland?

Answer 24

Balloon-dilation

Or superficial parotidectomy

Question 25

How to tx stones in parotid gland?

Answer 25

If at duct opening - excision Extra-glandular duct - basket retrieval If in parenchyma - lithotripsy/ parotidectomy

Question 26

What is balloon dilation?

Answer 26

Intra-ductal technique Dilation of papilla w/ lacrimal probe followed by insertion of angioplasty balloon Uninflated balloon positioned across stricture under x-ray guidance and inflated

Question 27

Complications of balloon dilation?

Answer 27

Stricture can be too tight Can be uncomfortable - even with LA Some strictures won't dilate 1/3 will re-stenose

Question 28

What is the success of baskets and balloons?

Answer 28

Basket - 68% | Balloon - 76% - reduce 50% after 2 years

Question 29

Common feature of salivary gland tumour?

Answer 29

slow-growing solid mass

Question 30

What features would be more predictive of a malignant tumour?

Answer 30

Rapid growth, fixation to skin/ underlying tissue, pain

Question 31

What would you see with malignant parotid tumour?

Answer 31

Facial nerve weakness

Question 32

Rule of thumb for gland tumour?

Answer 32

Smaller the gland the higher the chance of malignancy

Question 33

What are the two common benign salivary gland tumours?

Answer 33

Pelomorphic adenoma | Warthin's tumour

Question 34

What is plemorphic adenoma and who does it affect?

Answer 34

Benign tumour Affect male:female 1:1 Affect 30-60 year olds

Question 35

Where does Warthin's tumour appear?

Answer 35

Only in parotid - in parotid tail | and only in smokers

Question 36

Imaging features of benign salivary neoplasms?

Answer 36

Well-defined solid mass w/ smooth-lobulated margin

Question 37

Imaging features of malignant salivary gland tumour?

Answer 37

Infiltrative, ill-defined margin

Question 38

Why are lymph nodes found in parotid but not submandibular/lingual?

Answer 38

Embryological development - parotid in encapsulated after devleopment of lymphatic system (sub encapsulated before)