32: The salivary glands

The salivary glands

Salivary gland disorders

Disorders of the major salivary glands are relatively common, with a large spectrum of underlying diseases. This has led to a variety of classifications. However, the presenting symptoms and complaints allow a broad division into six main categories:

The important causes of these complaints are summarized in Table 32.1.

Acute generalized swelling Chronic generalized swelling Discrete swelling Dry mouth Excess salivation

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Investigations

Several investigations can be used on the salivary glands, the most appropriate often being decided by the patient’s presenting symptoms. The main investigations include:

Plain radiography

The most common disorder of the major salivary glands is obstruction caused either by salivary stones (calculi) or stricture of the ducts. A large proportion of salivary calculi are radiopaque (approximately 40–60% in the parotid and 80% in the submandibular glands) so patients presenting with obstructive symptoms of acute intermittent swelling require routine radiographs to determine the presence and position of the stone(s), as shown in Fig. 32.1.

The radiographic projections used commonly for the parotid and submandibular glands are summarized in Table 32.2.

Submandibular

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Sialography

Sialography can be defined as the radiographic demonstration of the major salivary glands by introducing a radiopaque contrast medium into their ductal system. It is also very effective for the diagnosis of obstruction whether caused by stones or strictures. It is widely used and is probably still the most common specialized salivary gland investigation.

The procedure is divided into three phases.

Contrast media used

The types of contrast media (see Ch. 18) suitable for sialography are all iodine-based, and include:

Most radiology departments use aqueous solutions. Their relative advantages and disadvantages are summarized in Table 32.3.

Aqueous

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Note: Since the contrast medium is not being introduced into the bloodstream, there is no need to use the safer, but more expensive, non-ionic contrast media discussed in Chapter 18.

Jan 12, 2015 | Posted by in Oral and Maxillofacial Radiology | Comments Off on 32: The salivary glands
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