5 Methods of Investigation

Introduction

Examining the Patient

Examining Saliva

Ultrasonography

Fine-Needle Aspiration Cytology (FNAC)

Sialendoscopy

Salivary Gland Biopsy

Magnetic Resonance Imaging and Computed Tomography

Classic Sialography and Magnetic Resonance Sialography

Salivary Gland Scintigraphy

Serologic Examinations

Key Points

Introduction

The salivary glands can be affected by either localized or systemic disease. The diseases involved are diverse, ranging from acute infection by a wide variety of pathogens—viruses, bacteria, fungi, protozoans, or secondary to salivary stones—to chronic inflammation, predominantly in Sjögren syndrome; and benign or malignant primary neoplastic diseases, as well as involvement in secondary malignant neoplastic diseases, lymphoma, and cutaneous and mucosal malignancies. The symptoms of these diseases are often nonspecific, and a wide range of investigative methods need to be employed to confirm the likely diagnosis (overview in Table 5.1). This chapter provides an outline of these investigative methods and proposes a rationale for using them, as well as discussing symptoms and the causative disease processes likely to be associated with them (Table 5.2).

Examining the Patient

Examination of the patient is the cornerstone on which any diagnostic work-up in salivary gland diseases is based and which directs any further investigations. The clinical examination of patients who present with diseases related to the salivary glands is described in Chapter 6. Despite modern technology, taking the patient’s history and carrying out a physical examination are still crucial steps that are required before subsequent investigations are decided on. The cardinal symptoms usually determine the next steps in the further work-up, hopefully leading to a diagnosis (Table 5.2).

Examining Saliva

Although saliva is the most important product of the salivary glands, a detailed examination of it is only indicated in a small minority of patients.¹ The tests currently available are listed and discussed in Chapter 3. Saliva function tests play a role in patients with hyposalivation and xerostomia, to quantify the degree of saliva function. These are predominantly patients with Sjögren syndrome or patients who have been treated with chemotherapy and radiotherapy for head and neck cancer. Chapter 16 describes specific details involved in examining patients with Sjögren syndrome, and Chapter 42 discusses causes and findings in patients treated with chemotherapy and radiotherapy. Saliva flow has to be measured in patients with symptoms of drooling (or hypersalivation). This is important firstly in order to objectify the symptoms and secondly to allow the effects of treatment to be checked. The majority of patients with drooling are children, and details about these patients and saliva testing are given in Chapter 12.

CT, computed tomography; FNAC, fine-needle aspiration cytology; MRI, magnetic resonance imaging.

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