SALIVARY GLAND SALIVARY GLAND RADIOLOGYRADIOLOGY

DRG. SHANTY CHAIRANIDRG. SHANTY CHAIRANI

Dental diagnosticians are Dental diagnosticians are responsible for detecting responsible for detecting disorders of the salivary glands.disorders of the salivary glands.

Salivary gland disease processes Salivary gland disease processes may be divided into : may be divided into : inflammatory disorders, inflammatory disorders, noninflammatory disorders, and noninflammatory disorders, and space-occupying masses.space-occupying masses.

Diagnostic imaging of salivary gland disease Diagnostic imaging of salivary gland disease may be undertaken to :may be undertaken to :• Differentiate inflammatory processes from Differentiate inflammatory processes from

neoplastic disease.neoplastic disease.• Distinguish diffuse disease from focal suppurative Distinguish diffuse disease from focal suppurative

disease.disease.• Identify and localize sialoliths, and demonstrate Identify and localize sialoliths, and demonstrate

ductal morphology.ductal morphology.• Determine the anatomic location of tumor.Determine the anatomic location of tumor.• Differentiate benign from malignant diseaseDifferentiate benign from malignant disease• Demonstrate the relationship between a mass and Demonstrate the relationship between a mass and

adjacent anatomic structure, and aid in the adjacent anatomic structure, and aid in the selection of biopsy sites.selection of biopsy sites.

Applied Diagnostic Imaging of Applied Diagnostic Imaging of the Salivary Glandsthe Salivary Glands

Plain film radiography is typically the Plain film radiography is typically the appropriate starting point for imaging the appropriate starting point for imaging the major salivary glands from a cost-benefit major salivary glands from a cost-benefit point of view. point of view.

It can demonstrate sialoliths and the It can demonstrate sialoliths and the possible involvement of adjacent osseous possible involvement of adjacent osseous structures.structures.

Intraoral radiography that can be used such Intraoral radiography that can be used such as cross-sectional mandibular occlusal as cross-sectional mandibular occlusal projection and posterior oblique view.projection and posterior oblique view.

Extraoral radiography include panoramic Extraoral radiography include panoramic and posteroanterior skull radiographs.and posteroanterior skull radiographs.

Sialography is the most appropriate Sialography is the most appropriate imaging modality to image the ductal imaging modality to image the ductal system.system.

Alternatif imaging modality that can be Alternatif imaging modality that can be used are MRI and CT.used are MRI and CT.

IMAGE INTERPRETATION OF IMAGE INTERPRETATION OF SALIVARY GLAND DISORDERSSALIVARY GLAND DISORDERS

SIALOLITHIASISSIALOLITHIASIS

Synonyms : calculus and salivary Synonyms : calculus and salivary stone.stone.

The formation of a calcified The formation of a calcified obstruction within the salivary duct.obstruction within the salivary duct.

Clinical features :Clinical features :• Intermittent swelling and pain with eating Intermittent swelling and pain with eating

and signs of infection.and signs of infection.• Most frequently involved the Most frequently involved the

submandibular gland and wharton duct.submandibular gland and wharton duct.

Radiographic features ;Radiographic features ;• May appear either radiopaque or May appear either radiopaque or

radiolucent depending on their radiolucent depending on their degree of calcifications.degree of calcifications.

• Vary in shape.Vary in shape.• When visible, usually have a When visible, usually have a

homogeneous radiopaque internal homogeneous radiopaque internal structurestructure

• When it is radiolucent, sialography When it is radiolucent, sialography is helpful in locating obstructions.is helpful in locating obstructions.

BACTERIAL SIALADENITISBACTERIAL SIALADENITIS Synonym : parotitis and submandibulitisSynonym : parotitis and submandibulitis An acute or chronic bacterial infection of An acute or chronic bacterial infection of

the terminal acini or parenchyma of the the terminal acini or parenchyma of the salivary glands.salivary glands.

Clinical features :Clinical features :• Acute types most commonly affect the parotid Acute types most commonly affect the parotid

gland. Most are unilateral and may occur at gland. Most are unilateral and may occur at any age. Symptoms : swelling, redness, any age. Symptoms : swelling, redness, tenderness and malaise.tenderness and malaise.

• Chronic types may affect any of the major Chronic types may affect any of the major salivary glands, causing extensive swelling salivary glands, causing extensive swelling and culminating in fibrosis. Symptoms : and culminating in fibrosis. Symptoms : intermittent swelling, pain when eating, and intermittent swelling, pain when eating, and superimposed infection resulting from superimposed infection resulting from salivary stasis.salivary stasis.

Radiographic features ;Radiographic features ;• Sialography is contraindicated in Sialography is contraindicated in

acute infections because disrupted acute infections because disrupted ductal epithelium may allow ductal epithelium may allow extravasation of contrast agent, extravasation of contrast agent, resulting in a foreign body reaction resulting in a foreign body reaction and severe pain. So MRI is the and severe pain. So MRI is the appropriate alternatif examination.appropriate alternatif examination.

• On MRI, inflamed glands are usually On MRI, inflamed glands are usually enlarged.enlarged.

• In chronic types, epithelial In chronic types, epithelial flattening may lead to mildly flattening may lead to mildly dilated terminal ducts and saclike dilated terminal ducts and saclike acini, which is demonstrable with acini, which is demonstrable with sialographysialography

AUTOIMMUNE SIALADENITISAUTOIMMUNE SIALADENITIS Synonym : Sjogren syndromeSynonym : Sjogren syndrome A group of disorders that affect the A group of disorders that affect the

salivary glands and share an salivary glands and share an autosensitivity.autosensitivity.

Clinical features :Clinical features :• Range from recurrent painless swelling of Range from recurrent painless swelling of

the salivary glands to a stage that the salivary glands to a stage that includes enlargement of the lacrimal includes enlargement of the lacrimal glands.glands.

• Glandular swelling may be accompanied Glandular swelling may be accompanied by xerostomia and xerophtalmia.by xerostomia and xerophtalmia.

• Most common in adults.Most common in adults.

Radiographic features :Radiographic features :• Sialography is helpful in the diagnosis Sialography is helpful in the diagnosis

and stagin the autoimmune disorders.and stagin the autoimmune disorders.• The early stages of disease are witness to The early stages of disease are witness to

the initation of punctate (less than 1 mm) the initation of punctate (less than 1 mm) and globular (1-2 mm) spherical and globular (1-2 mm) spherical collections of contrast agent evenly collections of contrast agent evenly distributed throughout the glands. These distributed throughout the glands. These collections are referred to as sialectases. collections are referred to as sialectases. At this stage, the main duct may appear At this stage, the main duct may appear to be normal, but the intraglandular ducts to be normal, but the intraglandular ducts may be narrowed or non even evident.may be narrowed or non even evident.

• As the disease progresses, the collections As the disease progresses, the collections of contrast agent increase in size (greater of contrast agent increase in size (greater than 2 mm in diameter) and are irregular than 2 mm in diameter) and are irregular in shape. These pools of contrast agent in shape. These pools of contrast agent are termed cavitary sialectases.are termed cavitary sialectases.

SIALADENOSISSIALADENOSIS Synonym : sialosisSynonym : sialosis A nonneoplastic, noninflammatory A nonneoplastic, noninflammatory

enlargement of primarily the parotid enlargement of primarily the parotid salivary glands. It is usually related salivary glands. It is usually related to metabolic and secretory disorders to metabolic and secretory disorders of the parenchyma.of the parenchyma.

Clinical feature : affected glands are Clinical feature : affected glands are typically enlarged.typically enlarged.

Radiographic feature : sialography Radiographic feature : sialography may demonstrate enlargement of the may demonstrate enlargement of the affected glands or a normal affected glands or a normal appearance. In enlarged glands, the appearance. In enlarged glands, the ducts will be splayed.ducts will be splayed.

BENIGN TUMORSBENIGN TUMORS Salivary gland tumors are relatively Salivary gland tumors are relatively

uncommon.uncommon. The majority of these tumors occur in The majority of these tumors occur in

the superficial lobe of the parotid the superficial lobe of the parotid glandgland

Radiographic features :Radiographic features :• Typically have well-defined margins, Typically have well-defined margins,

which are most apparent on CT or MRI which are most apparent on CT or MRI examinations.examinations.

• Sialography may suggest a space-Sialography may suggest a space-occupying mass when the ducts are occupying mass when the ducts are compressed or smoothly displaced around compressed or smoothly displaced around the lesion.the lesion.

MALIGNANT TUMORSMALIGNANT TUMORS About 20% of tumors in parotid are About 20% of tumors in parotid are

malignant, compared with 50% -60% malignant, compared with 50% -60% of submandibular tumors, 90% of of submandibular tumors, 90% of sublingual tumors and 60%-75% of sublingual tumors and 60%-75% of minor salivary gland tumors.minor salivary gland tumors.

Radiographic features:Radiographic features:• Variable an is related to the grade, Variable an is related to the grade,

aggresivenes, location and type of tumor.aggresivenes, location and type of tumor.• Typical indicator of malignancy are ill-Typical indicator of malignancy are ill-

defined margins, invasion of adjacent soft defined margins, invasion of adjacent soft tissues (such as fat spaces) and tissues (such as fat spaces) and destruction of adjacent osseous destruction of adjacent osseous structures.structures.