SALIVARY GLANDS
I-INTRODUCTION
Disorders of the major salivary glands are relatively common.
They represent a broad spectrum of underlying pathologies
II-ANATOMIC REMINDER
The salivary glands, attached to the oral cavity, produce about 1 liter of saliva per day.
III-DIAGNOSIS MEANS
1-Standard X-ray:
- Parotid:
Panoramic X-ray
Oblique lateral incidence
Anterior posterior incidence
Oblique or anteroposterior with cheek inflated with air
Intraoral X-ray of the cheek
- Submandibular:
Panoramic X-ray
Oblique lateral incidence
Mandibular ortho-occlusal incidence for the salivary duct
Mandibular oblique occlusal incidence for the gland
True lateral incidence of the skull with lowered tongue
Anterior posterior incidence
oblique antero-posterior incidence under the mandible
2-Sialography:
Rx examination of the major salivary glands
Injection of radiopaque PC into their canal system
Obstruction caused by stones or strictures
- Preoperative phase:
Shots before PC injection
Determine the position or presence of radiopaque obstruction
- Filling phase:
fine catheter inside the excretory duct of the salivary gland (Stenon duct for the parotid gland and Wharton duct for the submaxillary gland) in order to inject the contrast product. Several images are then taken in different positions.
- Draining phase:
Catheter removed, patient can rinse, lemon juice facilitates excretion of PC
3-Ultrasound:
High frequency probe
- Isolated and generalized swelling
- Salivary obstruction
4-MRI:
Morphological sequence, diffusion, with PC injection, sialo-MRI
5-Scanner:
Without and with injection of contrast product
IV-ETIOLOGICAL DIAGNOSIS
A-LITHIASIC PATHOLOGY
Most common submandibular gland then parotid gland
_1/X-rays without preparation
The so-called “bitten” occlusal images of the endo-oral cavity (anterior and posterior) allow us to see large and sufficiently calcified stones.
Systematic, the dental panoramic allows to visualize the large stones and to eliminate a non-salivary pathology, dental in particular.
radiopaque oval image projecting on a line from the mandibular angle to the incisal region for submandibular calculi.
_2/Scialography:
Filling anomaly in the main duct
Dilation of the duct near the stone
PC retention beyond calculation on snapshot taken during draining
_3/Ultrasound:
Ultrasound (+) is a simple, non-invasive examination,
visualizes stones when they measure more than 2 mm in diameter.
The calculation appears as a hyperechoic image with a posterior shadow cone.
_4/Scanography:
Scanography (++) has a very high sensitivity for radiopaque stones and a high localizing value.
These criteria are useful for guiding the surgeon’s actions.
B-INFECTIOUS PATHOLOGY
Imaging is not indicated in cases of acute inflammation
We distinguish:
*Parenchymal infection: sialadenitis
*Infection of the canals: sialodochitis.
*Viral sialadenitis: mumps
_1/ETM:
parotid gland enlarged in size, homogeneous with ductal dilatation
Cervical lymphadenopathy
_2/MRI:
increase in gland volume with modification of the parenchyma signal: T1 hyposignal and T2 hypersignal with contrast uptake
sialodochitis
Segmented formation of saccules: Series of dilatations and stenoses of the main duct: sausage-like appearance
Lithiasis or associated stenosis of the salivary duct
C-TUMOR PATHOLOGY
_1/Dental panoramic:
Useful to eliminate another pathology (dental)
salivary lithiasis
Glandular calcifications extrinsic imprint of the posterior edge of the mandibular ramus.
_2/Ultrasound:
Unscrambling test
specifies the intra- or extraglandular topography of cervical swellings.
The image of a parotid tumor is hypoechoic with, sometimes, a pseudocystic appearance.
_3/Scanography:
tumor characteristics
superficial or deep lobe
tumor diameter
clear limits of good prognosis or irregular limits of less good prognosis
solid or liquid tumor density
the number of tumors (multifocal or bilateral tumors)
the locoregional extension.
● benign tumor: lacunar, single, intraglandular image, with a well-limited capsule and a repression of the ductal and glandular system (corbelling)
● malignant tumor: inconsistent image of extravasation, heterogeneous opacification, ductal amputation.
_4/MRI:
Non-irradiating, non-invasive, with a higher resolution than scanography, MRI (++ +) can highlight
small tumors, sometimes to locate the facial nerve in relation to the tumor and to eliminate extraparotid images.
It affirms the nature of the mass.
It also offers diagnostic guidance
V-CONCLUSION
Panoramic always the first test to do
The scanner allows the characterization of lithiatic, infectious and tumor pathologies.
MRI is a reliable imaging test in the study of parotid tumors .
It allows to differentiate a benign lesion from a malignant lesion and to approach the histological nature of benign lesions .
SALIVARY GLANDS
Early cavities in children need to be treated promptly.
Dental veneers cover imperfections such as stains or cracks.
Misaligned teeth can cause difficulty chewing.
Dental implants provide a stable solution to replace missing teeth.
Antiseptic mouthwashes reduce bacteria that cause bad breath.
Decayed baby teeth can affect the health of permanent teeth.
A soft-bristled toothbrush preserves enamel and gums.