Salivary Gland Imaging

Question 1

What are common problems related to salivary gland?

Answer 1

1. Dry mouth
2. Painful and swollen gland
3. Lump in gland

Question 2

What are causes of dry mouth

Answer 2

Diabetes
Medication
Radiotherapy
Immune- conditions

Question 3

Examples of medications cause dry mouth?

Answer 3

Anti-cholinergics
Cytotoxic
Diuretics
Antidepressants

Question 4

What can cause painful and swollen gland?

Answer 4

Sialadenitis
Can be chronic or acute
Bacterial or viral

Question 5

What is likely cause of lump in saliva gland?

Answer 5

Tumour - benign or malignant

Question 6

What imaging can be taken if dry mouth?

Answer 6

Ultrasound first line

If suspect Sjogren - sialography

Question 7

What imaging can be taken is painful/swollen gland?

Answer 7

Plain radiography followed sialography

Question 8

What imaging can be used if lump in gland?

Answer 8

Ultrasound

Need core biopsy for tissue diagnosis (if malignant MRI)

Question 9

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

Answer 9

Sjogrens syndrome

Question 10

How does Sjogren’s present on imaging?

Answer 10

Normal gland replaced by inflammation = black spaces

Disease process destroy gland parenchyma

Question 11

How does obstructive sialadentitis present?

Answer 11

Swollen and painful gland occurs at mealtime/ thinking/ smelling food

Question 12

What causes obstructive sialadentitis?

Answer 12

Salivary calculi/ strictures or debris in ductal system

Question 13

Where is it most common for obstructive sialadenitis to occur?

Answer 13

Submandibular gland

Question 14

What gland is more prone to strictures?

Answer 14

Parotid

Question 15

Why is obstruction of sublingual gland rare?

Answer 15

Doesn’t have single duct - multiple opening in floor of mouth

Question 16

What radiographs are needed to identify submandibular obstruction?

Answer 16

Lower true occlusal

Posterior oblique occlusal film

Question 17

How is sialography performed?

Answer 17

Inject iodine contract along duct - contrast makes duct densely radiopaque, stones are less dense than contrast so appear radiolucent

Question 18

What gland should sialograpy not be performed in?

Answer 18

Sublingual

Question 19

What expect to see on sialography if have calculi/ obstruction?

Answer 19

Radiolucent obstruction within duct

Dilation of duct

Question 20

How does treatment of submandibular calculi vary?

Answer 20

Depends on size, location and mobility of stone

Question 21

When can intra-oral surgical approach be used?

Answer 21

Stone in anterior 1/3rd of duct

Question 22

When may basket removal be indicated?

Answer 22

Small and mobile stone

Anterior to mylohyoid bend

Question 23

When is extra-oral approach taken?

Answer 23

Calculi large

Beyond mylohyoid bend

Question 24

What is basket removal?

Answer 24

Intra-ductal technique under LA

Question 25

How is basket removal carried out?

Answer 25

Closed helical wire inserted into duct opening Advance wire past calculi Open wire Calculus snared in basket and drawn duct opening Calculi released w/ small papillotomy incisor

Question 26

Complication basket remova;?

Answer 26

Pain and swelling spot proceudre Failure remove stone - esp if >1cm Basket stuck in duct Persistent symptoms

Question 27

Why can symptoms carry on after calculus removed by basket

Answer 27

Possible ductal stenosis post incision

Question 28

What common see sialography of parotid?

Answer 28

Strictures and narrowing of duct

Question 29

How to treat parotid strictures?

Answer 29

Balloon-dilation

Question 30

How to treat parotid strictures?

Answer 30

Balloon-dilation if extra-glandular | Superficial parotidectomy intra-glandular

Question 31

How treat parotid stones?

Answer 31

Surgical excision - if at duct opening Basket retrieval - if in extra-glandular duct Superficial parotidectomy/ lithotripsy - if in gland parenchyma

Question 32

What is lithotripsy?

Answer 32

Way to shatter stones using sound waves

Question 33

How is balloon-dialtion carried out

Answer 33

Intra-ductal procedure under LA | Articaine mixed iodinated contract - allows identification stricture site

Question 34

Technique of balloon dilation?

Answer 34

Parotid papilla dilated using lacrimal probe Insert angioplasty balloon along duct Balloon positioned across stricture using x-ray gudiance Inflated 90 sec - can do 2/3 inflation

Question 35

What are associated complication of balloon dilation?

Answer 35

Stricture can be too tight to pass balloon Uncomfortable even with LA Some strictures all not dilate Re-stenosis

Question 36

How do salivary gland tumours present?

Answer 36

Slow-growing solid masses

Question 37

What features of salivary gland tumour would be indicative of malignancy?

Answer 37

Rapid growth Fixation to skin/ underlying tissue Pain If in parotid - facial nerve weakness

Question 38

Rule of thumb regarding salivary gland malignancy?

Answer 38

Smaller gland higher risk of malignancy e.g Sublingual 85% malignant Minor salivary gland 50% malignant

Question 39

Which gland is most likely to have malignant tumour?

Answer 39

Sublingual

Question 40

What are two common benign salivary gland tumour?

Answer 40

Pleomorphic adenoma | Warthins tumour

Question 41

What salivary gland tumour only occurs in parotid?

Answer 41

Warthin's tumour

Question 42

Most common benign salivary gland tumour?

Answer 42

Pleomorphic adenoma | Most common parotid

Question 43

Can pleomorphic adenoma be malignant?

Answer 43

Small malignant transformation rate

Question 44

When is it more likely to see Warthin tumour?

Answer 44

Tail of parotid Elderly - over 60 Smokers Males (2:1)

Question 45

How can Warthins tumours present clinically?

Answer 45

10-15% bilateral

Question 46

How do benign salivary gland lesions present imaging?

Answer 46

Well defined solid mass | Smooth/lobulated margin

Question 47

How do malignant salivary gland lesion present on imaging?

Answer 47

Infiltrative | Speculated margin - ill-defined

Question 48

Which salivary gland are lymph nodes found in?

Answer 48

Parotid - not submandibular or lingual

Question 49

Why are nodes found in parotid?

Answer 49

Parotid is encapsulation after the development of lymphatic system - submand/lingual encapsulated before

Question 50

What differential can be given to a parotid gland mass that isn't given to submandbiualr/lingual mass?

Answer 50

Pathological intra-parotid lymph nodes