Investigation of salivary gland disease

CHAPTER 6 Investigation of salivary gland disease





Introduction


Salivary gland tissue has been shown to display a wide diversity of pathology encompassing inflammatory, obstructive, infectious, neoplastic and systemic disease. Inflammatory and obstructive disease within salivary gland tissue accounts for the majority of patients seeking treatment for their symptoms whereas the incidence of salivary gland tumors is extremely low.


This pathology division is reflected in the radiological techniques employed when imaging patients with salivary gland disease. For those patients presenting with inflammatory disease, plain film radiography, either alone or in combination with contrast studies and/or ultrasonography, often comprises ‘first-line’ imaging. These techniques provide the high resolution images with which to detail the presence of salivary calculi and allow the clinician to document accurately any significant changes within the ductal architecture of the gland. For those patients in whom a mass lesion is suspected then computed tomography (CT) and magnetic resonance imaging (MRI) are the imaging modalities of choice.


The presenting symptoms of the patient are often very useful in determining the type of abnormality present. Typical symptoms of inflammatory disease are swelling of the salivary gland allied with mealtimes and the sight and smell of food followed by a gradual reduction of the swelling having eaten. The latter is highly suggestive of either obstruction by a calculus or an inflammatory induced ductal stricture which indirectly compromises salivary flow. In some cases, the patient may additionally complain of pain, a bad taste and pus may or may not be evident at the duct orifice. These symptoms and signs are indicative of current inflammatory disease. Finally, a number of patients may present with a dry mouth, the causes of which are wide ranging.


The aim of this chapter is to provide details of the most common radiographic techniques with which to image salivary gland pathology, whilst also providing the reader with an overview of each of the other competing investigations and the rationale for their use.



Sialography


The technique employs the use of contrast media to delineate the fine anatomy of the salivary gland ductal system. Patient symptoms will range from pain, which may be acute or chronic in its presentation, to a generalized recurrent or discrete swelling which is often present at mealtimes. Some patients are referred with a dry mouth which relates to a myriad of clinical conditions including autoimmune diseases, drug therapy and previous radiotherapy.





Complementary and competing investigations




Computed tomography (CT)


The technique can be used to diagnose swellings both associated with the salivary glands themselves and those structures extrinsic to the glands.



Dec 26, 2015 | Posted by in GASTROINTESTINAL IMAGING | Comments Off on Investigation of salivary gland disease

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