Sialography

General

Synonym/Acronym:

Ptyalogram, radiosialography, salivary gland studies.

Rationale

To assess parotid, submaxillary, sublingual, and submandibular ducts for structure, tumors, and inflammation related to pain, swelling, and tenderness.

Patient Preparation

There are no food, fluid, activity, or medication restrictions unless by medical direction.

Normal Findings

  • Normal salivary ducts with no indication of gland abnormalities.

Critical Findings and Potential Interventions

N/A

Overview

(Study type: Radiology, special/contrast; related body system: Digestive system [base of the tongue, mandible, parotid gland, submandibular gland, sublingual gland].)

Sialography is the radiographic visualization of the salivary glands and ducts. These glands secrete saliva into the mouth, and there are three pairs of salivary glands: parotid, ubmandibular, and sublingual. Sialography involves the introduction of a water-soluble contrast medium into the orifices of the salivary gland ducts with a small cannula, followed by a series of radiographic images. There are four imaging methods that can be used in the evaluation of the salivary glands:

  • Ultrasound—noninvasive, cost effective, and provides results quickly; commonly used for assessment
  • Computed tomography (CT) sialography—invasive, good visualization, good diagnostic tool, similar to the conventional sialography procedure; drawbacks associated with use of contrast and radiation
  • Magnetic resonance (MR) sialography—noninvasive, rapid results, good visualization, good diagnostic tool; drawbacks associated with presence of pacemakers, implants, claustrophobia, dental fillings, and so on, that can disqualify the patient or produce unclear images
  • Conventional/fluoroscopic sialography (with or without digital subtraction)—invasive, allows therapeutic application to remove salivary stones or repair narrowing of ducts; drawbacks associated with use of contrast, radiation, and high failure rate due to difficulty achieving effective cannulation and lack of patient cooperation during the procedure

Conventional sialography is the method of choice when a definite diagnosis is required for pathology such as sialadenitis (inflammation of the salivary glands) or if the oral component of Sjögren syndrome is a concern.

Indications

  • Evaluate the presence of calculi in the salivary glands.
  • Evaluate the presence of tumors in the salivary glands.
  • Evaluate narrowing of the salivary ducts.

Interfering Factors

Contraindications

Pregnancy is a general contraindication to procedures involving radiation.

Patients with conditions associated with adverse reactions to contrast medium (e.g., asthma, food allergies, or allergy to contrast medium). Patients with a known hypersensitivity to the medium may benefit from premedication with corticosteroids and diphenhydramine; the use of nonionic contrast or an alternative noncontrast imaging study, if available, may be considered for patients who have severe asthma or who have experienced moderate to severe reactions to contrast medium.

Patients with bleeding disorders because the puncture site may not stop bleeding.

Potential Medical Diagnosis: Clinical Significance of Results

Abnormal Findings In:

  • Calculi
  • Fistulas
  • Mixed parotid tumors
  • Sialectasia (dilation of a duct)
  • Strictures of the ducts

Nursing Implications, Nursing Process, Clinical Judgement

Before the Study: Planning and Implementation

Teaching the Patient What to Expect

  • Discuss how this procedure can assist in assessing duct glands in the neck and mouth.
  • Explain that the procedure takes about 15 to 30 min and is performed in a radiology department.
  • Review the procedure with the patient.
  • Explain that pregnancy testing may be required.
  • Instruct the patient to remove dentures or removable bridgework prior to examination.
  • Explain that there may be moments of discomfort or pain experienced when the cannula is inserted to allow infusion of contrast medium.
  • Explain that lemon juice may be given to dilate the salivary orifice, and a local anesthetic spray or liquid may be applied to the throat to ease with insertion of the cannula.

Procedural Information

  • Baseline vital signs are recorded and monitored throughout the procedure.
  • Positioning for this procedure is in the supine position on an examination table.
  • The patient is reminded that it is important to follow instructions to inhale deeply and hold the breath while the x-ray images are taken, and exhale after the images are taken.
  • Topical anesthetic is instilled in the throat and allowed time to work.
  • Once the salivary duct is located and dilated, the cannula is inserted, and the contrast medium is injected.
  • This is followed by a series of x-ray images; a CT scan may also be performed.
  • Delayed images may be taken to examine the ducts in cases of ductal obstruction.
  • If lemon juice was given, additional images are taken to examine drainage of saliva from the ducts and glands into the mouth.
  • Once the procedure is completed, the cannula is removed.

Potential Nursing Actions

Make sure a written and informed consent has been signed prior to the procedure and before administering any medications.

After the Study: Implementation & Evaluation Potential Nursing Actions

Avoiding Complications

  • Monitor the patient for complications related to the procedure.
  • Observe/assess the cannula insertion site for bleeding, inflammation, or hematoma formation.
  • Administer ordered antihistamines or prophylactic steroids if the patient has an allergic reaction.

Treatment Considerations

  • Follow postprocedure vital sign and assessment protocol.
  • Resume usual diet, fluids, medications, or activity, as directed by the health-care provider.
  • Provide instruction on the care and assessment of the cannula insertion site.

Clinical Judgement

  • Consider ways to convince the patient to adhere to the therapeutic management required to resolve diagnosed salivary gland disease.

Followup Evaluation and Desired Outcomes

  • Acknowledges that further testing may be necessary to evaluate disease progression and treatment effectiveness.

Sialographyis the Nursing Central Word of the day!