Sialography is a radiopaque diagnosis of the parotid, submandibular, sublingual salivary glands. The procedure, as a rule, does not require special conditions and is carried out in an ordinary X-ray room. Sialography of the sebaceous glands is highly accurate. Despite its high information content and unpretentiousness, sometimes you have to abandon the method due to the presence of contraindications.
What?
In medical practice, there are many diagnostic methods. Some of them make it possible to assess the general picture of the state of health, and some specific ones provide narrow but accurate information about the state of a particular organ.
Sialography is a method of x-ray contrast examination of the salivary glands. It has a long and rich history, was first used in 1904 by Sharpey. The study was carried out on a corpse, mercury was used as a contrast medium. In Moscow, salivary gland sialography has been used since the 80s of the last century.
The essence of the method is the introduction into the body under study of the required amount of radiopaque substance under pressure with simultaneous radiography. The pressure under which the substance is introduced is 180-200 mm Hg. Art., it is this pressure that does not harm the tissue of the gland.
Until recently, iodinated oils were used as a radiopaque substance. Later it turned out that iodolipol, lipiodol and other oils were not removed from the body for a long time, contributing to the development of the inflammatory process, accompanied by dystrophy of the gland epithelium. At present, aqueous solutions of triiodinated compounds are used: visotrust, verographin. The substances are quite radiopaque, but have low toxicity, have high resorption and therefore do not linger in the gland.
Sialography is considered the best diagnostic method for salivary gland pathologies, but not the only one. Other studies - ultrasound, CT - complement. The methods of radionuclide sialography and radiopaque studies are very similar. But the first method still does not provide overview information.
Indications for the study
In the early stages of salivary gland pathology, the dentist often reveals a routine examination. If patients come with complaints of pain, passivity of the movements of the masticatory muscles, a feeling of fullness in the jaw, this indicates that the disease is very progressing.
Indications for sialography are the following violations:
- Inflammation of the salivary glands. The method allows you to identify changes in the excretory ducts, to evaluate how much their motor function is impaired. With the help of the study, it is possible to determine the stage of the disease, to detect purulent inflammation.
- Benign and malignant neoplasms. Sialography of the salivary glands is prescribed for suspected polymorphic and monomorphic adenomas, angioma, neurinoma, cylinder, carcinoma. The method also allows you to determine the presence of metastases.
- The formation of calculi in the ducts of the salivary glands. The study allows not only to confirm the presence of sialolithiasis, but also helps to determine the exact location, size of stones, the presence of concomitant inflammation.
- Sjogren's syndrome. Using radiopaque diagnostics, the degree of narrowing of the glands and atrophy of their parenchyma is determined.
In what cases is the study contraindicated
X-ray diagnostics is considered one of the most accurate. Unlike, for example, ultrasound, the images obtained are not operator-dependent. The procedure can be performed anywhere, and not just where the doctor gave the direction. Before deciding where to make sialography of the salivary glands, it should be clarified whether there are any contraindications to it.
General contraindications are the same as with any x-ray: serious condition, radiation sickness, first trimester of pregnancy. Sialography is not performed in acute inflammation of the oral mucosa and papilla of the excretory duct of the glands. Also, the procedure will be refused if the patient is intolerant of iodine.
Preparing for sialography
For the procedure, the patient does not need any special preparation. The doctor finds out the presence of contraindications and, if there are none, issues a referral for examination.
How is sialography performed? Unlike patients, the radiologist needs preparation for the study. It consists in the selection of the necessary tool:
- Conical expander of the entrance to the duct or a set of bougie (a special probe that expands the duct).
- A set of polyethylene catheters with an external diameter of 1-3 mm and a length of 10 cm. One end of the catheter is pulled and sharpened with the flame of an alcohol burner. Due to its softness, the catheter easily passes through all bends of the duct. To impart rigidity, a wire mandrin (rod) is inserted inside the catheter.
Sialography: how is the procedure
The procedure is performed in a sitting position. The mouth of the excretory duct of the salivary gland is found and an expander or bougie is introduced into it for 2-3 minutes. The cheek is pulled forward, the expander is removed and, with the help of rotational movements, it is introduced into the duct with the mandrin. When a catheter is inserted, the wire rod is retracted so that its end is located at the level of the mouth of the duct. The elongated length is used to judge the depth of catheter insertion. After the introduction of the polyethylene tube to a depth of 1.5-2 cm, the mandrin is removed, and the patient holds the tube with his lips. With a normally functioning iron, saliva is released from the polyethylene tube. In the case when saliva is not excreted into the catheter due to the lesion of the gland, saline solution is introduced to prevent air from entering the gland in order to avoid erroneous interpretation of sialograms.
For examination of the submandibular gland, the catheter is driven in a similar manner. If the impediment to making sialography is the impossibility of introducing a catheter due to the unfavorable anatomical capabilities of the glands, then the surgical method is used. To do this, isolate the duct and dissect it, a polyethylene tube is introduced through the incision.
The catheter is attached to the apparatus for sialography and a contrast medium is supplied under pressure, pre-heated to 35-40 Β° C. The substance is administered until the patient begins to feel a gland full, usually 0.5-1 ml is sufficient. Immediately after filling the ducts, pictures are taken in three projections: straight, lateral, axial. For a more accurate diagnosis and assessment of the additional function of the sebaceous glands, pictures are taken every half hour for 2 hours.
With the help of an X-ray contrast study, doctors obtain accurate information both about the anatomical structure of the salivary glands and about their functionality.
Healthy people
Sialography of the salivary glands allows you to evaluate the condition of the ducts and tissues of the organs studied, as well as their functional abilities. Decryption is based on an assessment of the following criteria:
- The dimensions of the ducts.
- The narrowing and expansion of the ducts.
- Displacement of the ducts.
- The presence of cavities.
- The clarity of the contours of the cavities.
- Intermittent ducts.
No matter where sialography of the salivary glands is done, the results will be interpreted based on differences from healthy people:
- Parotid gland. The width of the excretory duct should be within 1 mm, a length of about seven centimeters. It slightly bends around the masticatory muscle, for the rest of the straight line with smooth and smooth contours. The ducts of the first order branch into smaller ones, visually resembling a fan.
- The submandibular gland. The main inlet duct is wider in appearance - up to 2 mm. It flows into the salivary gland from top to bottom after an arcuate bend. The lobar ducts should extend perpendicularly. The ducts branch into thin, unexpanded interlobular and interstitial. The contours of the salivary glands are oval.
Deciphering the results
Regardless of where the sialography was performed - in Nizhny Novgorod or in Moscow - the results of the studies are treated equally. X-ray examination is accurate and informative, and therefore treatment can be prescribed on the basis of images:
- The presence of acute lymphadenitis is indicated by the lack of filling of the parenchyma of the parotid and submandibular glands. This happens because gland tissues are involved in the pathological process. After the elimination of acute lymphadenitis, the x-ray picture of the gland becomes normal. If after treatment changes for the better do not occur, this may indicate that lymphogenous mumps or submaxillitis has developed.
- With parenchymal sialadenitis, there are accumulations of radiopaque substance evenly distributed in the gland tissue. The contours of the first and second order of the excretory duct are not changed. The shadow of the secretory end sections is not determined.
- With interstitial sialadenitis and sialosis, the ducts are narrowed, there is no filling of the acini, the functionality of the salivary glands does not suffer.
- The presence of salivary stone is a sign of calculous sialadenitis. Also, the presence of pathology is indicated by a bulbous expansion of the excretory duct.
- Benign tumors are defined as a defect in the filling of the ducts of the gland and secretory end sections.
- Symptoms of a malignant tumor are the breakage and fragmentation of the ducts, the presence of foci of accumulation of contrast medium in the places of destruction of the gland parenchyma.
Other research methods
The most important for salivary gland pathologies is the study of their secretory function. In medical practice, several research methods are used. Methods using expensive equipment are mainly used in Moscow, sialography of salivary glands with artificial contrasting is carried out in most cities of the country.
Physiological research methods:
- Pantomosialography is a simultaneous radiopaque study of several large salivary glands with further panoramic tomography. The film shows all the contrasted organs at once. The method is used in the same cases as sialography of the salivary glands.
- CT The image is built on the basis of tangential projection. To obtain it, the x-ray tube is placed at an angle of 60-120 Β° relative to the axis of the body of the subject. Information is run through a computer program and presented on the screen in the form of numerous images.
- Echosialography. Ultrasonic biolocation is used to judge the size, shape, density of the tissue structures of the glands and their depth.
- Thermal imaging. The study is carried out in a darkened room at t 18-20 Β° C using thermal imagers. On the picture tube, a thermal cartogram of the temperature of the neck and face is created. Using the study, changes in the trophism of tissues in the oral cavity during inflammatory processes of the salivary glands are determined.
- Radiosialography. The method is the second most important after an X-ray contrast study.
Radionuclein Sialography
Radionucleic or radioisotope sialography is the study of the salivary glands by introducing pharmaceutical radioactive nuclides into a vein. The drugs are used to study the anatomical and topographic state and assess the functionality of the organ. The technique of radionuclide sialography is based on the ability of the glands to accumulate and excrete radiopharmaceuticals that are pre-administered intravenously with saliva. The study allows you to evaluate the cumulative, secretory and excretory function of the salivary glands. The main object of study are the parotid glands.
Indications for radiosialography are the following pathologies:
- Heerfordt's syndrome.
- Mumps (mumps).
- Inadequate salivation, which is characterized by dry oral mucosa (xerostomia).
- Prolonged inflammation of the salivary glands with the formation of salivary stones in its ducts (sialolithiasis).
Radiosialography is performed on radiometric installations, placing sensors above the parotid gland and heart in the patientβs lying position. To obtain comparative data, another sensor is installed above the hip. An artificial radioactive element of technetium is administered intravenously at a rate of 50-70 ΞΌCi per 7 kg of body weight, always on an empty stomach.
After 30 minutes, give 15 g of lemon or 5 g of sugar to stimulate salivation. The study data are recorded in the form of three curves: two parallel, which reflect the level of accumulation of the introduced radiopharmaceutical drug of both parotid glands, the third curve reflects the level of blood radioactivity.
Patients who performed radioisotope sialography of the salivary glands, in the reviews express strong concern about the negative impact of radioactive drugs on the body. The procedure is performed in compliance with all rules for working with radioactive substances. Technetium belongs to the group of radiation hazard that does not require registration. The half-life of a substance in the body is 6.04 hours.
What do the radio sialograms indicate?
Radiosialography is used for the differential diagnosis of neoplasia and inflammatory diseases of the salivary glands. The method shows certain diagnostic signs characteristic of individual pathologies:
- Chronic mumps in the images obtained during the radionuclein sialography of the salivary glands is characterized by increased accumulation of the radionuclide in the organ under study.
- In severe forms of mumps, a significant decrease or complete absence of drug accumulation is noted.
- With xerostomia of the first degree (decreased secretion of the salivary glands), the accumulation of the radiopharmaceutical increases, and with the second and third degrees, it decreases significantly.
- With some benign neoplasms, for example, a lipoma in saliva contains an increased content of radionuclide.
- Fistulas are also accompanied by an increase in technetium in the investigated organ.
Where to make salial gland sialography in Moscow?
The method relates to extraoral x-ray studies in dentistry. It is used in preparation for prosthetics, planning orthodontic treatment. Therefore, the answer to the question of where in Moscow to do sialography is in dentistry. But these, fortunately, are not the only places where this study is carried out.
Conducting sialography does not require any special expensive equipment, drugs, or the qualifications of doctors. The procedure can be performed in any medical institution that has the necessary x-ray equipment and in its staff as a radiologist.
When looking for a clinic, you need to pay attention to the following:
- The experience of medical staff in radiology, in particular, sialography.
- Equipment. X-ray machines must comply with interstate standards and have all the necessary certificates.
- Medical facility compliance with radiation safety requirements.
- The remoteness of the clinic from home. Contrast sialography involves the introduction of an iodine-containing substance. Clinics that conduct research have an antidote in the event of an allergic shock to the drug.
- The cost of the procedure. In some clinics, the price is unreasonably high.
A small list of where salivary gland sialography can be done is not at an overpriced price:
- "Clinic of functional impairment" (m. "Schukinskaya"). The cost of the procedure is 1180 rubles.
- "Vallex" - dental center (metro station "Kaluga"). The price of the procedure is 1170 r.
- State Clinical Hospital No. 36 (metro station "Izmailovo"). The cost of sialography is 1000 rubles.
- MONICA them. M.F. Vladimirsky (metro station "Prospect Mira"). The research price is 1490 r.
Reviews
At various forums, it is usually discussed not the procedure itself, but the clinics where it is conducted. Users who have already undergone sialography, claim to have experienced unpleasant, painful sensations during the manipulation process. And yet, those who underwent the procedure are satisfied that only one study is necessary to prescribe adequate therapy.