The salivary glands
Salivary gland disorders
• Acute intermittent generalized swelling of a gland, often related to meals
• Acute generalized swelling of one or more glands
• Chronic generalized swelling, often involving more than one gland
The important causes of these complaints are summarized in Table 32.1.
Table 32.1
A summary of the main salivary gland complaints and their causes
Salivary gland complaint | Cause |
Acute intermittent generalized swelling |
Investigations
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.
Table 32.2
A summary of the commonly used radiographic projections for the parotid and submandibular glands
Salivary gland | Radiographic projections used |
Parotid |
Sialography
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.
Table 32.3
A summary of the advantages and disadvantages of oil-based and aqueous contrast media
Contrast | Advantages | Disadvantages |
Oil-based |
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.
Main indications
The main clinical indications for sialography include:
• To determine the presence and/or position of calculi or other blockages, whatever their radiodensity
• To assess the extent of ductal and glandular destruction secondary to an obstruction