Documente Academic
Documente Profesional
Documente Cultură
radiology
DONE BY
IBRAHIM AMER
Disease
mechanism of
Dental
diagnosticiansgland
have
salivary
Disease mechanism
of salivary gland
inflammatory disorders
space-occupying masses.
are cystic or neoplastic; the neoplasms are
.benign or malignant
Clinical Signs
and Symptoms
Disease of major salivary glands may have
single or multiple feature :A. Swelling in the area of parotid and
submandibular gland
B. Pain and altered salivary flow
C. The periodicity and longevity of these
symptoms
D. a review of the medical history and physical
condition of the patient may provide
important information.
Differential
Diagnosis
of Salivary
Enlargements
Differential Diagnosis
Parotid Gland Area- of Salivary
Enlargements
BILATERAL
UNILATERAL
Bacterial sialadenitis
Viral sialadenitis
(mumps)
Sjgren syndrome
Alcoholic hypertrophy
Medication-induced
hypertrophy (iodine,
heavy metals)
Human immunodefi
ciency virus associated
multicentric
cysts
Masseter muscle
hypertrophy
Bacterial
sialadenitis
Sialodochitis
Cyst
Benign neoplasm
Malignant
neoplasm
Intraglandular
lymph node
Masseter muscle
hypertrophy
Lesions of adjacent
Differential Diagnosis
Submandibular Area- of
Salivary Enlargements
BILATERAL
UILATERAL
Bacterial
sialadenitis
Sjgren
syndrome
Lymphadenitis
Branchial cleft
cyst
Submandibular
Bacterial
sialadenitis
Sialodochitis
Fibrosis
Cyst
Benign
neoplasm
Malignant
neoplasm
Imaging
of the Salivary
Diagnostic imaging
Glands
of salivary gland
PLAIN FILM
RADIOGRAPHY
Plain film radiography is a fundamental part of
the examination of the salivary glands and
may provide sufficient information to preclude
the use of more sophisticated and expensive
imaging techniques .
It has the potential to identify unrelated
pathoses in the areas of the salivary glands
that may be mistakenly identified as salivary
gland disease, such as resorptive or
osteoblastic changes in adjacent bone .
PLAIN FILM
RADIOGRAPHY
INTRAORAL
RADIOGRAPHY
Sialoliths in the anterior two thirds of the submandibular duct are
typically imaged with a cross-sectional mandibular occlusal
projection
The posterior part of the duct is demonstrated with an over-theshoulder occlusal projection view, where the directing cone is
placed on the shoulder and central
occlusal radiograph
demonstrating radiopaque
sialolith in
.
Wharton duct. Note the
classic laminated
.appearance
Periapical
radiographs of the
same case. The
radiopaque
calculus can be
localized lingual to
the teeth by
applying
appropriate object
EXTRAORAL
RADIOGRAPHY
EXTRAORAL
RADIOGRAPHY
Sialoliths in the distal portion of
Stensen duct or in the parotid gland
are difficult to demonstrate by
intraoral or lateral extraoral views.
However, a PA skull projection with
the cheeks puffed out may move the
image of the sialolith free of the bone
.
Stereoscopic panoramic
plain film
.projection
Stereoscopic panoramic plain fi lm
projection. Note the laminated
appearance of
this sialolith in the submandibular
gland. The
image of the sialolith is magnifi ed
because of its
relatively lingual placement in the
image layer.
Taken from slightly different
horizontal angles, a
three-dimensional appearance can be
Overtheshoulder
occlusal
projection
revealing a
sialolith.
Anteroposterior
skull view with
cheek blown
out to provide
air contrast to
reveal a parotid
sialolith
(arrow).
Cropped panoramic
radiograph
Parotid sialolith
superimposed over
condylar neck
((arrow )) is
superior to the
plane of occlussion
which differentiate
from palatine
tonsillolith
Cropped panoramic
radiograph
Submandibular
sialolith (arrow )
near the
antagonial notch
of the mandibular
and superior to
the hyoid bone
CONVENTIONA
L
SIALOGRAPHY
this technique.
A survey or scout film is usually made before the infusion of the
contrast solution into the ductal system
.
With this technique, Lipid-soluble (e.g., Ethiodol) or non Lipid-soluble
(e.g., Sinografi n) contrast solution is then slowly infused
until the patient feels discomfort (usually between 0.2 and 1.5 ml).
CONVENTIONA
L
SIALOGRAPHY
CONVENTIONAL
SIALOGRAPHY
Sialography
Lateral projection
of the parotid
demonstrating
opacifi cation all
the way
to the terminal
ducts and acini. B,
Anteroposterior
projection of the
same gland
demonstrating
parenchymal
blushing from
Sialography
Sialogram of Normal
Submandibular Gland.
This lateral
view demonstrates
parenchymal blushing.
Normal fine branching is
visible. Lack of
parenchymal blushing at
the anteroinferior margin
is
caused by radiographic
COMPUTED TOMOGRAPHY
CT is useful in evaluating structures
in and adjacent to salivary glands; it
displays both soft and hard tissues
and minute differences in soft tissue
densities .
CT is useful in assessing acute
inflammatory processes and
abscesses as well as cysts,
mucoceles, and neoplasia.
COMPUTED
TOMOGRAPHY
CT Images with Soft
Tissue Algorithm. A, Axial
view
demonstrating bilateral
enlargement of the parotid
glands (arrowheads).
B, Coronal view of the
same patient. The
clinical/histopathologic
diagnosis was
.autoimmune parotitis
Multidetector computed
tomographic imaging (MDCT )
Advantages : Its use in evaluating structure in and adjacent to
salivary gland
Display both soft and hard tissue
The parotid glang is moe radiopaque than the
surrounded fat but less than adjacent muscles
Its useful in assessing acute inflammatory
process
Disadvantage : Isnt recognized as sensitive study for salivary
tumor .
Multidetector computed
tomographic imaging
MAGNETIC RESONANCE
IMAGING
MRI for soft tissue mass details and
localization
Differanciates :
Soft tissue vs. hard tissue
Normal vs. abnormal tissue
Identifies facial nerve ( parotid )
Contraindications:1) -pacemaker
2) -cochlear implant
And the
matching T2weighted image
reveals that the
lesion has a high
internal signal
SCINTIGRAPHY (NUCLEAR
MEDICINE, POSITRON
EMISSION COMPUTED
TOMOGRAPHY)
Selective up take of techntium
Assesees silvary gland function (not
anatomy)
Expel technetium after stimulations
Scintigraphy
Scintigraphy. A, 99m Tcpertechnetate
scan of the salivary glands (right and left
anterior
oblique views) demonstrates increased
uptake of
radioisotope in the right parotid gland
(black
arrowhead). B, Scintigram taken after
administration
of a sialogog (lemon juice) demonstrates
retention of isotope in right parotid gland
(white
arrowheads). This is a typical presentation
of salivary
stasis, Warthin tumor, or oncocytoma.
ULTRASONOGRAPHY
For superficial , soft tissue swilling
Differentioates cystic vs. solid
Us-guide FNA
also be helpful in detecting sialoliths
and diagnosing advanced
autoimmune
lesions (Sj gren syndrome).
ULTRASONOGR
APHY
Ultrasonography
(US) Image of
Right Parotid
Gland. Awelldelineated solid
mass is suggested
by echo returns
within the
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