Salivary X-ray technique

The article is professionally consulted by Master, Doctor Nguyen Van Phan - Head of Interventional Imaging Unit - Department of Diagnostic Imaging and Nuclear Medicine - Vinmec Times City International General Hospital.

Salivary X-ray is a method that uses a small amount of iodine-containing contrast material injected directly into the salivary ducts through the opening of the ducts in the oral cavity.
Although computed tomography, magnetic resonance imaging and ultrasound are the methods used to diagnose salivary gland diseases, salivary x-ray still has certain value in diagnosis and treatment. Treatment of diseases of the salivary glands.

The salivary glands secrete ~1000 – 2000ml of saliva per day and empty into the oral cavity. Saliva is a liquid that is about 99% water and a small amount of mucus, the combination of mucus and water creates a viscous substance to lubricate food and maintain oral hygiene. Saliva contains the enzyme amylase, a substance involved in the digestion of starch.
Each person normally has three pairs of salivary glands: parotid, submandibular, and sublingual.
Parotid gland
The largest salivary gland in the body, located in front and below the ear, the parotid gland consists of the superficial and deep parts. The deep part of the parotid gland lies below the neck and behind the angle of the jaw. The parotid duct is called the Stensen's duct, 5 to 7 cm long, it crosses to the anterior border of the masseter muscle, then it turns midway and drains into the mouth opposite the second maxillary tooth.
Submandibular gland
Located in the middle part of the body of the mandible, the submandibular gland has two parts: the superficial part and the deep part. The larger superficial part is located below and anteriorly of the mandibular angle, the smaller deep part encloses the posterior border of the hyoid muscle. The submandibular duct is a Wharton tube, born from the deep, averaging ~5 cm in length, it goes anteriorly and into the middle of the mandible and empties into the oral cavity at the base of the glottis.
Sublingual gland
This is the smallest of the three pairs of salivary glands. They are located under the lining of the mouth and form a longitudinal band on either side of the tongue, the sublingual fold. Unlike the parotid or submandibular glands, the sublingual salivary glands do not have a single duct but about 12 small ducts, the ducts of Rivinus, which extend from the posterior border of the gland to empty into the sublingual fold. One or two of these ducts, the Bartholin's duct, may empty into the submandibular duct.

● Assessing the relationship between the salivary glands and adjacent structures, it provides diagnostic and preoperative information for salivary gland disorders.
Salivary gland stones
Salivary gland stenosis
Salivary gland dilatation
Salivary gland fistula
Salivary gland polymorphism or mixed salivary gland tumor

● Severe inflammation of the salivary glands
Allergy to iodinated contrast media (relative contraindication)

Unprepared radiograph: if no glandular stone or salivary duct stone is suspected, it is not required, but if adenolith or ductal stone is suspected, an unprepared radiograph must be taken to avoid the contrast agent erasing the image. Gallstones make the diagnosis inaccurate. This technique should be done in a television room with a video recording mode

A salivary x-ray does not require any special preparation. It is necessary to fully exploit information for using iodinated contrast agents, especially information on allergies to iodinated contrast agents, and sign consent forms to use contrast in x-ray examinations. The patient was fully explained about the imaging procedure, psychologically prepared and signed a consent form to have the salivary x-ray taken. Remove all dentures or remove bridges before examination

● Rabinov 22G catheter and 0.018 inch lead
Intravenous infusion lines
● Tongue rod, adhesive tape, gauze...
● Syringe 5, 10, 20ml
● Needle 18G, 20G
● Disinfectant solution
● Local anesthetic spray, sedative
● Contrast containing iodine (usually water-soluble).
● Distilled water or physiological saline
● Sterile gloves, hats, masks
Bean tray set, surgical forceps
● Sterile cotton, gauze
Shockproof box
● Fresh lemon
● Lamp headlight

● Take enough contrast material into the 20ml syringe, connect the syringe to the connecting wire, and remove the air bubbles.
● Determine the correct location of the ductal foramen by observing salivary activity. To easily observe the opening of the duct, we put a few drops of lemon in the patient's mouth.
● Local anesthetic with anesthetic gauze (if necessary).
● Insert the guide wire into the duct, once the wire is in the duct, move the catheter into the duct. Once the catheter is in the duct, hold the catheter with one hand and pull out the guide wire with the other, connecting the catheter to the connection of the syringe containing the contrast agent.
● Wrap the end of the catheter with a piece of gauze, place the gauze between the patient's teeth, ask the patient to bite the gauze to fix the catheter during the scan.
Conduct shooting.
● Take pictures of anterior, posterior, inclined, oblique, and submandibular - craniofacial positions
● Can be taken as a panoramic film based on the patient's condition (Panorama).

Standard salivary x-ray shows contrast enhancement in the main salivary duct and its lateral branches. This helps the doctor analyze the images to make appropriate diagnoses for salivary gland diseases.

The patient was monitored for signs of reaction to contrast during the examination. If an allergy to contrast occurs, depending on the severity, the patient is treated according to the contrast agent shock protocol.
If there is bleeding when the catheter is removed, the patient will be treated with a local hemostatic bandage.
If there is an infection after the scan, the patient is prescribed antibiotics to treat.
After the scan, the patient needs to be massaged with the salivary glands or use drugs to increase secretion to clear the contrast in the gland and in the duct.
Dr. Nguyen Van Phan is an interventional radiologist and radiologist, with extensive experience in diagnosing and performing vascular interventions such as brain aneurysm implantation, brain stenting, and vascular malformations. cerebrovascular brain; embolization for the treatment of hemoptysis; treatment of liver tumors, uterine fibroids, benign prostatic hypertrophy, stem cell transplantation for treatment of cirrhosis, congenital biliary atrophy, Type II diabetes... Non-vascular interventions such as high-frequency ablation frequency (RFA) treatment of liver tumors, benign thyroid tumors; aspiration and drainage of abscesses, drainage and stenting of biliary tract, urinary kidney; aspiration cytology and biopsies of breast, thyroid, lymph nodes, soft tissue, biopsy of liver tumors, lung tumors, bone tumors ...