Hydrostatic sialography.

Abstract

Demonstrable gross anatomical changes in salivary glands may be present in a wide variety of conditions. Because of their superficial position, radiological examination is particularly suitable for the investigation of disease in these structures, and it is the purpose of this communication to present a quick and safe method of sialography employing a hydrostatic technic which is suitable for routine use. Adequate demonstration of the duct system and, where possible, of the acini forms the essential part of the examination. When clinical and roentgen findings are used in conjunction, a high degree of diagnostic accuracy may be obtained. A method of introduction of contrast agent by hydrostatic means, first described in 1957 by Gullmo and Böök-Hederström (7), is in our opinion superior to the hand injection methods presently in vogue. We have modified a technic described by Drevattne and Stiris (3) to enable us to perform sialographic examinations speedily and satisfactorily on large numbers of patients in groups of three or four. With experience, we have found that the procedure can be completed in fifteen to twenty minutes. The equipment (Fig. 1) consists of the following: Drip stand A 20 cc glass syringe barrel Two catheters— i. Portex polythene tubing P.E. 205 100 cm in length ii. Portex polythene tubing P.E. 160 finely tapered at one end, 25 cm in length. Two metal connectors Adapter and tap for polythene tubing, size P.E. 205, with a Luer-Lok fitting. Adapter and tap especially designed with a screw cap to fit tubing P.E. 205 at one end and to take tubing P.E. 160 at the other end (This is not manufactured but can be easily machined) Lacrimal probe dilator Elema-Schönander skull table No. 13 cone with a slit diaphragm 8×6 Ilford Blue Brand Film with fast tungstate screen Sodium metrizoate 45 per cent (Triosil ‘45’) Slices of fresh lemon. Method Identical procedures were carried out in each patient for whom sialographic investigation had been requested. 1. Proforma: It was found desirable during this study to have information detailed on a proforma. The following data were included: a. Name, age, sex, ward, hospital number b. Presenting complaints c. History, previous history, any allergic history d. Clinical examination e. Oral examination f. Salivary flow studies g. Radiological examination: glands examined and volume of contrast medium used h. Radiological report i. Any reported side effects. 2. Plain Films: Plain radiographs are taken first to demonstrate sialolithiasis, calcification, or gland enlargements. 3. Sialography: (a) Passive Filling Phase: With the apparatus assembled, the syringe barrel is filled with contrast material and set at a height of 70 cm above the level of the patient's mouth. The medium is allowed to run through the catheter system freely to expel all air bubbles. The duct orifice is located by a lacrimal probe and, where necessary, gently dilated (Figs. 2 and 3).